 This paper presents a novel approach to developing a decision-making guide for families and healthcare professionals who are faced with difficult decisions regarding eating and drinking for patients with severe dementia. Through a systematic review, interviews with family carers, healthcare professionals, and patients with mild dementia, as well as co-design workshops, a decision-making guide was created which provides a framework for making informed decisions based on patients' values and preferences. This guide has been successfully implemented in English hospitals and is currently being evaluated for its real-world impact. This article was authored by Kandiyan Antipong, Andrea Brun, and Walford, and others.