Background Many people with dementia reach the end-of-life without an advance care plan. Many are not ready to have conversations about end-of-life, and decision-making is left to their families and professionals when they no longer have capacity. Carers may benefit from further support with decision-making. To develop this support, it is important to understand the decision-making process. Aim Explore with family carers and people living with dementia the decision-making process and factors that influence decision-making in dementia end of life care, to produce a model of decision-making in the context of dementia end-of-life care. Methods Semi-structured interviews with 21 family carers and 11 people with dementia in England (2018–2019) from memory clinics, general practice and carer organisations. Interviews were analysed using thematic analysis and findings were mapped onto the Interprofessional Shared Decision Making model, refined to produce a modified model of decision-making in dementia. Results Participants described five key decisions towards the end-of-life as examples of decision making. We used these experiences to produce a modified model of decision-making in dementia end-of-life-care. The model considers the contextual factors that influence the decision-making process, including: personal preferences; advance care planning and Lasting Power of Attorney; capacity and health and wellbeing of the person with dementia; support from others and clarity of roles. The decision-making process consists of seven inter-linked stages: 1) identifying the decision maker or team; 2) sharing and exchanging information; 3) clarifying values and preferences; 4) managing and considering emotions; 5) considering the feasibility of options; 6) balancing preferred choice and the actual choice; and 7) implementation and reflecting on outcomes. Conclusions The modified model breaks down the decision-making process and attempts to simplify the process while capturing the subtle nuances of decision making. It provides a framework for conversations and supporting decisions by carers.

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When searching for a specific object, we often form an image of the target, which we use as a search template. This template is thought to be maintained in working memory, primarily because of evidence that the contents of working memory influences search behavior. However, it is unknown whether this interaction applies in both directions. Here, we show that changes in search templates influence working memory. Participants were asked to remember the orientation of a line that changed every trial, and on some trials (75%) search for that orientation, but on remaining trials recall the orientation. Critically, we manipulated the target template by introducing a predictable context-distractors in the visual search task were always counterclockwise (or clockwise) from the search target. The predictable context produced a large bias in search. Importantly, we also found a similar bias in orientation memory reports, demonstrating that working memory and target templates were not held as completely separate, isolated representations. However, the memory bias was considerably smaller than the search bias, suggesting that, although there is a common source, the two may not be driven by a single, shared process. to working memory representations (Soto, Hodsoll, Rotshtein, & Humphreys, 2008), at least when targets change on a per trial basis (Woodman, Luck, & Schall, 2007). Versions of this theory vary in the nature of the relationship between the two constructs. According to some theories, being stored in working memory may be necessary but not sufficient for a representation to be a template (Dube & Al-Aidroos, 2019; Hollingworth & Hwang, 2013), that is, templates require some additional top-down process, such as attention (Gunseli, Meeter, & Olivers, 2014; van Driel, Gunseli, Meeter, & Olivers, 2017). There is evidence that attentional templates have independent properties from working memory representations, suggesting that the two can be dissociated (Carlisle & Woodman, 2011, 2013; Kerzel, 2019). However, most theories tend to favor a strong link between the two constructs. Evidence for the overlap of templates and working memory representations comes largely from studies showing that the contents of working memory influence attention, commonly referred to as memory-driven attentional capture (Downing, 2000; Olivers, Meijer, & Theeuwes, 2006; Soto, Heinke, Humphreys, & Blanco, 2005). Here we examine this interaction in the other direction. Previous research has found that memory representations improve due to visual search (Rajsic, Ouslis, Wilson, & Pratt, 2017; Williams, Henderson, & Zacks, 2005). However, it is difficult to disentangle the memory improvement because of an item becoming the search template from the general memory improvement that comes from attending to an item for longer, either while present or within memory (i.e., the retro-cue effect; Griffin & Nobre, 2003). Instead, we will directly ask whether changes in the target template will influence memory reports. If target templates are equivalent to me...