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.