Abstract
The purpose of our study was to clarify a family's decision-making process for conducting a gastrostomy for an elderly patient in a nursing care home for the aged. Our subjects were 18 families of elderly patients in nursing care facilities, faced with the decision as proxies whether or not to perform a gastrostomy for the patients. Semi-structured interviews were done with all subjects for information on the subjects' decision-making process up to the time of and after their choice to proceed with the gastrostomy for the aged family member. The results were analyzed using the modified grounded theory approach method. The results consisted of 18 concepts, 4 sub-categories, and 6 categories. We noted that the decision-making process of the subjects in choosing gastrostomy was comprised of 6 stages: (1) trying "their upmost to be a responsible proxy" as a relative of the elderly patient, through the (2) "resolution of their inner conflict" which arises from a (3) "feeling of fear of the consequences of the patient's inability to eat". The family could then (4) "sense relief from the heavy feeling of responsibility" to allow them make the decision as proxy, further eased by (5) "receiving support for the decision", and finally acknowledge (6) their "desire to keep the elderly relative alive". Our analyses suggest the importance of a nurse's role in helping reduce the emotional conflicts faced by families who make decisions as proxies of elderly patients who have difficulty in eating, and the importance of supporting these families' responsibility.
