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Is individual educational level related to end-of-life care use? : results from a nationwide retrospective cohort study in Belgium

(2011) JOURNAL OF PALLIATIVE MEDICINE. 14(10). p.1135-1141
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Abstract
Background: Educational level has repeatedly been identified as an important determinant of access to health care, but little is known about its influence on end-of-life care use. Objectives: To examine the relationship between individual educational attainment and end-of-life care use and to assess the importance of individual educational attainment in explaining differential end-of-life care use. Research Design: A retrospective cohort study via a nationwide sentinel network of general practitioners (GPs; SENTI-MELC Study) provided data on end-of-life care utilization. Multilevel analysis was used to model the association between educational level and health care use, adjusting for individual and contextual confounders based upon Andersen's behavioral model of health services use. Subjects: A Belgian nationwide representative sample of people who died not suddenly in 2005-2007. Results: In comparison to their less educated counterparts, higher educated people equally often had a palliative treatment goal but more often used multidisciplinary palliative care services (odds ratios [OR] for lower secondary education 1.28 [1.04-1.59] and for higher [secondary] education: 1.31 [1.02-1.68]), moved between care settings more frequently (OR: 1.68 [1.13-2.48] for lower secondary education and 1.51 [0.93-2.48] for higher [secondary] education) and had more contacts with the GP in the final 3 months of life. Conclusions: Less well-educated people appear to be disadvantaged in terms of access to specialist palliative care services, and GP contacts at the end of life, suggesting a need for empowerment of less well-educated terminally ill people regarding specialist palliative and general end-of-life care use.
Keywords
PATIENT, ACCESS, SERVICES, SENTINEL NETWORK, SOCIOECONOMIC DIFFERENCES, CANCER-PATIENTS, PALLIATIVE CARE, HEALTH LITERACY, AGE, INEQUALITIES

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MLA
Bossuyt, Nathalie, Lieve Van den Block, Joachim Cohen, et al. “Is Individual Educational Level Related to End-of-life Care Use? : Results from a Nationwide Retrospective Cohort Study in Belgium.” JOURNAL OF PALLIATIVE MEDICINE 14.10 (2011): 1135–1141. Print.
APA
Bossuyt, N., Van den Block, L., Cohen, J., Meeussen, K., Bilsen, J., Echteld, M., Deliens, L., et al. (2011). Is individual educational level related to end-of-life care use? : results from a nationwide retrospective cohort study in Belgium. JOURNAL OF PALLIATIVE MEDICINE, 14(10), 1135–1141.
Chicago author-date
Bossuyt, Nathalie, Lieve Van den Block, Joachim Cohen, Koen Meeussen, Johan Bilsen, Michael Echteld, Luc Deliens, and Viviane Van Casteren. 2011. “Is Individual Educational Level Related to End-of-life Care Use? : Results from a Nationwide Retrospective Cohort Study in Belgium.” Journal of Palliative Medicine 14 (10): 1135–1141.
Chicago author-date (all authors)
Bossuyt, Nathalie, Lieve Van den Block, Joachim Cohen, Koen Meeussen, Johan Bilsen, Michael Echteld, Luc Deliens, and Viviane Van Casteren. 2011. “Is Individual Educational Level Related to End-of-life Care Use? : Results from a Nationwide Retrospective Cohort Study in Belgium.” Journal of Palliative Medicine 14 (10): 1135–1141.
Vancouver
1.
Bossuyt N, Van den Block L, Cohen J, Meeussen K, Bilsen J, Echteld M, et al. Is individual educational level related to end-of-life care use? : results from a nationwide retrospective cohort study in Belgium. JOURNAL OF PALLIATIVE MEDICINE. 2011;14(10):1135–41.
IEEE
[1]
N. Bossuyt et al., “Is individual educational level related to end-of-life care use? : results from a nationwide retrospective cohort study in Belgium,” JOURNAL OF PALLIATIVE MEDICINE, vol. 14, no. 10, pp. 1135–1141, 2011.
@article{5823777,
  abstract     = {Background: Educational level has repeatedly been identified as an important determinant of access to health care, but little is known about its influence on end-of-life care use. 
Objectives: To examine the relationship between individual educational attainment and end-of-life care use and to assess the importance of individual educational attainment in explaining differential end-of-life care use. 
Research Design: A retrospective cohort study via a nationwide sentinel network of general practitioners (GPs; SENTI-MELC Study) provided data on end-of-life care utilization. Multilevel analysis was used to model the association between educational level and health care use, adjusting for individual and contextual confounders based upon Andersen's behavioral model of health services use. 
Subjects: A Belgian nationwide representative sample of people who died not suddenly in 2005-2007. 
Results: In comparison to their less educated counterparts, higher educated people equally often had a palliative treatment goal but more often used multidisciplinary palliative care services (odds ratios [OR] for lower secondary education 1.28 [1.04-1.59] and for higher [secondary] education: 1.31 [1.02-1.68]), moved between care settings more frequently (OR: 1.68 [1.13-2.48] for lower secondary education and 1.51 [0.93-2.48] for higher [secondary] education) and had more contacts with the GP in the final 3 months of life. 
Conclusions: Less well-educated people appear to be disadvantaged in terms of access to specialist palliative care services, and GP contacts at the end of life, suggesting a need for empowerment of less well-educated terminally ill people regarding specialist palliative and general end-of-life care use.},
  author       = {Bossuyt, Nathalie and Van den Block, Lieve and Cohen, Joachim and Meeussen, Koen and Bilsen, Johan and Echteld, Michael and Deliens, Luc and Van Casteren, Viviane},
  issn         = {1096-6218},
  journal      = {JOURNAL OF PALLIATIVE MEDICINE},
  keywords     = {PATIENT,ACCESS,SERVICES,SENTINEL NETWORK,SOCIOECONOMIC DIFFERENCES,CANCER-PATIENTS,PALLIATIVE CARE,HEALTH LITERACY,AGE,INEQUALITIES},
  language     = {eng},
  number       = {10},
  pages        = {1135--1141},
  title        = {Is individual educational level related to end-of-life care use? : results from a nationwide retrospective cohort study in Belgium},
  url          = {http://dx.doi.org/10.1089/jpm.2011.0045},
  volume       = {14},
  year         = {2011},
}

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