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Revista Médica del Uruguay

Print version ISSN 0303-3295On-line version ISSN 1688-0390


BERNADA, Mercedes; NOTEJANE, Martín; MARTINEZ, Rodrigo  and  CAMPOS, Catalina. Opinion of health professionals on a document to record guidelines for the adequacy of therapeutic efforts in pediatrics. Rev. Méd. Urug. [online]. 2020, vol.36, n.2, pp.36-58.  Epub June 01, 2020. ISSN 0303-3295.


during the medical care of children with life-threatening or life-limiting conditions (EALV), sometimes is necessary to adequate the therapeutic effort (ATE). The pediatric palliative care unit of the Pereira Rossell Hospital Center (PPCU- PRHC) implemented a decision-making procedure on ATE and its registration in the clinical history.


to know: the opinion of health care professionals regarding the utility of the ATE registration document, the main difficulties found, and the interest in training activities.

Material and method:

descriptive, cross-sectional study, by means of a survey of physicians and nurses working in the PRHC, between 23 / 10-12 / 11/2018. It was endorsed by the Ethics Committee.


75.4% (181/240) of the respondents had attended children with ATE documents, occasionally: 73.5%, frequently: 21.5%. They considered it useful to have ATE records: 30% and very useful: 58%. They expressed to find ethical, clinical and / or legal doubts, occasionally: 51.4%, frequently: 27.6%; the main doubts: responsibility when fulfilling the directives and the lack of signature of the parents. The main difficulties referred to were: that the parents do not have the document at the consultation, and that they are distressed and ask to “do everything”. Most professionals expressed that it would be useful or very useful to receive more information and/ or training on ATE.


most of the professionals surveyed had participated in the care of children with ATE registration. They considered it useful or very useful to have these records, but they expressed occasional clinical, ethical and/ or legal doubts.

Keywords : Pediatric palliative care; Decision making; Advance care planning; Adequacy of therapeutic effort.

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