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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I have read with interest the study by Garc&#237;a Caballero et al&#46; on &#8220;Limitation of therapeutic effort &#40;LTE&#41; in patients hospitalized in departments of internal medicine&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> In their introduction&#44; the authors aptly comment on the marked variability in the terminology&#46; The Bioethics Workgroup of the Spanish Society of Intensive and Critical Care and Coronary Units &#40;SEMICYUC&#41; abandoned the term LTE to avoid the interpretation that no effort was being performing in treating these patients&#44; opting for the term life support treatment limitation &#40;LSTL&#41;&#46; There are barely any published studies that have evaluated the LSTL decisions in internal medicine&#46; These decisions constitute an indicator of quality&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The authors have documented highly interesting data&#44; in which knowing the population characteristics is essential&#44; given that most studies have not considered the progression and follow-up of patients who have decided not to be admitted to the ICU&#46; Despite the structural and functional differences between the hospital ward and the ICU&#44; 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&#46;<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&#44; as was the time elapsed between the treatment limitation decision and exitus&#46; 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 &#40;such as intensive medicine&#41; in the decisions&#46; It is advisable to avoid individual LSTL decisions&#44; and instead make decisions as a team&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> A coordinated intervention among various specialties is essential&#44; depending on the clinical facts&#44; prognosis and patient values&#44; for making prudent decisions that improve patients&#8217; quality of care at the end of their life&#46;</p></span>"
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June - July 2018 Team clinical decision making in end-of-life care
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Vol. 218. Issue 5.
Pages 266-267 (June - July 2018)
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Vol. 218. Issue 5.
Pages 266-267 (June - July 2018)
Correspondence
DOI: 10.1016/j.rceng.2018.02.008
Team clinical decision making in end-of-life care
Toma de decisiones en equipo en los cuidados al final de la vida
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Á. Estella
Servicio de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, Cádiz, Spain
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