Grounded theory served to develop a model of the family caregiver decision-making process regarding placement of a cognitively impaired elderly relative. Eighteen caregivers were interviewed every 6 months over an average 20 months. Results show the process is activated when the caregiver or a health care professional introduces the possibility of placement. The caregiver's assessment of the pros and cons of placement is modulated primarily by interactions with the formal and informal social network. Three types of longitudinal trajectory emerged from the data suggesting avenues of intervention to support caregivers during this painful process.

In this article, we explore the role of health care professionals within the decision-making process of family caregivers regarding placement of a cognitively impaired elderly relative. Grounded theory was used to describe interactions with health care professionals, modulating the caregivers’ decision-making process. A total of 18 caregivers of cognitively impaired elderly relatives were interviewed every 6 months over an average of 20 months. Results showed that health care professionals were involved in the decision-making process in three ways: (a) in assessing the need for placement; (b) in helping caregivers navigate through the health care system; and (c) in taking care of family dynamics. There were great variations in the way health care professionals supported caregivers. Future research is needed to identify professional interventions that are helpful for caregivers and in which context.

L’intérêt porté aux soins palliatifs va grandissant. Lorsque ce type de soins est offert à un aîné à domicile, le conjoint endosse généralement le rôle d’aidant principal. Cet article s’appuie sur les résultats d’une étude visant à relever les éléments influençant l’expérience d’accompagnement en soins palliatifs à domicile prodigués à un conjoint âgé. À partir de huit récits expérienciels de proches aidants ayant accompagné leur conjoint âgé en soins palliatifs à domicile, nous avons dégagé un modèle de représentation de l’accompagnement. Nous proposons aussi une réflexion sur l’intervention professionnelle auprès de cette clientèle âgée.

The elderly in palliative care are confronted with difficult decisions relating to treatments. The philosophy of palliative care, namely, including the patient and his/her family right away, leads the doctor to consult with the two parties involved when choosing a treatment. As no theoretical model allows us to understand how the decision-making process hinges on the trio (a capable elderly person, a family caregiver, and the doctor) in a context of palliative care, we propose one which was developed from three strategies of document analysis: theoretical synthesis, theoretical analysis, and theoretical derivation. According to our model, the decision-making process depends on individual factors influencing the decision of the participant, expectations and attitudes as to the role, the level of confidence amongst the parties involved, the manner in which they communicate with each other, their mutual understanding of the clinical and ethical issues, and, finally, their ability to cooperate.