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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">End-of-life care has evolved in recent decades and now forms part of good clinical practice&#46; Healthcare at the end of life has been institutionalized&#44; professionalized&#44; and medicalized and is now part of daily practice in internal medicine&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This care for and palliation of terminal illness is no longer considered optional&#44; rather it is an ethical and professional obligation&#46; Just as it is obligatory to prescribe antibiotics for bacterial pneumonia&#44; for patients at the end of life&#44; initiating palliative measures is an unavoidable duty&#46; For all patients&#44; we must seek out the best option for their health&#44; inform them&#44; and request consent&#44; whether it is pneumonia or the end of life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The change that has taken place in end-of-life care in recent years has affected healthcare professionals&#44; patients and their families&#44; and society as a whole&#46; This transition has been accompanied by confusion and has led to misunderstandings about what end-of-life care should be&#46; Before&#44; when terminal patients were deemed lost causes&#44; they passed away in their homes surrounded by their loved ones&#44; but endured enormous physical suffering&#46; With the later medicalization and technicalization of death&#44; patients then died in acute-care hospitals&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> where attempts were made to prolong life at all costs because medicine &#8220;could do everything&#46;&#8221; In the journey towards palliation&#44; physicians have had to learn to refocus the aims of medicine&#44; to know and manage its limits&#44; and to comprehensively care for patients in the final stage of life&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; this change has not been accompanied by adequate training for internal medicine physicians &#40;some of the protagonists in end-of-life care&#41; on palliative care&#44; communication&#44; and bioethics&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Internists have had to learn on the fly in their day-to-day about this complex area of knowledge&#46; In a recent survey&#44; only one out of every four internists know what limitation of therapeutic efforts was&#46; Forty-three percent did not have training on palliative care&#44; and more than 60&#37; had anxiety when facing the planning of end-of-life care with patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This is why the Best Practices at the End of Life Guide by the Spanish and Portuguese Societies of Internal Medicine is so important&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This guide is an essential training document for clinicians who treat patients at the end of life&#44; although it is not the first of its kind&#46; Various scientific societies&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> institutions&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> hospitals&#44; and private groups<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> have established and published their indications&#46; But compared to others&#44; this guide has the advantage of having been created by means of a rigorous Delphi process which included 105 Spanish and Portuguese panelists &#40;the majority of whom are physicians but which also includes lawyers&#44; experts in bioethics&#44; managers&#44; politicians&#44; and journalists&#41;&#44; which lends great external validity to its recommendations&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The guide proposes 37 recommendations with a high degree of consensus that are structured in different groups&#58; patient identification&#59; the patient&#8217;s knowledge&#44; values&#44; and preferences&#59; information&#59; the patient&#39;s needs&#59; attention and care&#59; palliative sedation&#59; and care after death&#46; In an attempt at synthesis&#44; it explains the recommendations and contextualizes them legally&#46; With all of this&#44; it intends to improve the care and attention in patients&#39; final last days and ensure a good death&#46; For this to occur&#44; it is necessary for professionals to speak the same language&#59; this is possible through the guide&#44; which is eminently clear&#46; All of this is in addition to the fact that a consensus document on end-of-life care provides support to professionals and decreases the stress that these situations cause&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Like all guides&#44; the document is oriented towards the majority of cases and situations&#46; However&#44; it is the clinicians who then have to know that treatment must be individualized to each patient and take into account their circumstances&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> As one of the principles of a good death&#44; one of the recommendations states that patients should be accompanied by their caregivers and loved ones&#46; During the SARS-CoV-2 crisis&#44; this principle has not been able to be fully abided by&#44; which has caused great emotional stress in patients&#44; their loved ones &#40;generating possible pathological grief&#41;&#44; and professionals&#46; However&#44; this does not invalidate this recommendation&#58; the guide provides guidance on how treatment should be for patients at the end of life&#44; even if a specific patient or a certain circumstance does not allow all of its recommendations to be fully carried out&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The guide and its recommendations are useful both for experts in palliative care and for physicians who are less familiarized with managing patients at the end of life&#46; During this epidemic&#44; many physicians who were not used to treating patients in the final days of life have had to confront this&#46; Managing and facing death has been an additional source of stress for them on top of the difficult situation they were already living through&#46; This guide would have been of great help to all&#44; experts and nonexperts alike&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The professionals who treat patients at the end of life know what their objectives are&#44; how to achieve them&#44; and&#44; most of all&#44; that these objectives are based on rigor&#46;</p></span>"
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Editorial
Areas for improvement in end-of-life care
Áreas de mejora en la asistencia al final de la vida
R. García Caballeroa,
Corresponding author
rebecagarciacaballero@gmail.com

Corresponding author.
, B. Herrerosb
a Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Grupo de Trabajo de Bioética y Profesionalismo de Sociedad Española de Medicina Interna, Spain
b Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid. Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, Spain

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