{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:50:33Z","timestamp":1769730633396,"version":"3.49.0"},"reference-count":46,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951525100424_sec1a\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to explore the end-of-life decision-making experiences of bereaved family caregivers of Alzheimer\u2019s disease (AD) patients, focusing on do-not-resuscitate orders. Given the high emotional and ethical burden on caregivers, understanding their challenges and needs is crucial to enhancing palliative care for AD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525100424_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative, exploratory study was conducted using semi-structured interviews with 22 family caregivers recruited through purposive sampling in central Taiwan. Participants were primary caregivers for AD patients who had been bedridden for at least a year before death. Analysis employed inductive thematic coding to identify key themes, with rigor ensured through multiple coding, member checking, and reflective journaling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525100424_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three major themes emerged: (1) Decision-making difficulties, where caregivers felt pressure and conflict when making urgent decisions; (2) Willingness to let go, which involved accepting the inevitability of death when recovery was no longer possible; and (3) Embracing the consequences of the decision, reflecting caregivers\u2019 sense of relief and acceptance post-decision. Cultural factors, such as filial piety, were found to influence decision-making processes, often intensifying emotional conflicts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525100424_sec4d\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings underscore the importance of early, culturally sensitive discussions around end-of-life care in palliative settings for AD patients. Healthcare providers are encouraged to initiate these discussions, offering clear explanations and emotional support to assist caregivers through decision-making. This study highlights the need for a family-centered approach that respects cultural nuances, helping to reduce caregiver stress and enhance the quality of palliative care in AD contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951525100424","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T08:13:59Z","timestamp":1769674439000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Experiences of bereaved family caregivers of patients with Alzheimer\u2019s disease regarding do-not-resuscitate orders: A qualitative study"],"prefix":"10.1017","volume":"24","author":[{"given":"Hsin-Hsin","family":"Shih","sequence":"first","affiliation":[{"name":"China Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chin-Yi","family":"Lo","sequence":"additional","affiliation":[{"name":"Evangelical Lutheran Senior Long-Term Care Facility, affiliated with the China Evangelical Lutheran Church"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu-Hua","family":"Lu","sequence":"additional","affiliation":[{"name":"China Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pi-Chu","family":"Lin","sequence":"additional","affiliation":[{"name":"Asia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-2331","authenticated-orcid":false,"given":"Kwo-Chen","family":"Lee","sequence":"additional","affiliation":[{"name":"China Medical University"},{"name":"China Medical University Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"S1478951525100424_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2011-100373"},{"key":"S1478951525100424_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2021.04.021"},{"key":"S1478951525100424_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2021.09.012"},{"key":"S1478951525100424_ref9","volume-title":"The Sage Handbook of Qualitative Research","author":"Denzin","year":"2011"},{"key":"S1478951525100424_ref28","doi-asserted-by":"publisher","DOI":"10.1080\/02699050410001720013"},{"key":"S1478951525100424_ref17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7182.493"},{"key":"S1478951525100424_ref29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178997"},{"key":"S1478951525100424_ref37","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2022-003525"},{"key":"S1478951525100424_ref43","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-154-5-201103010-00008"},{"key":"S1478951525100424_ref45","doi-asserted-by":"publisher","DOI":"10.1163\/15406253-12340000"},{"key":"S1478951525100424_ref33","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902234"},{"key":"S1478951525100424_ref4","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01069-1"},{"key":"S1478951525100424_ref11","doi-asserted-by":"publisher","DOI":"10.1002\/gps.397"},{"key":"S1478951525100424_ref36","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0271-y"},{"key":"S1478951525100424_ref1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951523001876"},{"key":"S1478951525100424_ref7","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120933535"},{"key":"S1478951525100424_ref20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2018-001526"},{"key":"S1478951525100424_ref13","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200209000-00009"},{"key":"S1478951525100424_ref26","first-page":"118","article-title":"Experience after bereavement in main family members making DNR decisions","volume":"14","author":"Kim","year":"2011","journal-title":"The Korean Journal of Rehabilitation Nursing"},{"key":"S1478951525100424_ref34","doi-asserted-by":"publisher","DOI":"10.1177\/1077800413513733"},{"key":"S1478951525100424_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2021.04.021"},{"key":"S1478951525100424_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67889-0"},{"key":"S1478951525100424_ref30","first-page":"438","volume-title":"Naturalistic Inquiry","volume":"75","author":"Lincoln","year":"1985"},{"key":"S1478951525100424_ref3","first-page":"e250002","article-title":"Factors affecting the initiation and consideration of Advance Care Planning (ACP) with surrogates of older adults with advanced dementia: a systematic review","volume":"7","author":"Chan","year":"2025","journal-title":"Advances in Geriatric Medicine and Research"},{"key":"S1478951525100424_ref41","doi-asserted-by":"publisher","DOI":"10.1080\/10376178.2018.1478232"},{"key":"S1478951525100424_ref44","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-024-01559-4"},{"key":"S1478951525100424_ref19","doi-asserted-by":"publisher","DOI":"10.1080\/08870440903194015"},{"key":"S1478951525100424_ref10","first-page":"1","article-title":"The effect of prognostic communication on patient outcomes in palliative cancer care: a systematic review","volume":"21","author":"der Velden Nca","year":"2020","journal-title":"Current Treatment Options in Oncology"},{"key":"S1478951525100424_ref23","first-page":"1","article-title":"Defining exploratory-descriptive qualitative (EDQ) research and considering its application to healthcare","volume":"4","author":"Hunter","year":"2019","journal-title":"Journal of Nursing and Health Care"},{"key":"S1478951525100424_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2011.03.003"},{"key":"S1478951525100424_ref38","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-200823"},{"key":"S1478951525100424_ref6","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1373726"},{"key":"S1478951525100424_ref40","article-title":"Exploring the perceptions of families and nurses after signing a do-not-resuscitate order for patients in respiratory care wards","author":"Tsai","year":"2024","journal-title":"American Journal of Hospice and Palliative Medicine\u00ae"},{"key":"S1478951525100424_ref12","doi-asserted-by":"publisher","DOI":"10.1177\/23337214211003431"},{"key":"S1478951525100424_ref16","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17186869"},{"key":"S1478951525100424_ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-021-00768-5"},{"key":"S1478951525100424_ref22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0240684"},{"key":"S1478951525100424_ref32","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-3227"},{"key":"S1478951525100424_ref25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249198"},{"key":"S1478951525100424_ref8","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S283923"},{"key":"S1478951525100424_ref35","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-014-9399-y"},{"key":"S1478951525100424_ref39","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"S1478951525100424_ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2021.01.133"},{"key":"S1478951525100424_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951523001165"},{"key":"S1478951525100424_ref5","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2023.0446"},{"key":"S1478951525100424_ref2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228423"}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951525100424","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:05:52Z","timestamp":1769688352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951525100424\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":46,"alternative-id":["S1478951525100424"],"URL":"https:\/\/doi.org\/10.1017\/s1478951525100424","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited. The written permission of Cambridge University Press must be obtained prior to any commercial use and\/or adaptation of the article.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e43"}}