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Limitation of therapeutic effort in elderly patients
Limitación del esfuerzo terapéutico en pacientes mayores
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Ameneiros-Lago, C. Carballada-Rico, J.A. Garrido-Sanjuán" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Ameneiros-Lago" "email" => array:1 [ 0 => "eugenia.ameneiros.lago@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Carballada-Rico" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.A." "apellidos" => "Garrido-Sanjuán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Comité de Ética Asistencial, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Hospitalización a Domicilio, Comité de Ética Asistencial, Complejo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Limitación del esfuerzo terapéutico en pacientes mayores" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the study by Pérez Figueras et al. on “What do older patients and their families think about the limitation of therapeutic effort?”,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and we would like to add a few comments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The decisions to limit therapeutic effort require an assessment of numerous aspects.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> If we ask a patient what they think of a treatment in general, without specifying the clinical situation for it is being proposed and the expected benefits, the response will not be particularly valuable, given that it would likely differ greatly from that given if that information were made available.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a recent study, Ruiz García et al. assessed the survival expectations of a patient group with heart disease after cardiopulmonary resuscitation (CPR) and their wishes concerning CPR.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In this study, the predicted survival (75.6%) and the survival free of neurological impairment (64.5%) was far above the actual survival rates recorded in the studies (25% and 30%, respectively).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> With these expectations, 89% of the patients wanted to be resuscitated, while the percentage dropped to 55% if diagnosed with a disease with an estimated survival of less than 12 months. The authors concluded that these expectations, so far from reality, had conditioned most of the patients to want to be resuscitated. A study confirmed that when the patients were showed the true likelihood of success after CPR, the percentage of patients who wanted to be resuscitated dropped significantly (from 41% to 22%).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore, although most of the patients in the actual study expressed willingness to undergo diagnostic or therapeutic procedures “most of the time or always”, these results should be taken with caution, because they likely do not reflect the patients’ true wishes.</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: Ameneiros-Lago E, Carballada-Rico C, Garrido-Sanjuán JA. Limitación del esfuerzo terapéutico en pacientes mayores. Rev Clin Esp. 2019;219:224.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Qué opinan los pacientes mayores y sus familiares sobre la limitación del esfuerzo terapéutico?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Pérez Figueras" 1 => "A. Blanco Portillo" 2 => "G. Navarro Jiménez" 3 => "M. 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