Decision Fatigue Among Family Caregivers of Elderly People with Disabilities or Dementia in China: A Qualitative Descriptive Study

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Methods Eighteen family caregivers of elderly people with impaired functioning and dementia were purposefully recruited from a tertiary hospital in Shanghai. Data were collected through semi-structured interviews and analyzed using thematic analysis. The report followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Five themes and multiple subthemes were identified: (1) High-demand decision-making tasks; (2) Limited decision-making resources; (3) Insufficient decision-making support; (4) Substantial psychological burden; and (5) Maladaptive decision-making strategies. Conclusion Decision fatigue among family caregivers is shaped by complex decision demands, constrained resources, and inadequate support systems, leading to significant psychological burden and suboptimal coping strategies. Interventions should focus on enhancing decision support, improving resource accessibility, and addressing caregivers’ psychological needs. These findings provide insights for developing context-specific nursing strategies to support caregivers in long-term care settings. Clinical trial number Not applicable. Disability Dementia Caregiver Decision fatigue Qualitative research 1 Introduction As the global population ages rapidly, the prevalence of older individuals with disability or dementia is increasing. Statistics from the National Health Commission indicate that over 45 million adults aged 60 and older in China are afflicted with impairments or dementia, a number that is steadily increasing. Within the “9073” elderly care paradigm, over 80% of older adults with impairments or dementia opt to age in place, with the substantial burdens of daily care, medical decision-making, and rehabilitation planning predominantly assumed by family members, including spouses and children [1] . This decision is intentional; it is profoundly grounded in the ethical principles of Confucian filial piety in China. In conventional thought, "filial piety" is considered the cornerstone of all virtues, obligating children to support, respect, and care for their elderly parents. This ethical obligation constitutes the cultural basis of elder care within Chinese families [2] . The Analects asserts, “In serving one’s parents, one should devote one’s utmost effort,” indicating that filial piety transforms caregiving from simple material assistance to a dual practice of emotional and ethical dedication, thereby imbuing family care with substantial cultural importance [3] . As the disease advances, the cognitive capacities of senior adults with disabilities or dementia progressively deteriorate, ultimately resulting in a total inability to make autonomous judgments. As a result, family caregivers inevitably assume the role of “substitute decision-makers,” necessitating frequent intervention in a range of intricate decisions, including treatment plans, medication modifications, rehabilitation strategies, care arrangements, and the evaluation of ethical considerations at the end of life [4, 5] . The decision-making process is defined by its long-term nature, steady advancement, high intensity, and irreversibility, presenting considerable difficulties to caregivers' cognitive resources, emotional regulation, and psychological resilience. Simultaneously, elements such as "decreasing birth rates," "population mobility," and "rising female employment" are transforming conventional family caring paradigms. Adult offspring are anticipated to meet their familial obligations while navigating the concurrent demands of employment and caregiving. This practical difficulty imposes distinct cultural demands on caregivers during decision-making: they must assess the patient's health while simultaneously grappling with the ethical question of fulfilling their filial responsibilities. "Decision fatigue" denotes a condition when an individual, as a consequence of frequent decision-making, suffers a depletion of self-control resources, leading to diminished decision-making capacity and decreased cognitive processing and emotional regulation abilities [6] . Baumeister et al. [7] initially introduced this concept, which is defined as the internal depletion of mental resources, in accordance with the self-control resources model. For family caregivers, decision fatigue presents as indecision, impulsive choices, or total avoidance of decision-making, and is closely associated with heightened negative emotions such as anxiety and depression, a decline in care quality, and a deterioration in the caregiver's health [8, 9] . Global research indicates that decision fatigue is common among healthcare providers, cancer patients, and surrogates for critically sick individuals, and its detrimental impacts have garnered significant attention within the academic community [10–12] . In recent years, researchers have concentrated on the distinctive cohort of family caregivers for individuals with dementia. A qualitative study conducted in Sweden in 2025 revealed that caregivers have a fundamental challenge about the "balancing of autonomy in caregiving decisions." They assume complete responsibility for decision-making while possessing restricted access to information, often opting to delegate decision-making to specialists [13] . A systematic review of 21 qualitative studies involving 502 informal caregivers in end-of-life decision-making identified that caregivers frequently encounter "uncertainty" and "ethical dilemmas." They struggle to determine the patient's wishes due to cognitive impairment while fearing that withholding treatment equates to neglecting the patient [14] . Current research has revealed various factors contributing to decision fatigue across diverse disciplines. Sociodemographic characteristics, including female gender, lower household income, higher educational attainment, and work status, are correlated with heightened psychological load and decision-related strain among caregivers [15, 16] ; At the behavioral level, decision fatigue is affected by the frequency, complexity, and conflict present in decision-making processes. Frequent decision-making requirements and elevated task complexity elevate cognitive load, while decisional conflict exacerbates psychological strain, collectively leading to the exhaustion of cognitive resources [17–19] ;At the self-regulation level, resource elements such as decision-making self-efficacy, familial support, and social support serve a significant buffering function [20, 21] . Domestic scholars have utilized intervention strategies, including “4Y in Place” photo-elicited interviews and the FOUCS model, which have demonstrated efficacy in mitigating choice fatigue [22, 23] . Despite advancements in the examination of decision fatigue, contemporary domestic research predominantly concentrates on acute or end-of-life care contexts, namely including the families of ICU patients and surrogate decision-makers for cancer patients [24, 25] ,Investigations concerning the distinct cohort of caregivers for older individuals with impairments or dementia are notably limited. Taiwanese researchers, including Tseng Hsiu-yun, have discovered that family caregivers of individuals with dementia encounter numerous caregiving challenges [26] An intervention by Wu Feiyi et al., grounded in the Pearlin stress model, has demonstrated success in enhancing caregivers' self-efficacy and alleviating their burden [27] . Nevertheless, although current quantitative studies can pinpoint various influencing factors, they fail to deliver a comprehensive understanding of caregivers' genuine inner experiences, particular challenges, obstacles to resource access, and the rationale behind their behavioral responses amid increasing decision-making pressures throughout the prolonged, evolving caregiving process [28] . In which specific decision-making scenarios can caregivers experience a sense of "burden"? In what ways do external variables such as family, community, and legislation influence the perception of "burden"? How do they manage this emotional burden? These inquiries remain to be thoroughly examined by qualitative research. Consequently, this study utilizes a descriptive phenomenological research methodology. The study employs comprehensive, semi-structured interviews with family caregivers of elderly patients with disabilities and dementia to elucidate their genuine experiences of decision-making fatigue. It systematically examines the decision-making dilemmas they encounter, the support resources accessible to them, their internal psychological experiences, and their coping strategies, thereby offering empirical evidence to guide the formulation of targeted clinical intervention plans. 2 Research methods 2.1 Aim This study aimed to explore the lived experiences of decision fatigue among family caregivers of older adults with functional impairments or dementia. 2.2 Design This study employed a descriptive phenomenological qualitative design, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), to explore caregivers’ experiences of decision fatigue. Semi-structured, in-depth interviews were conducted to capture caregivers’ subjective experiences, emotional responses, and coping strategies in the context of long-term caregiving and complex decision-making. Qualitative methodology was considered appropriate, as decision fatigue is a multidimensional internal experience involving cognitive, emotional, and behavioural components that are difficult to fully capture using quantitative approaches [6, 28] . The interview guide was developed based on a comprehensive review of the literature on decision fatigue, caregiving burden, and surrogate decision-making. It was reviewed by experts in geriatric nursing and caregiver research to ensure clarity and relevance. A pilot test was conducted with two caregivers who met the inclusion criteria, and minor revisions were made accordingly. The research team consisted of trained qualitative researchers with nursing backgrounds and prior experience in geriatric care and caregiver research. Interviews were conducted by researchers who had no prior relationship with participants. To minimise potential bias, researchers maintained a neutral stance and employed reflexive practices throughout data collection. 2.3 Theoretical orientation This study was conceptually informed by the self-regulation resource model of decision fatigue [7] , which conceptualises decision fatigue as a depletion of cognitive and self-control resources following repeated decision-making. This framework guided the development of interview questions and supported the interpretation of caregivers’ cognitive, emotional, and behavioural responses. 2.4 Study setting and participants Participants were recruited from a tertiary hospital in Shanghai, China. Purposive sampling was used to ensure variation in caregivers’ age, gender, relationship to the patient, and caregiving duration, thereby enhancing data richness and diversity. 2.5 Inclusion and exclusion criteria Inclusion criteria : Participants were eligible if they: (1) were family caregivers (e.g., spouse, child, or sibling) aged ≥ 18 years; (2) had provided care for at least 3 months, with a minimum of 4 hours per day; (3) were the primary decision-maker for the patient’s medical or care-related decisions; (4) cared for older adults who met at least one of the following conditions: (a) functional impairment requiring assistance in ≥ 1 activity of daily living, assessed by the Katz Index [29] ; (b) diagnosis of dementia according to DSM-5 criteria [30] ; (5) were able to communicate clearly and provide informed consent. Exclusion criteria : Participants were excluded if they: (1) were paid caregivers; (2) had severe physical or mental illness affecting participation; (3) had experienced major stressful life events in the past 3 months; (4) had communication barriers. 2.6 Data collection Data were collected through semi-structured, face-to-face interviews conducted in a quiet and private setting within the hospital. Prior to the interviews, participants were informed about the study purpose, procedures, and confidentiality, and written informed consent was obtained. Interviews were conducted by trained researchers with a nursing background. Rapport was established before data collection, and interview duration was flexibly adjusted according to participants’ responses. Each interview lasted approximately 30–45 minutes and was audio-recorded with permission. During the interviews, researchers used probing, paraphrasing, and summarising techniques to facilitate in-depth discussion. Field notes were taken to capture non-verbal cues and contextual information. Data collection continued until data saturation was achieved. Saturation was reached after 15 interviews, and three additional interviews were conducted to confirm that no new themes emerged. The interview guide is provided in Table 1 . Table 1 Interview Outline (thematic guide). No. Interview Guide (1) What kinds of medical care decisions do you encounter when caring for elderly people with disabilities or dementia? (2) Do you find it difficult to make such decisions? If so, in what specific ways? Could you give an example that stands out to you? (3) When faced with important healthcare decisions, who do you turn to for support and advice? (4) What kinds of psychological stress or negative feelings do you experience during the decision-making process? (5) What experiences and advice do you have for reducing decision fatigue? (6) When faced with decisions regarding medical care, what specific types of support would you most like to receive? 2.7 Data analysis Data were analysed using Colaizzi’s seven-step phenomenological method. All interviews were transcribed verbatim within 24 hours. Transcripts were checked against audio recordings and supplemented with field notes. Two researchers independently coded the data and identified significant statements. Meanings were formulated and organised into themes and subthemes. Discrepancies were resolved through discussion within the research team to achieve consensus. Finally, the findings were returned to participants for validation (member checking), and minor modifications were made based on their feedback to enhance credibility. 2.8 Rigour Several strategies were employed to ensure methodological rigour. Credibility was enhanced through prolonged engagement, member checking, and independent coding by two researchers. Dependability was ensured by maintaining a clear audit trail of data collection and analysis processes. Confirmability was supported through reflexive practices, including maintaining reflective notes to minimise researcher bias. Transferability was facilitated by providing detailed descriptions of participants and study context. 2.9 Ethical considerations This study was approved by the Medical Ethics Committee of Dongfang Hospital affiliated with Tongji University (Approval No.: 2025 − 299). The study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent and were informed of their right to withdraw at any time without consequences. Participant anonymity was ensured using pseudonyms, and all data were securely stored and used solely for research purposes. 3 Results A total of 18 family caregivers were included in this study. Of the participants, 8 were male (44.4%) and 10 were female (55.6%); participants were aged across middle-aged and older groups, with most aged between 50 and 79 years. Relationships with the patients comprised spouses (10 individuals, 55.6%), children (5 individuals, 27.8%), and other relatives (3 individuals, 16.7%). The duration of care spanned from 6 months to over 5 years. The sample characteristics are delineated in Table 2 . Table 2 Participant characteristics (n = 18) Caregiver Patient No. Gender Age group (years) Employment Status Level of education Relationship with Patients Duration of disability/dementia Self-reliance N1 Female 50–59 Retirement Junior High School mother-daughter 3-5years Fully dependent N2 Female 70–79 Retirement Elementary School married couple 3–5 years Partially dependent N3 Male 50–59 Resignation High School married couple 1–2 years Fully dependent N4 Male 50–59 Resignation High School Mother and son 6–12 months Partially dependent N5 Female 60–69 Retirement Junior High School married couple 3–5 years Fully dependent N6 Male 60–69 Retirement High School married couple 1–2 years Fully dependent N7 Female 40–49 Currently employed High School sisters-in-law 3–5 years Fully dependent N8 Male 60–69 Retirement Junior High School Father and Son >5 years Fully dependent N9 Female 50–59 Retirement High School mother-daughter 1–2 years Partially dependent N10 Male 60–69 Retirement Community college Mother and son 1–2 years Partially dependent N11 Male 50–59 Currently employed High School Mother and son >5 years Fully dependent N12 Female 70–79 Retirement Junior High School married couple 3–5 years Fully dependent N13 Female 60–69 Retirement Junior High School married couple 6–12 months Partially dependent N14 Female 40–49 Currently employed Undergraduate Mother-in-law and daughter-in-law 3–5 years Partially dependent N15 Male 70–79 Retirement Junior High School married couple 1–2 years Fully dependent N16 Female 70–79 Retirement Vocational High School married couple 1–2 years Fully dependent N17 Female 60–69 Retirement High School married couple 3–6 months Partially dependent N18 Male 60–69 Retirement High School Brother 3–5 years Partially dependent Note: Ages are presented in ranges to ensure participant anonymity. 3.1 Theme 1: High-demand decision-making tasks 3.1.1 Frequent decisions Carers must accompany patients to their routine follow-up consultations. Now I have to go to the hospital once a month for a blood test, and then decide what to do based on the results—it’s quite a hassle. (N7) Carers had a propensity for recurrent contemplation of past decisions, frequently engaged in sustained cognitive rumination. This continuous cognitive activity persisted beyond the decision-making moment, resulting in prolonged psychological strain and mental fatigue. Making decisions all the time is definitely draining. When I lie in bed at night and think of her—with her pillow and clothes right there beside me—my mind is filled with thoughts of her. (N15) 3.1.2 Complex decisions Carers often indicated that decision-making entailed pivotal considerations regarding patients' survival. The perceived irreversibility and ethical significance of such decisions exerted considerable psychological pressure, frequently resulting in increased vigilance and emotional strain. This is a human life. We only get one life; no one can just decide to give it up on a whim. (N3) The doctor said the resuscitation carries risks… but he also said that while there’s still a sliver of hope with resuscitation, there’s absolutely no hope if I don’t go through with it. (N6) Carers encountered significant ethical dilemmas when determining life-sustaining treatment options. The tension between the aspiration to extend life and the apprehension over patient suffering engendered considerable psychological turmoil and moral misery. When I think about the end, when he’s no longer able to go on, and whether to perform life-saving measures—like defibrillation or intubation—I feel that prolonging his suffering is pointless; it’s better to spare him as much pain as possible. (N12) Carers frequently have to concurrently fulfil various jobs, encompassing employment, familial obligations, and caring duties. The accretion of obligations heightened decision-making demands and led to emotional weariness. My son is really exhausted. His job is already busy enough, but when he gets home, he has to go shopping, take my spouse to the doctor, make appointments, and coordinate with the hospital. Every week, he also has to accompany my spouse to see a traditional Chinese medicine doctor for integrated Chinese and Western medicine treatment… and on top of that, he has to look after our granddaughter, who just started second grade. (N12) During that time when she couldn’t control her bowel movements, I had to handle work at the office—answering calls on one end while she was having another incident on the other. I was really at my wits’ end back then. (N14) 3.1.3 Conflicting decisions Carers often faced scenarios where therapeutic alternatives were mutually exclusive, necessitating challenging trade-offs between conflicting approaches. “My husband found the hyperbaric oxygen chamber quite comfortable at the time, but since we had to administer ‘Edaravone’ via IV, he couldn’t use it. In reality, we had to choose between the IV treatment and his rehabilitation.” (N5) Carers articulated profound emotional dilemmas when evaluating the persistence of treatment in relation to financial strain and unpredictable results. These decisions were frequently accompanied by sentiments of ambivalence and sadness. If a treatment is developed, and if it costs over a million, how could a family like ours possibly afford it? We’d either have to sell our house or forgo treatment—that dilemma weighs heavily on my mind. (N5) Differences in opinions among family members further complicated the decision-making process, often increasing uncertainty and emotional strain. My son has been talking about sending me to this nursing home for a long time, but I’ve always been against it. (N6) His three older sisters had different opinions: one said we should do everything we could, even if there was only a 1% chance; another said we shouldn’t cause too much distress; and the third didn’t come. (N17) Carers occasionally dismissed medical suggestions in favour of choices influenced by emotional needs, especially the inclination to maintain physical proximity to the patient. The doctor suggested we stay in the ICU, but I refused… because I can only feel at ease if I’m by her side every day. (N11) 3.2 Theme 2: Limited decision-making resources 3.2.1 Insufficient familial financial support Carers frequently encounter financial constraints that substantially restrict their capacity to make judgements about caregiving methods and medical alternatives. Financial limitations hinder their access to superior care resources and may compel them to forgo choices that could enhance the patient's quality of life. The paucity of resources not only intensifies decision-making issues but also heightens psychological strain, ultimately leading to decision fatigue. "There are certainly nursing homes that care for people with Alzheimer's, but they're beyond our means." (N4) Let me tell you about moving to a new place. Our friends have had their own homes for a long time now. If you want to move, you’ll have to cover the costs—where are we supposed to get that kind of money? (N5) 3.2.2 Lack of professional expertise and experience Owing to insufficient specialised medical knowledge and caregiving expertise, carers frequently depend on personal experience or trial and error to form judgements. This ambiguity elevates the cognitive burden in the decision-making process and extends the duration necessary to arrive at a conclusion. Simultaneously, previous caregiving experience or a medical background is regarded as a significant asset for coping, contributing to improved decision-making confidence and efficacy. A deficiency in information and experience intensifies decision-making stress, thereby leading to decision fatigue. Some of the medications prescribed there—the doctor said they were very effective and could help restore his consciousness. But in my opinion, I felt they made him unusually agitated, so I didn’t let him take them. (N4) I don’t know what to do, so I’ll just try everything and ask around—it’ll cost a little money and time. (N6) I have a solid foundation in my field. I previously attended a nursing program at a community college, and having worked with many patients, I’ve gained some experience myself. (N16) 3.2.3 Physical and mental deterioration among elderly caregivers Older carers exhibit differing levels of functional deterioration in domains such as information processing, memory, and physical endurance, which partially hinders their capacity to manage intricate decision-making information. Challenges in information processing, memory impairment, and physical constraints render individuals more susceptible to confusion and tiredness during decision-making, hence exacerbating the burden of decision-making and leading to decision fatigue. At our age, there’s a lot I don’t understand, and I don’t know if what’s said online is true or not. (N6) The doctor told me something, but I can’t remember what it was right now. (N10) As I’ve gotten older, my physical condition has declined in every way, and my way of thinking can’t keep up with today’s society. (N12) 3.3 Theme 3: Insufficient decision-making support 3.3.1 Absence of familial assistance At the familial level, certain carers experience inadequate assistance from relatives, leading to the sole burden of decision-making on the individual, which generates considerable pressure. Simultaneously, discord among family members or their evasion of accountability exacerbates the ambiguity and psychological strain related to decision-making. The exclusion of non-immediate family carers from the decision-making process diminishes their sense of engagement and support. Inadequate familial support markedly enhances decision fatigue. Sometimes I wonder why I don’t have two, three, or four siblings I can talk things over with. These days, there’s just no one to talk to. (N4) I make all the decisions; the kids have no say in the matter. (N6) He has a few uncles over there. I called them, and they said, ‘It’s up to you—if you want to send it, go ahead.’ (N8) As his wife, if I were to suggest sending her to a psychiatric hospital, his sister would definitely object... She still believes her mother is perfectly fine... I can’t get a word in edgewise. (N14) 3.3.2 Lack of community professional services Carers frequently indicate that community services typically operate at a fundamental care level, without expert assistance in medical decision-making and care planning. Simultaneously, access to services is hindered by factors such as household registration and residential location, while convoluted application procedures and insufficient implementation further diminish carers' propensity to utilise these services. The lack of professional help deprives carers of direction in complex decision-making, consequently heightening their cognitive load and intensifying decision fatigue. There is a doctor in the community, but to be honest, the most he can do is fill a prescription for my mom. (N1) The community is over by the public housing; I don’t think there are any for people from out of town. (N7) The community used to have a family doctor. After I filled out the form, they called once or twice to check in, but that was about it—no concrete measures were ever implemented. (N12) I have to make two trips to get my prescription costs reimbursed because they’re in meetings all the time. (N6) 3.3.3 Insufficient government safety net policies Existing regulations remain inadequate in terms of financial assistance, service coordination, and continuity of care, hindering the ability to address complex care needs. Insufficient financial compensation, arbitrary evaluation criteria, and rigid hospitalization and referral protocols compel caregivers, to some extent, to make “suboptimal decisions” within practical constraints. These structural constraints intensify the pressure and sense of powerlessness they experience, leading to decision fatigue. Specialized nursing homes for Alzheimer’s patients are too expensive, and health insurance might not even cover the costs. (N14) The requirements for long-term care insurance are very strict; we were only able to qualify after my spouse developed breathing difficulties and became unable to care for themselves. (N16) The rules say you have to go home after staying for 14 days… So we’ve been alternating between staying here for two weeks on IV drips and going home for two weeks—we haven’t really made much progress with our recovery here. (N5) For elderly people like those in the village, we really need to improve age-friendly facilities based on their age group. (N9) 3.4 Theme 4: Substantial psychological burden 3.4.1 Decision regret Certain carers ascribe negative results to their own judgement following a decision, resulting in profound sentiments of self-reproach and remorse. Moreover, information asymmetry or cognitive constraints intensifies negative feelings through the retrospective reassessment of prior decisions. This enduring emotional strain diminishes their confidence in future decision-making and exacerbates decision fatigue. I scheduled eight hours of rehab for him a day. He might have been too exhausted; he just couldn’t handle it... I feel really guilty about it—truly guilty. (N5) We didn’t know back then that we needed to use thrombolytics or anything like that, because she seemed to be in pretty good spirits. But the CT scan showed she had a stroke—as a doctor, you should understand that. (N11) 3.4.2 Decision hesitation Carers frequently demonstrate considerable reluctance and ambiguity in the decision-making process, arising from a lack of confidence in the quality of external care and apprehensions regarding social judgement and the patient's capacity to manage. This constant weighing of options and hesitation prolongs the decision-making process, increases cognitive and emotional strain, and thereby exacerbates decision fatigue. I don’t really trust the rehabilitation hospital, so I try not to go out as much as possible and just tough it out on my own. (N10) People have two sides to them. If you do something right, they’ll praise you, but if you mess up, they’ll turn around and criticize you. (N3) If it requires open surgery, I won’t let him do it; minimally invasive surgery is fine, but he definitely couldn’t handle open surgery. (N18) 3.4.3 Decision disappointment When carers dedicate substantial time, financial resources, and emotional effort yet do not attain the anticipated outcomes, they are likely to encounter deep disappointment and a feeling of powerlessness. Especially in circumstances with a bleak outlook, this feeling of "effort without reward" might erode their confidence in decision-making and diminish their willingness to persist, so intensifying decision fatigue. I took him for traditional Chinese acupuncture for a year and hyperbaric oxygen therapy for a full three months—not missing a single day. But after completing the entire treatment, his condition actually got worse and worse, and he lost the ability to swallow. (N5) We have absolutely no hope of caring for him; the emotional strain is truly overwhelming. With other illnesses, there are times when patients recover, but with this condition, it’s as if we’re trapped under a dome—there’s not a shred of hope. (The patient’s wife spoke with a choked voice, tears streaming down her face.) (N5) Dr. Zhang performed the surgery. At the time, we were very confident and delighted that it had been a success, but unfortunately, as time went on, the cancer metastasized. (N12) 3.5 Theme 5: Maladaptive decision-making strategies 3.5.1 Procrastination in decision-making Certain carers frequently postpone decision-making owing to uncertainty or psychological distress, often opting for passive alternatives until after the patient's condition has deteriorated. Moreover, incessantly evaluating several alternatives can extend the decision-making process. Such delays may not only impact the scheduling of treatment but also heighten the psychological burden of the decision-making process, hence intensifying decision fatigue. I’ve had this for a week now. At first, I didn’t want to go to the hospital and thought I’d wait and see, but since it’s been going on for so long, I figured getting admitted would be the quickest way to get better. (N1) At the time, he seemed fine to me... but a week later, his mental state was completely different from what it had been before the fall, so I decided to bring him to the hospital for a checkup. (N9) For example, last time, it took us from morning until afternoon to decide to take him to the hospital. In between, we kept wavering—one moment thinking it wasn’t serious enough to warrant a trip, and the next worrying that his condition might worsen by evening and that we wouldn’t have the stamina to handle it. (N17) 3.5.2 Evasion of decisions In high-pressure decision-making situations, some carers mitigate their own stress by transferring decision-making responsibility to medical professionals or other family members. Avoidance frequently emerges as a prevalent coping mechanism when family members are in disagreement. Although this may alleviate tension temporarily, it can diminish their sense of engagement and control over time, so indirectly intensifying decision fatigue. Huashan Hospital is supposed to be a leading institution, right? ... They just said that surgery was absolutely necessary, so they performed it right away. (N7) I wasn’t really in the mood to make a decision anyway; it’s easier for me when they make the decision. (N14) Sometimes my wife and I argue over his issues, which is definitely tough, but there’s nothing I can do about it. (N8) 3.5.3 Impulsive choices Motivated by intense emotions or the anticipation of a favourable result, carers can make hasty decisions without doing a comprehensive evaluation. Such decisions frequently include significant expenses and uncertainty; if the outcomes are inadequate, they may exacerbate the caregiver’s psychological strain and decision fatigue. The doctor told us to get injections of nerve growth factor, so we did. Each shot cost 200 yuan, and we had them for a whole month, but there was no real effect or improvement. (N5) If the doctor prescribes those imported IV nutrition solutions, we’ll definitely use them without hesitation. (N11) 4 Discussion 4.1 Comprehensive assistance to mitigate carers' stress and adverse experiences to diminish decision fatigue Carers typically endure elevated levels of caregiving stress and adverse emotions, and varying decision-making techniques considerably influence the extent of decision fatigue. Studies demonstrate that when carers encounter intricate caregiving responsibilities, their burden escalates, and they are presented with additional decisions [31] . In contrast to carers who use a satisfaction-oriented decision-making style, those with an optimality-oriented approach—who seek perfection in choice outcomes—are required to allocate greater cognitive resources to the processes of gathering, screening, and evaluating diverse care options. As a result, individuals endure a heightened psychological and physiological strain, rendering them more susceptible to decision fatigue [32] . Research indicates that the Life Hope Care Program, problem-solving training, and mindfulness-based stress reduction training can significantly mitigate carer stress, diminish its adverse emotional effects, and consequently alleviate decision fatigue [33–35] . Moreover, owing to insufficient professional expertise, carers often experience decision-making anxiety and regret when independently navigating difficult choices related to drug management, rehabilitation plan selection, and the evaluation of acute health concerns [36] . It is advisable to utilise decision-support technologies to assist carers in obtaining information about rehabilitation care and associated subjects, assess the advantages and disadvantages of different treatment alternatives, mitigate the challenges of decision-making, and facilitate optimal decision-making [37] . International researchers have employed clinical decision support systems to swiftly evaluate the long-term prognosis of patients with impairments, establishing a scientific foundation for home care and community assistance, thereby enhancing the quality of carers' decision-making [38] . Simultaneously, customised medical decision-making training and health education initiatives can be offered to carers of older patients with disabilities or dementia, considering the unique requirements of these individuals. These programs may encompass lectures, videos, and rehabilitative applications, aimed at instructing carers on the collection and analysis of treatment data, effective communication with physicians and family members, and making educated decisions. Suen et al. discovered that employing video conferencing to enhance decision-making communication between clinicians and carers enables clinicians to more comprehensively grasp the caregivers’ principal concerns, expectations concerning the patient’s prognosis, and care objectives, thus significantly enhancing the quality of shared decision-making [39] . Consequently, it is advisable for healthcare experts to formulate optimal treatment plans and rehabilitation programs tailored to the specific conditions of both carers and patients, while also encouraging carers to articulate their concerns and alleviate stress. 4.2 Strengthening professional support from families and the community to improve decision-making support for caregivers Familial and social support significantly influence the decision-making process of carers. Nonetheless, the majority of carers indicate challenges in achieving consensus on pivotal decisions—such as selecting a rehabilitation center or determining the necessity of hospital admission—or perceive that they must bear the entire responsibility of decision-making without sufficient assistance. This frequently results in feelings of isolation and helplessness while confronting caring difficulties independently and sifting through an overwhelming amount of medical information, thus eroding their confidence in decision-making [40, 41] . Studies indicate that when carers express their emotions to family and friends, it can significantly reduce caregiving stress and facilitate emotional processing, enabling them to regain composure more swiftly [42] . The State Council specifically indicates in the “14th Five-Year Plan” for the Development of Aging-Related Services and the older Care System that family members of older adults with disabilities or dementia should be motivated to actively fulfil their tasks. This study revealed that numerous carers identified a substantial disparity between their expectations of family physicians and the actual circumstances. While family physicians are the most readily available professional resource for carers, they frequently neglect to offer proactive, individualised advice on pertinent decision-making matters; in certain instances, there is even a deficiency in fundamental communication. Studies indicate that the guidance and information provided to carers by healthcare experts can mitigate their anxieties and diminish their uncertainty regarding the condition, thereby decreasing their decision fatigue [43] . Consequently, it is advisable to utilise digital health systems to facilitate carers in uploading patients' health statuses in real time, so enabling them to obtain prompt, specific advise from family physicians. This will facilitate the establishment of consistent and accessible communication channels between family physicians and carers, allowing carers to obtain effective professional assistance and psychological counselling while significantly reducing decision fatigue. 4.3 Enhance policy and resource assistance to reduce the decision-making load on carers. Carers have decision fatigue mostly because to significant limitations in financial and informational resources. This study revealed that numerous carers could not afford superior long-term care alternatives, such as professional nursing facilities or high-quality caregiving services, owing to financial constraints. Some carers faced difficulties in reconciling full-time caregiving responsibilities with their employment obligations. The simultaneous pressure dramatically heightened the difficulty of decision-making, resulting in decision fatigue. China is presently advancing a long-term care insurance system and enhancing its social assistance and welfare framework to establish financial policy protections. During implementation, the fragmented policy system, insufficient inter-departmental coordination, ambiguous assessment criteria for long-term care insurance eligibility, limited coverage, and onerous procedures have intensified the decision-making and administrative burdens on carers, failing to offer them financial support for essential decisions [44] . It is advisable for the government to provide financial incentives to motivate employers to implement "caregiving leave," flexible work arrangements, and remote work choices, thereby alleviating the challenging decision carers face between employment and caregiving responsibilities [45] , Simultaneously, we will delineate departmental responsibilities, standardise long-term care insurance assessment criteria, broaden medical insurance coverage, optimise administrative processes, enhance funding assurances, and institute care subsidies via community and nonprofit organisations to effectively mitigate the financial strain on carers. This study also revealed that certain carers, especially older ones, have restricted access to information. Inadequate transmission and interpretation of policies concerning senior care and healthcare hinder carers from acquiring comprehensive and precise knowledge about caregiving. As a result, individuals cannot properly assess the advantages and disadvantages, as well as the practicality, of different treatment and rehabilitation strategies, rendering them more susceptible to uncertainty and indecision, hence intensifying their decision fatigue. Cox et al. created a paper-based decision-making aid for persons unacquainted with technological gadgets, employing a blend of text and images to communicate information. Chinese researchers enhanced the guidance to assist family members in comprehending patients' preferences and making judgements that align more closely with patients' needs [46, 47] . The "Healthy China 2030" Outline advocates for the proactive dissemination of medical information within existing policies. The government is advised to spearhead the development of an integrated care policy and information service platform to continuously update pertinent policies regarding elderly care, medical services, and social assistance, while offering both online and offline policy interpretation and consultation services. Concurrently, by partnering with communities, family practitioners, and nonprofit organisations, professional support for carers, including care plan assessments and information coordination, can be facilitated. Leveraging digital health platforms, we can facilitate regular and convenient communication between family doctors and caregivers, thereby resolving the issue of information asymmetry. By enhancing the policy and resource support framework from both economic and informational standpoints, we may thoroughly mitigate the load on carers, diminish decision-making challenges stemming from resource scarcity, and address decision fatigue at its source. 5 Conclusion Carers of older individuals with impairments or dementia may encounter decision fatigue. Challenging decision-making tasks, constrained decision-making resources, and inadequate decision support intensify the psychological stress experienced by carers, resulting in suboptimal decisions and hindering patients from obtaining optimal rehabilitation treatment. Consequently, healthcare personnel must closely monitor and prioritise decision-making fatigue among carers of older patients with impairments or dementia, using tailored intervention strategies. Relevant authorities must enhance policies for aged care support, fortify professional assistance from both familial and societal sources, and advance social stability alongside the expansion of the elderly healthcare system. Declarations Prior to the interviews, participants were fully informed about the study purpose, procedures, confidentiality, and their right to withdraw at any time without consequences. All participants provided written informed consent prior to participation. All authors have read and agreed to the published version of the manuscript. Note: Ages are presented in ranges to ensure participant anonymity. Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Medical Ethics Committee of Shanghai East Hospital, Tongji University, China (Approval No.: 2025 − 299). Clinical trial number Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the National Natural Science Foundation of China (Grant No.72274136). The Academic Leaders Training Program of Pudong Health Bureau of Shanghai (Grant No. PWRd2022-16). The Medical Discipline Construction Program of Shanghai Pudong New Area Health Commission (the Key Disciplines Program) (PWZxk2022-14). Author Contribution Xiao Lei Shen: Writing – review & editing, Writing – original draft, Visualization, Formal analysis, Data curation, Conceptualization. Yi Ni Zhang: Writing – review & editing, Validation, Supervision, Formal analysis, Conceptualization. Neng Neng Hu: Writing – review & editing. Yan Shi: Writing – review & editing, Visualization, Formal analysis, Data curation, Conceptualization. Hai Ping Yu: Writing – review & editing, Visualization, Resources, Formal analysis, Data curation, Conceptualization.All authors have read and agreed to the published version of the manuscript. Acknowledgements We wish to express our gratitude to the nurse managers and participants who made this study possible. Data Availability The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. References Xizhe P, Liangjun S, Jiankun H. Determinants of Long-Term Care Services among Disabled Older Adults in China: A Quantitative Study based on Andersen's Behavioral Model[J]. Population Research, 2017,41(04):46–59. Kong D. Filial Piety Under Pressure: A Qualitative Study of Dementia Caregiver Burdens in Rural China[J]. J Gerontol Soc Work, 2026:1–21.DOI: 10.1080/01634372.2025.2611754 . Shen Y, Ciobanu R O, van der Horst M, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9299292","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639116824,"identity":"e6798c6e-7c19-4aac-9a57-d01b0aae3bfe","order_by":0,"name":"xiaolei shen","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"xiaolei","middleName":"","lastName":"shen","suffix":""},{"id":639116825,"identity":"cb151869-7742-4573-9421-74a7ef7bcd87","order_by":1,"name":"yini zhang","email":"","orcid":"","institution":"Jinshanwei Town Community Health Service Center","correspondingAuthor":false,"prefix":"","firstName":"yini","middleName":"","lastName":"zhang","suffix":""},{"id":639116826,"identity":"1afd7096-4af7-4db2-8195-2559ea01ebcb","order_by":2,"name":"nengneng hu","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"nengneng","middleName":"","lastName":"hu","suffix":""},{"id":639116827,"identity":"5994e6ca-709d-44de-a345-b00304b5e020","order_by":3,"name":"yan shi","email":"","orcid":"","institution":"Shanghai Tenth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"yan","middleName":"","lastName":"shi","suffix":""},{"id":639116828,"identity":"da579fe4-8978-49b2-94d2-b7f4986e01af","order_by":4,"name":"haiping yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDACZhBhwMDAL/+w8QGIQbwWyYbkwwbEaYEBg4a0NAmiVJqz8x5+XVBwx24Dwxmzyh8Fd+QZ2A8f3YBPi2UzX5r1DINnydsZe8xu8xg8M2zgSUu7gdc9h3nMjHkMDidbNvOY3QZyGRskeMyI02JwjMes8IfBYXtitBg/BmqxMzjDlsYAZCQS1AJyD/MMg8MJkjOYD0uDrGsj5Bdz/jPGnwv+HLbnl2Bs/Pjjz2HbfvbDx/A7jIGBTRpIJzbARNjwKYdqYf4MpO0JKRwFo2AUjIIRDACir0kQZwr7TwAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai Pudong New Area Gongli Hospital","correspondingAuthor":true,"prefix":"","firstName":"haiping","middleName":"","lastName":"yu","suffix":""}],"badges":[],"createdAt":"2026-04-02 07:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9299292/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9299292/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109150408,"identity":"a34f115d-0b31-4d55-a3d1-ec68da6e9fc7","added_by":"auto","created_at":"2026-05-13 05:28:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":401383,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9299292/v1/7746a45c-68e9-4b4b-afb1-8edfdd3d0213.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Decision Fatigue Among Family Caregivers of Elderly People with Disabilities or Dementia in China: A Qualitative Descriptive Study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eAs the global population ages rapidly, the prevalence of older individuals with disability or dementia is increasing. Statistics from the National Health Commission indicate that over 45\u0026nbsp;million adults aged 60 and older in China are afflicted with impairments or dementia, a number that is steadily increasing. Within the \u0026ldquo;9073\u0026rdquo; elderly care paradigm, over 80% of older adults with impairments or dementia opt to age in place, with the substantial burdens of daily care, medical decision-making, and rehabilitation planning predominantly assumed by family members, including spouses and children\u003csup\u003e[1]\u003c/sup\u003e. This decision is intentional; it is profoundly grounded in the ethical principles of Confucian filial piety in China. In conventional thought, \"filial piety\" is considered the cornerstone of all virtues, obligating children to support, respect, and care for their elderly parents. This ethical obligation constitutes the cultural basis of elder care within Chinese families\u003csup\u003e[2]\u003c/sup\u003e. The Analects asserts, \u0026ldquo;In serving one\u0026rsquo;s parents, one should devote one\u0026rsquo;s utmost effort,\u0026rdquo; indicating that filial piety transforms caregiving from simple material assistance to a dual practice of emotional and ethical dedication, thereby imbuing family care with substantial cultural importance\u003csup\u003e[3]\u003c/sup\u003e. As the disease advances, the cognitive capacities of senior adults with disabilities or dementia progressively deteriorate, ultimately resulting in a total inability to make autonomous judgments. As a result, family caregivers inevitably assume the role of \u0026ldquo;substitute decision-makers,\u0026rdquo; necessitating frequent intervention in a range of intricate decisions, including treatment plans, medication modifications, rehabilitation strategies, care arrangements, and the evaluation of ethical considerations at the end of life\u003csup\u003e[4, 5]\u003c/sup\u003e. The decision-making process is defined by its long-term nature, steady advancement, high intensity, and irreversibility, presenting considerable difficulties to caregivers' cognitive resources, emotional regulation, and psychological resilience. Simultaneously, elements such as \"decreasing birth rates,\" \"population mobility,\" and \"rising female employment\" are transforming conventional family caring paradigms. Adult offspring are anticipated to meet their familial obligations while navigating the concurrent demands of employment and caregiving. This practical difficulty imposes distinct cultural demands on caregivers during decision-making: they must assess the patient's health while simultaneously grappling with the ethical question of fulfilling their filial responsibilities.\u003c/p\u003e \u003cp\u003e\"Decision fatigue\" denotes a condition when an individual, as a consequence of frequent decision-making, suffers a depletion of self-control resources, leading to diminished decision-making capacity and decreased cognitive processing and emotional regulation abilities\u003csup\u003e[6]\u003c/sup\u003e. Baumeister et al. \u003csup\u003e[7]\u003c/sup\u003e initially introduced this concept, which is defined as the internal depletion of mental resources, in accordance with the self-control resources model. For family caregivers, decision fatigue presents as indecision, impulsive choices, or total avoidance of decision-making, and is closely associated with heightened negative emotions such as anxiety and depression, a decline in care quality, and a deterioration in the caregiver's health \u003csup\u003e[8, 9]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGlobal research indicates that decision fatigue is common among healthcare providers, cancer patients, and surrogates for critically sick individuals, and its detrimental impacts have garnered significant attention within the academic community \u003csup\u003e[10\u0026ndash;12]\u003c/sup\u003e. In recent years, researchers have concentrated on the distinctive cohort of family caregivers for individuals with dementia. A qualitative study conducted in Sweden in 2025 revealed that caregivers have a fundamental challenge about the \"balancing of autonomy in caregiving decisions.\" They assume complete responsibility for decision-making while possessing restricted access to information, often opting to delegate decision-making to specialists \u003csup\u003e[13]\u003c/sup\u003e. A systematic review of 21 qualitative studies involving 502 informal caregivers in end-of-life decision-making identified that caregivers frequently encounter \"uncertainty\" and \"ethical dilemmas.\" They struggle to determine the patient's wishes due to cognitive impairment while fearing that withholding treatment equates to neglecting the patient \u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCurrent research has revealed various factors contributing to decision fatigue across diverse disciplines. Sociodemographic characteristics, including female gender, lower household income, higher educational attainment, and work status, are correlated with heightened psychological load and decision-related strain among caregivers\u003csup\u003e[15, 16]\u003c/sup\u003e; At the behavioral level, decision fatigue is affected by the frequency, complexity, and conflict present in decision-making processes. Frequent decision-making requirements and elevated task complexity elevate cognitive load, while decisional conflict exacerbates psychological strain, collectively leading to the exhaustion of cognitive resources\u003csup\u003e[17\u0026ndash;19]\u003c/sup\u003e;At the self-regulation level, resource elements such as decision-making self-efficacy, familial support, and social support serve a significant buffering function \u003csup\u003e[20, 21]\u003c/sup\u003e. Domestic scholars have utilized intervention strategies, including \u0026ldquo;4Y in Place\u0026rdquo; photo-elicited interviews and the FOUCS model, which have demonstrated efficacy in mitigating choice fatigue\u003csup\u003e[22, 23]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite advancements in the examination of decision fatigue, contemporary domestic research predominantly concentrates on acute or end-of-life care contexts, namely including the families of ICU patients and surrogate decision-makers for cancer patients\u003csup\u003e[24, 25]\u003c/sup\u003e,Investigations concerning the distinct cohort of caregivers for older individuals with impairments or dementia are notably limited. Taiwanese researchers, including Tseng Hsiu-yun, have discovered that family caregivers of individuals with dementia encounter numerous caregiving challenges\u003csup\u003e[26]\u003c/sup\u003e An intervention by Wu Feiyi et al., grounded in the Pearlin stress model, has demonstrated success in enhancing caregivers' self-efficacy and alleviating their burden\u003csup\u003e[27]\u003c/sup\u003e. Nevertheless, although current quantitative studies can pinpoint various influencing factors, they fail to deliver a comprehensive understanding of caregivers' genuine inner experiences, particular challenges, obstacles to resource access, and the rationale behind their behavioral responses amid increasing decision-making pressures throughout the prolonged, evolving caregiving process \u003csup\u003e[28]\u003c/sup\u003e. In which specific decision-making scenarios can caregivers experience a sense of \"burden\"? In what ways do external variables such as family, community, and legislation influence the perception of \"burden\"? How do they manage this emotional burden? These inquiries remain to be thoroughly examined by qualitative research.\u003c/p\u003e \u003cp\u003eConsequently, this study utilizes a descriptive phenomenological research methodology. The study employs comprehensive, semi-structured interviews with family caregivers of elderly patients with disabilities and dementia to elucidate their genuine experiences of decision-making fatigue. It systematically examines the decision-making dilemmas they encounter, the support resources accessible to them, their internal psychological experiences, and their coping strategies, thereby offering empirical evidence to guide the formulation of targeted clinical intervention plans.\u003c/p\u003e"},{"header":"2 Research methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Aim\u003c/h2\u003e \u003cp\u003eThis study aimed to explore the lived experiences of decision fatigue among family caregivers of older adults with functional impairments or dementia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Design\u003c/h2\u003e \u003cp\u003eThis study employed a descriptive phenomenological qualitative design, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), to explore caregivers\u0026rsquo; experiences of decision fatigue.\u003c/p\u003e \u003cp\u003eSemi-structured, in-depth interviews were conducted to capture caregivers\u0026rsquo; subjective experiences, emotional responses, and coping strategies in the context of long-term caregiving and complex decision-making. Qualitative methodology was considered appropriate, as decision fatigue is a multidimensional internal experience involving cognitive, emotional, and behavioural components that are difficult to fully capture using quantitative approaches\u003csup\u003e[6, 28]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe interview guide was developed based on a comprehensive review of the literature on decision fatigue, caregiving burden, and surrogate decision-making. It was reviewed by experts in geriatric nursing and caregiver research to ensure clarity and relevance. A pilot test was conducted with two caregivers who met the inclusion criteria, and minor revisions were made accordingly.\u003c/p\u003e \u003cp\u003eThe research team consisted of trained qualitative researchers with nursing backgrounds and prior experience in geriatric care and caregiver research. Interviews were conducted by researchers who had no prior relationship with participants. To minimise potential bias, researchers maintained a neutral stance and employed reflexive practices throughout data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Theoretical orientation\u003c/h2\u003e \u003cp\u003eThis study was conceptually informed by the self-regulation resource model of decision fatigue\u003csup\u003e[7]\u003c/sup\u003e, which conceptualises decision fatigue as a depletion of cognitive and self-control resources following repeated decision-making. This framework guided the development of interview questions and supported the interpretation of caregivers\u0026rsquo; cognitive, emotional, and behavioural responses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Study setting and participants\u003c/h2\u003e \u003cp\u003eParticipants were recruited from a tertiary hospital in Shanghai, China. Purposive sampling was used to ensure variation in caregivers\u0026rsquo; age, gender, relationship to the patient, and caregiving duration, thereby enhancing data richness and diversity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eParticipants were eligible if they:\u003c/p\u003e \u003cp\u003e(1) were family caregivers (e.g., spouse, child, or sibling) aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years;\u003c/p\u003e \u003cp\u003e(2) had provided care for at least 3 months, with a minimum of 4 hours per day;\u003c/p\u003e \u003cp\u003e(3) were the primary decision-maker for the patient\u0026rsquo;s medical or care-related decisions;\u003c/p\u003e \u003cp\u003e(4) cared for older adults who met at least one of the following conditions:\u003c/p\u003e \u003cp\u003e \u003cp\u003e(a) functional impairment requiring assistance in \u0026ge;\u0026thinsp;1 activity of daily living, assessed by the Katz Index\u003csup\u003e[29]\u003c/sup\u003e;\u003c/p\u003e \u003cp\u003e(b) diagnosis of dementia according to DSM-5 criteria\u003csup\u003e[30]\u003c/sup\u003e;\u003c/p\u003e \u003cp\u003e (5) were able to communicate clearly and provide informed consent.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eParticipants were excluded if they:\u003c/p\u003e \u003cp\u003e(1) were paid caregivers;\u003c/p\u003e \u003cp\u003e(2) had severe physical or mental illness affecting participation;\u003c/p\u003e \u003cp\u003e(3) had experienced major stressful life events in the past 3 months;\u003c/p\u003e \u003cp\u003e(4) had communication barriers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data collection\u003c/h2\u003e \u003cp\u003eData were collected through semi-structured, face-to-face interviews conducted in a quiet and private setting within the hospital. Prior to the interviews, participants were informed about the study purpose, procedures, and confidentiality, and written informed consent was obtained.\u003c/p\u003e \u003cp\u003eInterviews were conducted by trained researchers with a nursing background. Rapport was established before data collection, and interview duration was flexibly adjusted according to participants\u0026rsquo; responses. Each interview lasted approximately 30\u0026ndash;45 minutes and was audio-recorded with permission.\u003c/p\u003e \u003cp\u003eDuring the interviews, researchers used probing, paraphrasing, and summarising techniques to facilitate in-depth discussion. Field notes were taken to capture non-verbal cues and contextual information.\u003c/p\u003e \u003cp\u003eData collection continued until data saturation was achieved. Saturation was reached after 15 interviews, and three additional interviews were conducted to confirm that no new themes emerged. The interview guide is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview Outline (thematic guide).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterview Guide\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat kinds of medical care decisions do you encounter when caring for elderly people with disabilities or dementia?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo you find it difficult to make such decisions? If so, in what specific ways? Could you give an example that stands out to you?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen faced with important healthcare decisions, who do you turn to for support and advice?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat kinds of psychological stress or negative feelings do you experience during the decision-making process?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat experiences and advice do you have for reducing decision fatigue?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen faced with decisions regarding medical care, what specific types of support would you most like to receive?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Data analysis\u003c/h2\u003e \u003cp\u003eData were analysed using Colaizzi\u0026rsquo;s seven-step phenomenological method. All interviews were transcribed verbatim within 24 hours. Transcripts were checked against audio recordings and supplemented with field notes.\u003c/p\u003e \u003cp\u003eTwo researchers independently coded the data and identified significant statements. Meanings were formulated and organised into themes and subthemes. Discrepancies were resolved through discussion within the research team to achieve consensus.\u003c/p\u003e \u003cp\u003e Finally, the findings were returned to participants for validation (member checking), and minor modifications were made based on their feedback to enhance credibility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Rigour\u003c/h2\u003e \u003cp\u003eSeveral strategies were employed to ensure methodological rigour. Credibility was enhanced through prolonged engagement, member checking, and independent coding by two researchers. Dependability was ensured by maintaining a clear audit trail of data collection and analysis processes. Confirmability was supported through reflexive practices, including maintaining reflective notes to minimise researcher bias. Transferability was facilitated by providing detailed descriptions of participants and study context.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.9 Ethical considerations\u003c/h2\u003e \u003cp\u003e This study was approved by the Medical Ethics Committee of Dongfang Hospital affiliated with Tongji University (Approval No.: 2025\u0026thinsp;\u0026minus;\u0026thinsp;299). The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003e All participants provided written informed consent and were informed of their right to withdraw at any time without consequences. Participant anonymity was ensured using pseudonyms, and all data were securely stored and used solely for research purposes.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eA total of 18 family caregivers were included in this study. Of the participants, 8 were male (44.4%) and 10 were female (55.6%); participants were aged across middle-aged and older groups, with most aged between 50 and 79 years. Relationships with the patients comprised spouses (10 individuals, 55.6%), children (5 individuals, 27.8%), and other relatives (3 individuals, 16.7%). The duration of care spanned from 6 months to over 5 years. The sample characteristics are delineated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eCaregiver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge group (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRelationship with Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDuration of disability/dementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-reliance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emother-daughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3-5years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eElementary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResignation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResignation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMother and son\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrently employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003esisters-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFather and Son\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emother-daughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMother and son\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrently employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMother and son\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrently employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMother-in-law and daughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVocational High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFully dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emarried couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRetirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBrother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartially dependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: Ages are presented in ranges to ensure participant anonymity.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Theme 1: High-demand decision-making tasks\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 Frequent decisions\u003c/h2\u003e \u003cp\u003eCarers must accompany patients to their routine follow-up consultations.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNow I have to go to the hospital once a month for a blood test, and then decide what to do based on the results\u0026mdash;it\u0026rsquo;s quite a hassle.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N7)\u003c/p\u003e \u003cp\u003eCarers had a propensity for recurrent contemplation of past decisions, frequently engaged in sustained cognitive rumination. This continuous cognitive activity persisted beyond the decision-making moment, resulting in prolonged psychological strain and mental fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMaking decisions all the time is definitely draining. When I lie in bed at night and think of her\u0026mdash;with her pillow and clothes right there beside me\u0026mdash;my mind is filled with thoughts of her.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N15)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Complex decisions\u003c/h2\u003e \u003cp\u003eCarers often indicated that decision-making entailed pivotal considerations regarding patients' survival. The perceived irreversibility and ethical significance of such decisions exerted considerable psychological pressure, frequently resulting in increased vigilance and emotional strain.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis is a human life. We only get one life; no one can just decide to give it up on a whim.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N3)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe doctor said the resuscitation carries risks\u0026hellip; but he also said that while there\u0026rsquo;s still a sliver of hope with resuscitation, there\u0026rsquo;s absolutely no hope if I don\u0026rsquo;t go through with it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N6)\u003c/p\u003e \u003cp\u003eCarers encountered significant ethical dilemmas when determining life-sustaining treatment options. The tension between the aspiration to extend life and the apprehension over patient suffering engendered considerable psychological turmoil and moral misery.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen I think about the end, when he\u0026rsquo;s no longer able to go on, and whether to perform life-saving measures\u0026mdash;like defibrillation or intubation\u0026mdash;I feel that prolonging his suffering is pointless; it\u0026rsquo;s better to spare him as much pain as possible.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N12)\u003c/p\u003e \u003cp\u003eCarers frequently have to concurrently fulfil various jobs, encompassing employment, familial obligations, and caring duties. The accretion of obligations heightened decision-making demands and led to emotional weariness.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMy son is really exhausted. His job is already busy enough, but when he gets home, he has to go shopping, take my spouse to the doctor, make appointments, and coordinate with the hospital. Every week, he also has to accompany my spouse to see a traditional Chinese medicine doctor for integrated Chinese and Western medicine treatment\u0026hellip; and on top of that, he has to look after our granddaughter, who just started second grade.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N12)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDuring that time when she couldn\u0026rsquo;t control her bowel movements, I had to handle work at the office\u0026mdash;answering calls on one end while she was having another incident on the other. I was really at my wits\u0026rsquo; end back then.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N14)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Conflicting decisions\u003c/h2\u003e \u003cp\u003eCarers often faced scenarios where therapeutic alternatives were mutually exclusive, necessitating challenging trade-offs between conflicting approaches.\u003c/p\u003e \u003cp\u003e\u0026ldquo;My husband found the hyperbaric oxygen chamber quite comfortable at the time, but since we had to administer \u0026lsquo;Edaravone\u0026rsquo; via IV, he couldn\u0026rsquo;t use it. In reality, we had to choose between the IV treatment and his rehabilitation.\u0026rdquo;\u003c/p\u003e \u003cp\u003e(N5)\u003c/p\u003e \u003cp\u003eCarers articulated profound emotional dilemmas when evaluating the persistence of treatment in relation to financial strain and unpredictable results. These decisions were frequently accompanied by sentiments of ambivalence and sadness.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf a treatment is developed, and if it costs over a million, how could a family like ours possibly afford it? We\u0026rsquo;d either have to sell our house or forgo treatment\u0026mdash;that dilemma weighs heavily on my mind.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003c/p\u003e \u003cp\u003eDifferences in opinions among family members further complicated the decision-making process, often increasing uncertainty and emotional strain.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMy son has been talking about sending me to this nursing home for a long time, but I\u0026rsquo;ve always been against it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N6)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHis three older sisters had different opinions: one said we should do everything we could, even if there was only a 1% chance; another said we shouldn\u0026rsquo;t cause too much distress; and the third didn\u0026rsquo;t come.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N17)\u003c/p\u003e \u003cp\u003eCarers occasionally dismissed medical suggestions in favour of choices influenced by emotional needs, especially the inclination to maintain physical proximity to the patient.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe doctor suggested we stay in the ICU, but I refused\u0026hellip; because I can only feel at ease if I\u0026rsquo;m by her side every day.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N11)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Theme 2: Limited decision-making resources\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Insufficient familial financial support\u003c/h2\u003e \u003cp\u003eCarers frequently encounter financial constraints that substantially restrict their capacity to make judgements about caregiving methods and medical alternatives. Financial limitations hinder their access to superior care resources and may compel them to forgo choices that could enhance the patient's quality of life. The paucity of resources not only intensifies decision-making issues but also heightens psychological strain, ultimately leading to decision fatigue.\u003c/p\u003e \u003cp\u003e\"There are certainly nursing homes that care for people with Alzheimer's, but they're beyond our means.\"\u003c/p\u003e \u003cp\u003e(N4)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLet me tell you about moving to a new place. Our friends have had their own homes for a long time now. If you want to move, you\u0026rsquo;ll have to cover the costs\u0026mdash;where are we supposed to get that kind of money?\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Lack of professional expertise and experience\u003c/h2\u003e \u003cp\u003eOwing to insufficient specialised medical knowledge and caregiving expertise, carers frequently depend on personal experience or trial and error to form judgements. This ambiguity elevates the cognitive burden in the decision-making process and extends the duration necessary to arrive at a conclusion. Simultaneously, previous caregiving experience or a medical background is regarded as a significant asset for coping, contributing to improved decision-making confidence and efficacy. A deficiency in information and experience intensifies decision-making stress, thereby leading to decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSome of the medications prescribed there\u0026mdash;the doctor said they were very effective and could help restore his consciousness. But in my opinion, I felt they made him unusually agitated, so I didn\u0026rsquo;t let him take them.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N4)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI don\u0026rsquo;t know what to do, so I\u0026rsquo;ll just try everything and ask around\u0026mdash;it\u0026rsquo;ll cost a little money and time.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N6)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI have a solid foundation in my field. I previously attended a nursing program at a community college, and having worked with many patients, I\u0026rsquo;ve gained some experience myself.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N16)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Physical and mental deterioration among elderly caregivers\u003c/h2\u003e \u003cp\u003eOlder carers exhibit differing levels of functional deterioration in domains such as information processing, memory, and physical endurance, which partially hinders their capacity to manage intricate decision-making information. Challenges in information processing, memory impairment, and physical constraints render individuals more susceptible to confusion and tiredness during decision-making, hence exacerbating the burden of decision-making and leading to decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAt our age, there\u0026rsquo;s a lot I don\u0026rsquo;t understand, and I don\u0026rsquo;t know if what\u0026rsquo;s said online is true or not.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N6)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe doctor told me something, but I can\u0026rsquo;t remember what it was right now.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N10)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs I\u0026rsquo;ve gotten older, my physical condition has declined in every way, and my way of thinking can\u0026rsquo;t keep up with today\u0026rsquo;s society.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N12)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Theme 3: Insufficient decision-making support\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Absence of familial assistance\u003c/h2\u003e \u003cp\u003eAt the familial level, certain carers experience inadequate assistance from relatives, leading to the sole burden of decision-making on the individual, which generates considerable pressure. Simultaneously, discord among family members or their evasion of accountability exacerbates the ambiguity and psychological strain related to decision-making. The exclusion of non-immediate family carers from the decision-making process diminishes their sense of engagement and support. Inadequate familial support markedly enhances decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSometimes I wonder why I don\u0026rsquo;t have two, three, or four siblings I can talk things over with. These days, there\u0026rsquo;s just no one to talk to.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N4)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI make all the decisions; the kids have no say in the matter.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N6)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHe has a few uncles over there. I called them, and they said, \u0026lsquo;It\u0026rsquo;s up to you\u0026mdash;if you want to send it, go ahead.\u0026rsquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N8)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs his wife, if I were to suggest sending her to a psychiatric hospital, his sister would definitely object... She still believes her mother is perfectly fine... I can\u0026rsquo;t get a word in edgewise.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N14)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Lack of community professional services\u003c/h2\u003e \u003cp\u003eCarers frequently indicate that community services typically operate at a fundamental care level, without expert assistance in medical decision-making and care planning. Simultaneously, access to services is hindered by factors such as household registration and residential location, while convoluted application procedures and insufficient implementation further diminish carers' propensity to utilise these services. The lack of professional help deprives carers of direction in complex decision-making, consequently heightening their cognitive load and intensifying decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThere is a doctor in the community, but to be honest, the most he can do is fill a prescription for my mom.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N1)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe community is over by the public housing; I don\u0026rsquo;t think there are any for people from out of town.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N7)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe community used to have a family doctor. After I filled out the form, they called once or twice to check in, but that was about it\u0026mdash;no concrete measures were ever implemented.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N12)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI have to make two trips to get my prescription costs reimbursed because they\u0026rsquo;re in meetings all the time.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N6)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3 Insufficient government safety net policies\u003c/h2\u003e \u003cp\u003eExisting regulations remain inadequate in terms of financial assistance, service coordination, and continuity of care, hindering the ability to address complex care needs. Insufficient financial compensation, arbitrary evaluation criteria, and rigid hospitalization and referral protocols compel caregivers, to some extent, to make \u0026ldquo;suboptimal decisions\u0026rdquo; within practical constraints. These structural constraints intensify the pressure and sense of powerlessness they experience, leading to decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSpecialized nursing homes for Alzheimer\u0026rsquo;s patients are too expensive, and health insurance might not even cover the costs.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N14)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe requirements for long-term care insurance are very strict; we were only able to qualify after my spouse developed breathing difficulties and became unable to care for themselves.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N16)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe rules say you have to go home after staying for 14 days\u0026hellip; So we\u0026rsquo;ve been alternating between staying here for two weeks on IV drips and going home for two weeks\u0026mdash;we haven\u0026rsquo;t really made much progress with our recovery here.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor elderly people like those in the village, we really need to improve age-friendly facilities based on their age group.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N9)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Theme 4: Substantial psychological burden\u003c/h2\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Decision regret\u003c/h2\u003e \u003cp\u003eCertain carers ascribe negative results to their own judgement following a decision, resulting in profound sentiments of self-reproach and remorse. Moreover, information asymmetry or cognitive constraints intensifies negative feelings through the retrospective reassessment of prior decisions. This enduring emotional strain diminishes their confidence in future decision-making and exacerbates decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI scheduled eight hours of rehab for him a day. He might have been too exhausted; he just couldn\u0026rsquo;t handle it... I feel really guilty about it\u0026mdash;truly guilty.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe didn\u0026rsquo;t know back then that we needed to use thrombolytics or anything like that, because she seemed to be in pretty good spirits. But the CT scan showed she had a stroke\u0026mdash;as a doctor, you should understand that.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N11)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Decision hesitation\u003c/h2\u003e \u003cp\u003eCarers frequently demonstrate considerable reluctance and ambiguity in the decision-making process, arising from a lack of confidence in the quality of external care and apprehensions regarding social judgement and the patient's capacity to manage. This constant weighing of options and hesitation prolongs the decision-making process, increases cognitive and emotional strain, and thereby exacerbates decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI don\u0026rsquo;t really trust the rehabilitation hospital, so I try not to go out as much as possible and just tough it out on my own.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N10)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePeople have two sides to them. If you do something right, they\u0026rsquo;ll praise you, but if you mess up, they\u0026rsquo;ll turn around and criticize you.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N3)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf it requires open surgery, I won\u0026rsquo;t let him do it; minimally invasive surgery is fine, but he definitely couldn\u0026rsquo;t handle open surgery.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N18)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section3\"\u003e \u003ch2\u003e3.4.3 Decision disappointment\u003c/h2\u003e \u003cp\u003eWhen carers dedicate substantial time, financial resources, and emotional effort yet do not attain the anticipated outcomes, they are likely to encounter deep disappointment and a feeling of powerlessness. Especially in circumstances with a bleak outlook, this feeling of \"effort without reward\" might erode their confidence in decision-making and diminish their willingness to persist, so intensifying decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI took him for traditional Chinese acupuncture for a year and hyperbaric oxygen therapy for a full three months\u0026mdash;not missing a single day. But after completing the entire treatment, his condition actually got worse and worse, and he lost the ability to swallow.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe have absolutely no hope of caring for him; the emotional strain is truly overwhelming. With other illnesses, there are times when patients recover, but with this condition, it\u0026rsquo;s as if we\u0026rsquo;re trapped under a dome\u0026mdash;there\u0026rsquo;s not a shred of hope. (The patient\u0026rsquo;s wife spoke with a choked voice, tears streaming down her face.)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDr. Zhang performed the surgery. At the time, we were very confident and delighted that it had been a success, but unfortunately, as time went on, the cancer metastasized.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N12)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Theme 5: Maladaptive decision-making strategies\u003c/h2\u003e \u003cdiv id=\"Sec30\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1 Procrastination in decision-making\u003c/h2\u003e \u003cp\u003eCertain carers frequently postpone decision-making owing to uncertainty or psychological distress, often opting for passive alternatives until after the patient's condition has deteriorated. Moreover, incessantly evaluating several alternatives can extend the decision-making process. Such delays may not only impact the scheduling of treatment but also heighten the psychological burden of the decision-making process, hence intensifying decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI\u0026rsquo;ve had this for a week now. At first, I didn\u0026rsquo;t want to go to the hospital and thought I\u0026rsquo;d wait and see, but since it\u0026rsquo;s been going on for so long, I figured getting admitted would be the quickest way to get better.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N1)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAt the time, he seemed fine to me... but a week later, his mental state was completely different from what it had been before the fall, so I decided to bring him to the hospital for a checkup.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N9)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor example, last time, it took us from morning until afternoon to decide to take him to the hospital. In between, we kept wavering\u0026mdash;one moment thinking it wasn\u0026rsquo;t serious enough to warrant a trip, and the next worrying that his condition might worsen by evening and that we wouldn\u0026rsquo;t have the stamina to handle it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N17)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2 Evasion of decisions\u003c/h2\u003e \u003cp\u003eIn high-pressure decision-making situations, some carers mitigate their own stress by transferring decision-making responsibility to medical professionals or other family members. Avoidance frequently emerges as a prevalent coping mechanism when family members are in disagreement. Although this may alleviate tension temporarily, it can diminish their sense of engagement and control over time, so indirectly intensifying decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHuashan Hospital is supposed to be a leading institution, right? ... They just said that surgery was absolutely necessary, so they performed it right away.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N7)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI wasn\u0026rsquo;t really in the mood to make a decision anyway; it\u0026rsquo;s easier for me when they make the decision.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N14)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSometimes my wife and I argue over his issues, which is definitely tough, but there\u0026rsquo;s nothing I can do about it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N8)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section3\"\u003e \u003ch2\u003e3.5.3 Impulsive choices\u003c/h2\u003e \u003cp\u003eMotivated by intense emotions or the anticipation of a favourable result, carers can make hasty decisions without doing a comprehensive evaluation. Such decisions frequently include significant expenses and uncertainty; if the outcomes are inadequate, they may exacerbate the caregiver\u0026rsquo;s psychological strain and decision fatigue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe doctor told us to get injections of nerve growth factor, so we did. Each shot cost 200 yuan, and we had them for a whole month, but there was no real effect or improvement.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N5)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf the doctor prescribes those imported IV nutrition solutions, we\u0026rsquo;ll definitely use them without hesitation.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(N11)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Comprehensive assistance to mitigate carers' stress and adverse experiences to diminish decision fatigue\u003c/h2\u003e \u003cp\u003eCarers typically endure elevated levels of caregiving stress and adverse emotions, and varying decision-making techniques considerably influence the extent of decision fatigue. Studies demonstrate that when carers encounter intricate caregiving responsibilities, their burden escalates, and they are presented with additional decisions\u003csup\u003e[31]\u003c/sup\u003e. In contrast to carers who use a satisfaction-oriented decision-making style, those with an optimality-oriented approach\u0026mdash;who seek perfection in choice outcomes\u0026mdash;are required to allocate greater cognitive resources to the processes of gathering, screening, and evaluating diverse care options. As a result, individuals endure a heightened psychological and physiological strain, rendering them more susceptible to decision fatigue\u003csup\u003e[32]\u003c/sup\u003e. Research indicates that the Life Hope Care Program, problem-solving training, and mindfulness-based stress reduction training can significantly mitigate carer stress, diminish its adverse emotional effects, and consequently alleviate decision fatigue\u003csup\u003e[33\u0026ndash;35]\u003c/sup\u003e. Moreover, owing to insufficient professional expertise, carers often experience decision-making anxiety and regret when independently navigating difficult choices related to drug management, rehabilitation plan selection, and the evaluation of acute health concerns\u003csup\u003e[36]\u003c/sup\u003e. It is advisable to utilise decision-support technologies to assist carers in obtaining information about rehabilitation care and associated subjects, assess the advantages and disadvantages of different treatment alternatives, mitigate the challenges of decision-making, and facilitate optimal decision-making\u003csup\u003e[37]\u003c/sup\u003e. International researchers have employed clinical decision support systems to swiftly evaluate the long-term prognosis of patients with impairments, establishing a scientific foundation for home care and community assistance, thereby enhancing the quality of carers' decision-making\u003csup\u003e[38]\u003c/sup\u003e. Simultaneously, customised medical decision-making training and health education initiatives can be offered to carers of older patients with disabilities or dementia, considering the unique requirements of these individuals. These programs may encompass lectures, videos, and rehabilitative applications, aimed at instructing carers on the collection and analysis of treatment data, effective communication with physicians and family members, and making educated decisions. Suen et al. discovered that employing video conferencing to enhance decision-making communication between clinicians and carers enables clinicians to more comprehensively grasp the caregivers\u0026rsquo; principal concerns, expectations concerning the patient\u0026rsquo;s prognosis, and care objectives, thus significantly enhancing the quality of shared decision-making\u003csup\u003e[39]\u003c/sup\u003e. Consequently, it is advisable for healthcare experts to formulate optimal treatment plans and rehabilitation programs tailored to the specific conditions of both carers and patients, while also encouraging carers to articulate their concerns and alleviate stress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec35\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Strengthening professional support from families and the community to improve decision-making support for caregivers\u003c/h2\u003e \u003cp\u003eFamilial and social support significantly influence the decision-making process of carers. Nonetheless, the majority of carers indicate challenges in achieving consensus on pivotal decisions\u0026mdash;such as selecting a rehabilitation center or determining the necessity of hospital admission\u0026mdash;or perceive that they must bear the entire responsibility of decision-making without sufficient assistance. This frequently results in feelings of isolation and helplessness while confronting caring difficulties independently and sifting through an overwhelming amount of medical information, thus eroding their confidence in decision-making\u003csup\u003e[40, 41]\u003c/sup\u003e. Studies indicate that when carers express their emotions to family and friends, it can significantly reduce caregiving stress and facilitate emotional processing, enabling them to regain composure more swiftly\u003csup\u003e[42]\u003c/sup\u003e. The State Council specifically indicates in the \u0026ldquo;14th Five-Year Plan\u0026rdquo; for the Development of Aging-Related Services and the older Care System that family members of older adults with disabilities or dementia should be motivated to actively fulfil their tasks. This study revealed that numerous carers identified a substantial disparity between their expectations of family physicians and the actual circumstances. While family physicians are the most readily available professional resource for carers, they frequently neglect to offer proactive, individualised advice on pertinent decision-making matters; in certain instances, there is even a deficiency in fundamental communication. Studies indicate that the guidance and information provided to carers by healthcare experts can mitigate their anxieties and diminish their uncertainty regarding the condition, thereby decreasing their decision fatigue\u003csup\u003e[43]\u003c/sup\u003e. Consequently, it is advisable to utilise digital health systems to facilitate carers in uploading patients' health statuses in real time, so enabling them to obtain prompt, specific advise from family physicians. This will facilitate the establishment of consistent and accessible communication channels between family physicians and carers, allowing carers to obtain effective professional assistance and psychological counselling while significantly reducing decision fatigue.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec36\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Enhance policy and resource assistance to reduce the decision-making load on carers.\u003c/h2\u003e \u003cp\u003eCarers have decision fatigue mostly because to significant limitations in financial and informational resources. This study revealed that numerous carers could not afford superior long-term care alternatives, such as professional nursing facilities or high-quality caregiving services, owing to financial constraints. Some carers faced difficulties in reconciling full-time caregiving responsibilities with their employment obligations. The simultaneous pressure dramatically heightened the difficulty of decision-making, resulting in decision fatigue. China is presently advancing a long-term care insurance system and enhancing its social assistance and welfare framework to establish financial policy protections. During implementation, the fragmented policy system, insufficient inter-departmental coordination, ambiguous assessment criteria for long-term care insurance eligibility, limited coverage, and onerous procedures have intensified the decision-making and administrative burdens on carers, failing to offer them financial support for essential decisions\u003csup\u003e[44]\u003c/sup\u003e. It is advisable for the government to provide financial incentives to motivate employers to implement \"caregiving leave,\" flexible work arrangements, and remote work choices, thereby alleviating the challenging decision carers face between employment and caregiving responsibilities\u003csup\u003e[45]\u003c/sup\u003e, Simultaneously, we will delineate departmental responsibilities, standardise long-term care insurance assessment criteria, broaden medical insurance coverage, optimise administrative processes, enhance funding assurances, and institute care subsidies via community and nonprofit organisations to effectively mitigate the financial strain on carers.\u003c/p\u003e \u003cp\u003eThis study also revealed that certain carers, especially older ones, have restricted access to information. Inadequate transmission and interpretation of policies concerning senior care and healthcare hinder carers from acquiring comprehensive and precise knowledge about caregiving. As a result, individuals cannot properly assess the advantages and disadvantages, as well as the practicality, of different treatment and rehabilitation strategies, rendering them more susceptible to uncertainty and indecision, hence intensifying their decision fatigue. Cox et al. created a paper-based decision-making aid for persons unacquainted with technological gadgets, employing a blend of text and images to communicate information. Chinese researchers enhanced the guidance to assist family members in comprehending patients' preferences and making judgements that align more closely with patients' needs\u003csup\u003e[46, 47]\u003c/sup\u003e. The \"Healthy China 2030\" Outline advocates for the proactive dissemination of medical information within existing policies. The government is advised to spearhead the development of an integrated care policy and information service platform to continuously update pertinent policies regarding elderly care, medical services, and social assistance, while offering both online and offline policy interpretation and consultation services. Concurrently, by partnering with communities, family practitioners, and nonprofit organisations, professional support for carers, including care plan assessments and information coordination, can be facilitated. Leveraging digital health platforms, we can facilitate regular and convenient communication between family doctors and caregivers, thereby resolving the issue of information asymmetry. By enhancing the policy and resource support framework from both economic and informational standpoints, we may thoroughly mitigate the load on carers, diminish decision-making challenges stemming from resource scarcity, and address decision fatigue at its source.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eCarers of older individuals with impairments or dementia may encounter decision fatigue. Challenging decision-making tasks, constrained decision-making resources, and inadequate decision support intensify the psychological stress experienced by carers, resulting in suboptimal decisions and hindering patients from obtaining optimal rehabilitation treatment. Consequently, healthcare personnel must closely monitor and prioritise decision-making fatigue among carers of older patients with impairments or dementia, using tailored intervention strategies. Relevant authorities must enhance policies for aged care support, fortify professional assistance from both familial and societal sources, and advance social stability alongside the expansion of the elderly healthcare system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003ePrior to the interviews, participants were fully informed about the study purpose, procedures, confidentiality, and their right to withdraw at any time without consequences.\u003c/p\u003e\u003cp\u003eAll participants provided written informed consent prior to participation.\u003c/p\u003e\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003cp\u003eNote: Ages are presented in ranges to ensure participant anonymity.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Medical Ethics Committee of Shanghai East Hospital, Tongji University, China (Approval No.: 2025\u0026thinsp;\u0026minus;\u0026thinsp;299).\u003c/p\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (Grant No.72274136). The Academic Leaders Training Program of Pudong Health Bureau of Shanghai (Grant No. PWRd2022-16). The Medical Discipline Construction Program of Shanghai Pudong New Area Health Commission (the Key Disciplines Program) (PWZxk2022-14).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eXiao Lei Shen: Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Visualization, Formal analysis, Data curation, Conceptualization. Yi Ni Zhang: Writing \u0026ndash; review \u0026amp; editing, Validation, Supervision, Formal analysis, Conceptualization. Neng Neng Hu: Writing \u0026ndash; review \u0026amp; editing. Yan Shi: Writing \u0026ndash; review \u0026amp; editing, Visualization, Formal analysis, Data curation, Conceptualization. Hai Ping Yu: Writing \u0026ndash; review \u0026amp; editing, Visualization, Resources, Formal analysis, Data curation, Conceptualization.All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe wish to express our gratitude to the nurse managers and participants who made this study possible.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eXizhe P, Liangjun S, Jiankun H. Determinants of Long-Term Care Services among Disabled Older Adults in China: A Quantitative Study based on Andersen\u0026apos;s Behavioral Model[J]. 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Chinese Nursing Research, 2018,32(21):3453\u0026ndash;3456.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Disability, Dementia, Caregiver, Decision fatigue, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-9299292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9299292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo explore the lived experiences of decision fatigue among family caregivers of older adults with dementia or functional impairments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eEighteen family caregivers of elderly people with impaired functioning and dementia were purposefully recruited from a tertiary hospital in Shanghai. Data were collected through semi-structured interviews and analyzed using thematic analysis. The report followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive themes and multiple subthemes were identified: (1) High-demand decision-making tasks; (2) Limited decision-making resources; (3) Insufficient decision-making support; (4) Substantial psychological burden; and (5) Maladaptive decision-making strategies.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDecision fatigue among family caregivers is shaped by complex decision demands, constrained resources, and inadequate support systems, leading to significant psychological burden and suboptimal coping strategies. Interventions should focus on enhancing decision support, improving resource accessibility, and addressing caregivers\u0026rsquo; psychological needs. These findings provide insights for developing context-specific nursing strategies to support caregivers in long-term care settings.\u003c/p\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Decision Fatigue Among Family Caregivers of Elderly People with Disabilities or Dementia in China: A Qualitative Descriptive Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 05:26:57","doi":"10.21203/rs.3.rs-9299292/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-05T12:32:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T11:11:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-08T04:13:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T16:25:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-04-06T14:59:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a46b3ca-d286-473a-90dc-6bf16e6a4f19","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"31","date":"2026-05-05T12:32:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T11:11:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T05:26:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 05:26:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9299292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9299292","identity":"rs-9299292","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}