Abstract: Background: Thewishes and preferences of patientswith dementia should informthe decisionsmade about their future care. However, the decision-making that occurs at the end of life is a difficult experience for the families of patients.With regard to decision-making in the terminal stages, few studies have explored the experiences and feelings of caregivers of persons with dementia who are institutionalized. Aim: To describe the processes of decision-making used by families regarding treatments at the end of life of institutionalized patients with advanced stages of dementia. Methods: Five focus groups were conducted in five nursing homes in Spain, representing a total of 84 familiars. Results: Five categories that describe the context for decision-making were identified: the emotional effect, the ?living death,? the two faces of death, the values and objectives regarding treatments at the end of life, and the lack of knowledge about the progression of dementia. Conclusions: The participants have unresolved emotional needs resulting from both the disease and the institutionalization of a member of their family. The participants were unprepared tomake end-of-life treatment decisions, and they lacked a consistent healthcare provider to provide informational and emotional support that would have helpedwith decision-making. The carers? ownwishes and preferenceswere shaped by their perceptions and experiences of the dementia illness.

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