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Team clinical decision making in end-of-life care
Toma de decisiones en equipo en los cuidados al final de la vida
Á. Estella
Servicio de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, Cádiz, Spain
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Juan Pastor" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Juan Pastor" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518300675" "doi" => "10.1016/j.rce.2018.02.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518300675?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300523?idApp=WRCEE" "url" => "/22548874/0000021800000005/v1_201805300413/S2254887418300523/v1_201805300413/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "Team clinical decision making in end-of-life care" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "267" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Á. Estella" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Á." "apellidos" => "Estella" "email" => array:1 [ 0 => "litoestella@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, Cádiz, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Toma de decisiones en equipo en los cuidados al final de la vida" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I have read with interest the study by García Caballero et al. on “Limitation of therapeutic effort (LTE) in patients hospitalized in departments of internal medicine”.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> In their introduction, the authors aptly comment on the marked variability in the terminology. The Bioethics Workgroup of the Spanish Society of Intensive and Critical Care and Coronary Units (SEMICYUC) abandoned the term LTE to avoid the interpretation that no effort was being performing in treating these patients, opting for the term life support treatment limitation (LSTL). There are barely any published studies that have evaluated the LSTL decisions in internal medicine. These decisions constitute an indicator of quality.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The authors have documented highly interesting data, in which knowing the population characteristics is essential, given that most studies have not considered the progression and follow-up of patients who have decided not to be admitted to the ICU. Despite the structural and functional differences between the hospital ward and the ICU, we have encountered a number of similarities in their results with a multicenter study conducted on 39 Spanish ICUs that also analyzed the patients who died and LTSV.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The reported mortality rates for patients with some type of treatment limitation along with do-not-resuscitate orders were similar, as was the time elapsed between the treatment limitation decision and exitus. It would be interesting to determine the proportion of patients for whom LSTL measures were implemented but did not die and to determine the participation of other specialties (such as intensive medicine) in the decisions. It is advisable to avoid individual LSTL decisions, and instead make decisions as a team.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> A coordinated intervention among various specialties is essential, depending on the clinical facts, prognosis and patient values, for making prudent decisions that improve patients’ quality of care at the end of their life.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Estella Á. Toma de decisiones en equipo en los cuidados al final de la vida. 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Rubio Sanchiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.01.007" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "523" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28389026" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "End of life critical patients: a multicenter study in Spanish Intensive Care Units" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de Trabajo Bioética SEMICYUC" "etal" => false "autores" => array:6 [ 0 => "A. Estella" 1 => "M.C. Martín" 2 => "A. Hernández" 3 => "O. Rubio" 4 => "J.L. Monzón" 5 => "L. Cabré" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2015.12.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "448" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27033989" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients" "etal" => true "autores" => array:6 [ 0 => "A. Hernández-Tejedor" 1 => "O. Peñuelas" 2 => "G. Sirgo Rodríguez" 3 => "J.A. Llompart-Pou" 4 => "E. Palencia Herrejón" 5 => "A. 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