title: [Withholding and withdrawing treatment in patients admitted in an Internal Medicine ward].
abstract: BACKGROUND
  Many of the patients admitted to a general medical ward have a compromised quality of life, or short life expectancy, so they are potential candidates for withhold/withdraw (WH/WD) treatment. The first objectif was to describe which measures were WH/WD among patients who died during their admission in a general medical ward from a tertiary hospital in Madrid. Secondly, to define the clinical characteristics of this population.
  
  
  METHODS
  A cross-sectional descriptive study during 6 months from 2011 and 2012 of all the patients dead while their admission in the Internal Medicine Department.
  
  
  RESULTS
  2007 patients were admitted, 211 died (10.5%). 121 (57%) were female, with 85±9 years of mean age. 103 (48.8%) came from a residential facility and 105 fulfilled terminality criteria (49.8%). One decision to WH/WD treatment was made in 182 patients (86.3%, CI 95%: 81.4-91.1), two in 99 cases (46.9%, CI 95%: 39.9-53.9) and 3 or more in 31 subjects (14.7%, CI 95%: 9.6-19.7). The most frequent decisions involved do-not-resuscitate orders (154, 73.0%), rejection of «aggressive treatment measures» (80, 38.0%), use of antibiotics (19, 9.0%), admission in ICU (18, 8.5%), and/or surgical treatment (11, 5.2%).
  
  
  CONCLUSIONS
  WH/WD treatment is very frequent among patients who died in a general medical ward. The most frequent involved do-not-resuscitate orders and rejection of «aggressive treatment measures». WH/WD decisions are adopted in an elderly population, with extensive comorbidity and an elevated prevalence of advanced dementia and/or terminal disease.
authors.affiliation: Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, España. Electronic address: rebecagarciacaballero@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: García Caballero
authors.affiliation: Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Grupo de Trabajo de Bioética Clínica y Profesionalismo de la Sociedad Española de Medicina Interna.
authors.forename: B
authors.initials: B
authors.lastname: Herreros
authors.affiliation: Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, España; Grupo de Trabajo de Bioética Clínica y Profesionalismo de la Sociedad Española de Medicina Interna; Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: Real de Asúa
authors.affiliation: Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Alonso
authors.affiliation: Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors.forename: M M
authors.initials: MM
authors.lastname: Barrera
authors.affiliation: Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors.forename: V
authors.initials: V
authors.lastname: Castilla
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D011788:Quality of Life; D016414:Resuscitation Orders; D028761:Withholding Treatment
keywords: Decision making; Limitación del esfuerzo terapéutico; No resuscitation orders; Toma de decisiones; Withholding and withdrawing treatment; Órdenes de no reanimación