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Picón-Jaimes YA, Lozada-Martinez ID, Rahman S, Cantón Álvarez MB. Knowledge and attitudes of physicians in Chile toward Do-Not-Attempt-Resuscitation orders: A cross-sectional nation-wide study. SAGE Open Med 2024; 12:20503121241259285. [PMID: 38867717 PMCID: PMC11168045 DOI: 10.1177/20503121241259285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/19/2024] [Indexed: 06/14/2024] Open
Abstract
Objective Do-Not-Attempt-Resuscitation orders originated in the early 1960s with the establishment of advanced cardiopulmonary resuscitation. These orders aim to limit therapeutic efforts in cases where it may be futile. The decision not to resuscitate a patient is a process that involves a series of ethical, legal, and clinical considerations. Still, it also requires a process in which priority is given to the patients and their autonomy. The objective of this study was to describe the knowledge and attitudes of physicians working in Chile toward Do-Not-Attempt-Resuscitation orders. Methods A cross-sectional study was conducted, in which a digital questionnaire was sent to physicians from different regions of Chile. Quantitative variables were analyzed using measures of central tendency and dispersion (e.g., median and interquartile range), while qualitative variables were evaluated using frequencies and percentages. Results Four hundred and thirty-one physicians completed the survey. 85.4% were familiar with the ethical and legal guidelines for cardiopulmonary resuscitation and the rights and duties of the patient. 39.2% believed that patients should have the final decision Do-Not-Attempt-Resuscitation orders, especially if they themselves requested not to be resuscitated. 87.7% mentioned that the Do-Not-Attempt-Resuscitation orders should be reassessed if the patient's prognosis improves. In addition, it was found that the decision not to resuscitate was not always discussed with the patient or their family. Conclusions The study revealed an ethical conflict regarding Do-Not-Attempt-Resuscitation orders and their management by Chilean physicians. Therefore, it is necessary to create recommendations and provide training to guide professionals in this process, which should also involve patients and their families.
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Affiliation(s)
- Yelson Alejandro Picón-Jaimes
- Universidad Internacional de la Rioja, Logroño, Spain
- Faculty of Health Sciences, Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Ivan David Lozada-Martinez
- Epidemiology Program, Department of Graduate Studies in Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Which are the most prevalent ethical conflicts for Spanish internists? Rev Clin Esp 2021; 221:393-399. [PMID: 34332701 DOI: 10.1016/j.rceng.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.
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García Caballero R, Real de Asúa D, García Olmos L, Herreros B. Do internists know what limitation of therapeutic effort means? Rev Clin Esp 2021; 221:274-278. [PMID: 32414562 DOI: 10.1016/j.rce.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To ascertain whether internists know what limitation of therapeutic effort (LTE) means and whether training in palliative care affects this understanding. METHODS A survey was administered to Spanish internists on their knowledge of LTE and training in palliative care. RESULTS A total of 273 respondents completed the survey (mean age, 42±12 years), 80.2% of whom were associates. Some 23.8% of the respondents identified the complete definition of LTE. The most frecuently selected responses were «not starting an active treatment»(85.0%) and «withdrawing an active treatment» (65.9%). Forty-three percent of the respondents lacked training in palliative care, 73.3% considered their level of understanding to be good or very good, 62.3% stated that they became anxious when addressing planning for end-of-life care with a patient, and 81.3% stated that they had experienced some conflict with their LTE decisions. CONCLUSIONS Only 1 of every 4 internists knew the proper definition of LTE, with no association with level of training in palliative care.
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Affiliation(s)
- R García Caballero
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España.
| | - D Real de Asúa
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España; Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
| | - L García Olmos
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Sureste, Madrid, España
| | - B Herreros
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España
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García-Caballero R, Real de Asúa D, García Olmos L, Herreros B. Do internists know what limitation of therapeutic effort means? Rev Clin Esp 2021; 221:274-278. [PMID: 33998513 DOI: 10.1016/j.rceng.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To ascertain whether internists know what limitation of therapeutic effort (LTE) means and whether training in palliative care affects this understanding. METHODS A survey was administered to Spanish internists on their knowledge of LTE and training in palliative care. RESULTS A total of 273 respondents completed the survey (mean age, 42±12 years), 80.2% of whom were associates. Some 23.8% of the respondents identified the complete definition of LTE. The most frequently selected responses were "not starting an active treatment" (85.0%) and "withdrawing an active treatment" (65.9%). Forty-three percent of the respondents lacked training in palliative care, 73.3% considered their level of understanding to be good or very good, 62.3% stated that they became anxious when addressing planning for end-of-life care with a patient, and 81.3% stated that they had experienced some conflict with their LTE decisions. CONCLUSIONS Only 1 of every 4 internists knew the proper definition of LTE, with no association with the level of training in palliative care.
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Affiliation(s)
- R García-Caballero
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Spain; Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain.
| | - D Real de Asúa
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Spain; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
| | - L García Olmos
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Sureste, Madrid, Spain
| | - B Herreros
- Grupo de Trabajo de Bioética, Sociedad Española de Medicina Interna, Spain; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Vallejo LI, Palacio AM, Marulanda V, Restrepo A, Yepes LA, Valencia NL, Cruz MA. Evaluación del conocimiento y práctica de la limitación del esfuerzo terapéutico en personal asistencial de una institución prestadora de servicios de salud para pacientes oncológicos de Medellín, 2018. PERSONA Y BIOÉTICA 2020. [DOI: 10.5294/pebi.2020.24.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
La limitación del esfuerzo terapéutico (LET) es toda acción que implique suspender o no iniciar tratamientos o medidas terapéuticas en pacientes que no se beneficiarán clínicamente. En Latinoamérica, las investigaciones realizadas dejan en evidencia la falta de familiarización y discordancia que hay alrededor del tema y sus prácticas. El presente estudio buscó objetivizar el conocimiento en LET del personal de salud de una institución de Medellín, a partir de una encuesta autoaplicada que permitió el desarrollo de un estudio descriptivo de tipo transversal, con muestreo no probabilístico. Dentro de los resultados se encontró que el 56,5 % de los encuestados refirió conocer el concepto, y el 90 % manifestó aplicarlo. Sin embargo, había discordancias dentro de los conceptos clave de la definición y el ejercicio.
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Blanco Portillo A, García-Caballero R, Real de Asúa D, Herreros B. Which are the most prevalent ethical conflicts for Spanish internists? Rev Clin Esp 2020; 221:S0014-2565(20)30150-8. [PMID: 32650946 PMCID: PMC7340392 DOI: 10.1016/j.rce.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. MATERIALS AND METHODS Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. RESULTS The most common and relevant ethical issues for Spanish internists are related to patients' end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). CONCLUSIONS The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.
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Affiliation(s)
- A Blanco Portillo
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - R García-Caballero
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España
| | - D Real de Asúa
- Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España; Servicio de Medicina Interna, Hospital Universitario de La Princesa , Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España
| | - B Herreros
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética y Profesionalismo, Sociedad Española de Medicina Interna , Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, España
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Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna. Rev Clin Esp 2020; 220:75. [DOI: 10.1016/j.rce.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 06/24/2019] [Indexed: 11/20/2022]
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Ameneiros-Lago E, Carballada-Rico C, Gómez-Buela I. End-of-life care for patients hospitalized in internal medicine departments. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zamora Mur A. Paliar o no paliar, nunca debería ser la cuestión. Med Clin (Barc) 2019; 153:202-204. [DOI: 10.1016/j.medcli.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
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End-of-life care for patients hospitalized in internal medicine departments. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna. Rev Clin Esp 2019; 219:107-115. [DOI: 10.1016/j.rce.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 11/20/2022]
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Da Cunha Cavalcanti ÍM, Oliveira de Oliveira L, Cavalcanti de Macêdo L, Cezar Leal MH, Rocha Morimura MC, Tavares Gomes E. Princípios dos cuidados paliativos em terapia intensiva na perspectiva dos enfermeiros. REVISTA CUIDARTE 2018. [DOI: 10.15649/cuidarte.v10i1.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Limitation of therapeutic effort in departments of internal medicine. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Estella Á. Team clinical decision making in end-of-life care. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torrente Jiménez I, Villarino Marzo M, Herranz Martínez S. Limitación del esfuerzo terapéutico en medicina interna. Rev Clin Esp 2018. [DOI: 10.1016/j.rce.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Estella Á. Toma de decisiones en equipo en los cuidados al final de la vida. Rev Clin Esp 2018; 218:266-267. [DOI: 10.1016/j.rce.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/07/2018] [Indexed: 01/14/2023]
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Toyas Miazza C, Martínez-Álvarez RM, Díez-Manglano J, Ezpeleta Galindo AI, Laín Miranda ME, Aspiroz Sancho C. [Limitation of therapeutic effort in patients with bacteremia]. Rev Esp Geriatr Gerontol 2018; 53:262-267. [PMID: 29605450 DOI: 10.1016/j.regg.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/12/2018] [Accepted: 02/16/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The limitation of therapeutic effort (LTE) depends on medical, ethical and individual factors. We describe the characteristics of patients with bacteremia in which it was decided to limit the therapeutic effort. METHOD Prospective study of bacteremia in a community hospital in 2011. We collected information regarding patient variable (age, sex, Barthel index, comorbidities, Charlson Index and exogenous factors) as well as regarding the infectious episode (etiology, focus, place of adquisition, clinical expressivity, LTE and hospital mortality). The group in which LTE was performed was compared to the one that was not. RESULTS We collected 233 episodes of bacteremia in 227 patients. We performed LTE in 19 patients (8.2%). Patients with LTE were older (80.7 vs. 72.6 years, p=.014), had more comorbidity (Charlson index 4.6 vs. 2.1, p<.001 and most frequently were severe dependents (57.9% vs. 18.8%, p<.001). We found no association with sex, place of adquisition or clinical expressivity. The commonest clinical focus in patients with LTE was the urinary (42.1%) and there was a predominance of gram positive bacteria (63.2%). The empirical treatment was started early in 73.7% of cases. All patients except one died. CONCLUSION LTE is considered in an important number of patients with bacteremia. They usually are older, with more comorbidity and functional dependence, bad functional basal status and important comorbidity. Knowing their differential characteristics allow us to understand this decision.
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Affiliation(s)
- Carla Toyas Miazza
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - Rosa María Martínez-Álvarez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Jesús Díez-Manglano
- Servicio de Mecicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
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Conthe P. El médico clínico ante el paciente en el final de sus días. Rev Clin Esp 2018; 218:15-16. [DOI: 10.1016/j.rce.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Conthe P. The clinician and their patient at the end of life. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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