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Is educational attainment related to end-of-life decision-making? : a large post-mortem survey in Belgium

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Abstract
Background: Educational attainment has been shown to influence access to and quality of health care. However, the influence of educational attainment on decision-making at the end of life with possible or certain life-shortening effect (ELDs ie intensified pain and symptom alleviation, non-treatment decisions, euthanasia/physician-assisted suicide, and life-ending acts without explicit request) is scarcely studied. This paper examines differences between educational groups pertaining to prevalence of ELDs, the decision-making process and end-of-life treatment characteristics. Method: We performed a retrospective survey among physicians certifying a large representative sample of Belgian deaths in 2007. Differences between educational groups were adjusted for relevant confounders (age, sex, cause of death and marital status). Results: Intensified pain and symptom alleviation and non-treatment decisions are more likely to occur in higher educated than in lower educated patients. These decisions were less likely to be discussed with either patient or family, or with colleague physicians, in lower educated patients. A positive association between education and prevalence of euthanasia/assisted suicide (acts as well as requests) disappeared when adjusting for cause of death. No differences between educational groups were found in the treatment goal in the last week, but higher educated patients were more likely to receive opioids in the last day of life. Conclusion: There are some important differences and possible inequities between educational groups in end-of-life decision-making in Belgium. Future research should investigate whether the found differences reflect differences in knowledge of and adherence to patient preferences, and indicate a discrepancy in quality of the end of life.
Keywords
Cultural capital, Socio-economic inequalities, Educational attainment, End-of-life decisions, End-of-life care, Euthanasia, HEALTH INEQUALITIES, PHYSICIAN-ASSISTED SUICIDE, VULNERABLE PATIENTS, EUTHANASIA, ADVANCE DIRECTIVES, NETHERLANDS, FLANDERS, LITERACY, ADULTS, PATIENT

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MLA
Chambaere, Kenneth et al. “Is Educational Attainment Related to End-of-life Decision-making? : a Large Post-mortem Survey in Belgium.” BMC PUBLIC HEALTH 13 (2013): n. pag. Print.
APA
Chambaere, K., Rietjens, J. A., Cohen, J., Pardon, K., Deschepper, R., Pasman, H. R. W., & Deliens, L. (2013). Is educational attainment related to end-of-life decision-making? : a large post-mortem survey in Belgium. BMC PUBLIC HEALTH, 13.
Chicago author-date
Chambaere, Kenneth, Judith AC Rietjens, Joachim Cohen, Koen Pardon, Reginald Deschepper, H Roeline W Pasman, and Luc Deliens. 2013. “Is Educational Attainment Related to End-of-life Decision-making? : a Large Post-mortem Survey in Belgium.” Bmc Public Health 13.
Chicago author-date (all authors)
Chambaere, Kenneth, Judith AC Rietjens, Joachim Cohen, Koen Pardon, Reginald Deschepper, H Roeline W Pasman, and Luc Deliens. 2013. “Is Educational Attainment Related to End-of-life Decision-making? : a Large Post-mortem Survey in Belgium.” Bmc Public Health 13.
Vancouver
1.
Chambaere K, Rietjens JA, Cohen J, Pardon K, Deschepper R, Pasman HRW, et al. Is educational attainment related to end-of-life decision-making? : a large post-mortem survey in Belgium. BMC PUBLIC HEALTH. 2013;13.
IEEE
[1]
K. Chambaere et al., “Is educational attainment related to end-of-life decision-making? : a large post-mortem survey in Belgium,” BMC PUBLIC HEALTH, vol. 13, 2013.
@article{5674168,
  abstract     = {Background: Educational attainment has been shown to influence access to and quality of health care. However, the influence of educational attainment on decision-making at the end of life with possible or certain life-shortening effect (ELDs ie intensified pain and symptom alleviation, non-treatment decisions, euthanasia/physician-assisted suicide, and life-ending acts without explicit request) is scarcely studied. This paper examines differences between educational groups pertaining to prevalence of ELDs, the decision-making process and end-of-life treatment characteristics.
Method: We performed a retrospective survey among physicians certifying a large representative sample of Belgian deaths in 2007. Differences between educational groups were adjusted for relevant confounders (age, sex, cause of death and marital status).
Results: Intensified pain and symptom alleviation and non-treatment decisions are more likely to occur in higher educated than in lower educated patients. These decisions were less likely to be discussed with either patient or family, or with colleague physicians, in lower educated patients. A positive association between education and prevalence of euthanasia/assisted suicide (acts as well as requests) disappeared when adjusting for cause of death. No differences between educational groups were found in the treatment goal in the last week, but higher educated patients were more likely to receive opioids in the last day of life.
Conclusion: There are some important differences and possible inequities between educational groups in end-of-life decision-making in Belgium. Future research should investigate whether the found differences reflect differences in knowledge of and adherence to patient preferences, and indicate a discrepancy in quality of the end of life.},
  articleno    = {1055},
  author       = {Chambaere, Kenneth and Rietjens, Judith AC and Cohen, Joachim and Pardon, Koen and Deschepper, Reginald and Pasman, H Roeline W and Deliens, Luc},
  issn         = {1471-2458},
  journal      = {BMC PUBLIC HEALTH},
  keywords     = {Cultural capital,Socio-economic inequalities,Educational attainment,End-of-life decisions,End-of-life care,Euthanasia,HEALTH INEQUALITIES,PHYSICIAN-ASSISTED SUICIDE,VULNERABLE PATIENTS,EUTHANASIA,ADVANCE DIRECTIVES,NETHERLANDS,FLANDERS,LITERACY,ADULTS,PATIENT},
  language     = {eng},
  pages        = {9},
  title        = {Is educational attainment related to end-of-life decision-making? : a large post-mortem survey in Belgium},
  url          = {http://dx.doi.org/10.1186/1471-2458-13-1055},
  volume       = {13},
  year         = {2013},
}

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