Abstract
The objective of the present study was to elucidate the psychological process associated with the decision made by family members as surrogate decision-makers to select percutaneous endoscopic gastrostomy (PEG) feeding for elderly patients with advanced dementia, and to identify issues and suggestions for nursing support. Semi-structured interviews were conducted with 13 family members who selected gastrostomy for elderly dementia patients and interview contents were analyzed using the Modified Grounded Theory Approach. The process was shown to consist of the following six categories: "concerns regarding difficulty eating", "choices for prolonging life and narrowing down choices through conflict", "decision based on acceptance that one will take care of the patient until the end", "anxiety and expectation toward life with PEG feeding", "confidence and anxiety regarding provision of care", and "repeatedly second-guessing oneself despite being satisfied". Family members decided to select gastrostomy based on their trust in the physician and their desire to prolong the patient's life. However, this decision came with doubts, conflict, anxiety, and concerns about indecisiveness as a surrogate decision-maker. These findings suggest the need for nurses to encourage family members to consider the meaning of gastrostomy from the elderly individuals' perspective and to provide support that enables them to find meaning in their decisions.
