Background: In 2017, the elderly made up 27.3% of Japanâ??s population, accounting\nfor 57.2% of all ambulance trips. When an elderly person is in a\ncritical life situation, it is difficult to ascertain their decisions about treatment\nchoices, and for family members who become surrogate decision-makers, this\nis a grave responsibility. Aim: This study aimed to shed light on the constructs\nthat support decision-making by family members and medical staff in\ncritical situations, and to investigate decision-making by families of the elderly\nin critical situations. Method: We selected 29 papers published in Japan\nand elsewhere that focused on families involved in treatment decisions in\ncritical life situations and analyzed them using Rodgersâ?? concept analysis approach.\nResults: From 475 codes, we extracted six attributes, four antecedents,\nand four consequences. The unusual setting of the â??critical care unitâ?, lack of\ntime, and unstable psychological state are all considered by family members\nmaking treatment decisions, along with the patientâ??s prognosis, their relationship\nwith the patient, conjecture about the patientâ??s wishes, and taking\nother family memberâ??s views into account. Medical staff supports the family\nthroughout the process, through provision of treatment, preparing family\nmembers to face reality, empathizing with the difficulty of decision-making,\nbuilding relationships with family members, monitoring the decision-making\nprocess, and being attentive to family membersâ?? feelings until the end. Conclusion:\nOur results indicate the importance of advance confirmation of patientsâ??\nwishes, and the role played by cultural context and family relations in\ndecision-making by family members of the elderly.
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