Preferred place of death tracks public understanding of palliative care, national Swedish survey finds

A national Swedish population-based survey (1,752 respondents from a random sample of 3,750, a 48% response rate) used latent class analysis to identify subgroups within the adult population defined by how well they understand palliative care, and examined how this related to preferences for place of end-of-life care and death Primary Study. Overall, 59.6% of respondents preferred home-based end-of-life care and 54.2% preferred to die at home.

Five distinct subgroups emerged, ranging from “comprehensive understanding” to “misunderstanding” and “no opinion.” Comprehensive understanding — for example, correctly believing that palliative care supports families and alleviates suffering — was associated with a preference for home or hospice-based death. Misunderstanding — for example, incorrectly believing that palliative care hastens death — was associated with a preference for dying in hospital or a nursing home. The comprehensive-understanding subgroup skewed toward older, more highly educated respondents.

This is a cross-sectional, whole-population national survey, not an intervention trial: it establishes an association between literacy and preference, not that improving literacy would causally shift preferences or actual place of death. The authors do not test a literacy intervention.

The finding nonetheless has a direct implication for services seeking to improve achievement of preferred place of death: it suggests advance care planning conversations that address specific misunderstandings about what palliative care is and does — not only conversations about logistics or capacity — may be a lever for shifting preferences toward home-based care, independently of service availability.