{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:02:27Z","timestamp":1785528147248,"version":"3.56.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002428","name":"Austrian Science Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002428","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010109","name":"Medical University of Graz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010109","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Treatment goal limitations, such as \u201cdo not resuscitate\u201d, \u201cdo not escalate\u201d and \u201ccomfort terminal care\u201d are frequent in acute hospital care for patients with advanced illness, multimorbidity or impending death. Their ethical defensibility depends on transparent documentation of medical indications, proportionality and, where relevant, patient will.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether documentation made medical rationale, patient will, advance directives, relatives\u2019 involvement or ethics consultation visible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed documentation in an Austrian internal medicine department with intensive care over 12\u00a0months. Documents were identified in the hospital information system and descriptively analyzed. Deceased patients with documented limitations underwent manual review.<\/jats:p>\n                    <jats:p>Data were anonymized and analyzed using Microsoft Excel for Microsoft 365 (Microsoft Corporation, Redmond, WA, USA) and IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 3998 inpatient stays involving 1829 patients, 277 patients had a\u00a0documented treatment goal limitation (15.1%). Among 174 deceased patients, 111 had a\u00a0documented limitation at death (63.8%). The most frequent order was combined do not resuscitate\/do not escalate (75\/111; 67.6%), followed by isolated do not resuscitate (23\/111; 20.7%). Complete records were available for 101 cases; in\u00a010 the rationale was not clearly traceable. Among the 101 manually reviewed cases, an explicit or presumed patient will was documented in 7\u00a0cases (6.9%), involvement of relatives in 13\u00a0cases (12.9%) and ethics consultation in 1\u00a0case (1.0%); medical rationale or physician decision was documented in 90\u00a0of 91\u00a0cases with traceable rationale (98.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Treatment goal limitations were common and usually medically justified in the records. The findings do not imply inappropriate decisions or lack of communication but show limited reconstruction of patient-centered reasoning. Documentation should make clearer how benefit, care, respect for autonomy and justice informed treatment limitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00508-026-02799-5","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:19:52Z","timestamp":1785331192000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment goal limitations in acute hospital care"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6706-3344","authenticated-orcid":false,"given":"Thomas","family":"Fuchs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gremsl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2799_CR1","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1093\/ageing\/afz171","volume":"49","author":"MR Agar","year":"2020","unstructured":"Agar\u00a0MR. 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The study used anonymized retrospective clinical documentation and does not contain identifiable individual patient information.","order":2,"name":"Ethics","label":"Patient consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was reviewed by the Ethics Committee of the University of Graz and was considered ethically unobjectionable. The confirmation was issued on 26\u00a0April 2023 under reference number GZ. 39\/79\/63 ex 2022\/23.","order":3,"name":"Ethics","label":"Ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}}]}}