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

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...

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Autores principales: Chambaere, Kenneth, Rietjens, Judith AC, Cohen, Joachim, Pardon, Koen, Deschepper, Reginald, Pasman, H Roeline W, Deliens, Luc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840665/
https://www.ncbi.nlm.nih.gov/pubmed/24207110
http://dx.doi.org/10.1186/1471-2458-13-1055
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author Chambaere, Kenneth
Rietjens, Judith AC
Cohen, Joachim
Pardon, Koen
Deschepper, Reginald
Pasman, H Roeline W
Deliens, Luc
author_facet Chambaere, Kenneth
Rietjens, Judith AC
Cohen, Joachim
Pardon, Koen
Deschepper, Reginald
Pasman, H Roeline W
Deliens, Luc
author_sort Chambaere, Kenneth
collection PubMed
description 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.
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spelling pubmed-38406652013-11-27 Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium Chambaere, Kenneth Rietjens, Judith AC Cohen, Joachim Pardon, Koen Deschepper, Reginald Pasman, H Roeline W Deliens, Luc BMC Public Health Research Article 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. BioMed Central 2013-11-09 /pmc/articles/PMC3840665/ /pubmed/24207110 http://dx.doi.org/10.1186/1471-2458-13-1055 Text en Copyright © 2013 Chambaere et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Chambaere, Kenneth
Rietjens, Judith AC
Cohen, Joachim
Pardon, Koen
Deschepper, Reginald
Pasman, H Roeline W
Deliens, Luc
Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium
title Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium
title_full Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium
title_fullStr Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium
title_full_unstemmed Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium
title_short Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium
title_sort is educational attainment related to end-of-life decision-making? a large post-mortem survey in belgium
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840665/
https://www.ncbi.nlm.nih.gov/pubmed/24207110
http://dx.doi.org/10.1186/1471-2458-13-1055
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