[Limitation of life-sustaining treatment. A prospective study in a clinical ward].
The purpose of this study is to describe the limiting life-sustaining treatment process of patients admitted to a general ward. A prospective descriptive study was designed. The setting was the general ward of universitary hospital. Study participants were patients assisted by the internal medicine department during a 60-consecutive days period who had limitations of life sustaining treatments. During the study period, 402 patients were hospitalized, 62 (15%) of them had limitations of life support care. The median patient age of the last group was 86 years (78-90), 66% were women and the length of stay was 12 days (8-18). A low quality of life was the most frequent cause of limitation (69%). Information about the limitations was provided to 43 families (69%) and 8 patients (13%). The primary care physician participated in the decision in 50% of the cases, while the attending physician, the resident in charge, patient's family and patients themselves participated in 50%, 40%, 42% and 11% of the cases respectively. The decision of limiting life-sustaining treatments was recorded in seven patient's charts (11%). Seventeen (27%) patients with limitations died during the hospital stay while 44 (71%) were discharged. In conclusion, we found a frequent life sustaining treatment limitation in our patients. These decisions did not follow a uniform or systemized process. The need of guidelines to sort the medical and ethical challenges imposed to the medical team is undeniable.
Novillo
Abel
A
Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires.
Ladenheim
Roberta I
RI
Galante
Mariana
M
Isola
Ignacio M
IM
Musi
Martín E
ME
Naguel
Vanesa
V
Rodríguez
Pablo
P
D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011788:Quality of Life; D013727:Terminal Care; D028761:Withholding Treatment