Home deaths best match patient preference, but specialist units deliver better pain control, Canadian cohort finds

A decedent-proxy cohort analysis (n=1,287) drawn from the Canadian Longitudinal Study on Aging compared outcomes across home, palliative care unit or hospice, and hospital deaths Primary Study. Home deaths most closely matched the decedent’s preferred place of death (89.4%), while deaths in palliative care units or hospices had better pain control (81.5% reporting low pain). Regional policy was found to strongly predict access to specialist palliative units or hospices.

The Canadian Longitudinal Study on Aging is a large national cohort, giving this comparison more weight than smaller single-region studies typically offer on the trade-off between preferred place of death and quality of dying.

The finding sets out a genuine trade-off rather than a single “better” option: services planning end-of-life care provision need to weigh patients’ preference for a home death against the better pain control that specialist unit or hospice care can deliver, and regional variation in specialist access is itself a determinant of which of these a patient can realistically choose.