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

BMC Public Health

Luc Deliens¹  H Roeline W Pasman¹  Reginald Deschepper²  Koen Pardon²  Joachim Cohen²  Judith AC Rietjens²  Kenneth Chambaere² 

[1]Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands

[2]End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussel 1090, Belgium

关键词: Euthanasia;    End-of-life decisions;    End-of-life care;    Cultural capital;    Socio-economic inequalities;    Educational attainment;   

Others  :  1161572
DOI  :  10.1186/1471-2458-13-1055

 received in 2013-03-12, accepted in 2013-11-05,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Chambaere et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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