Access to respite services for family caregivers increases a palliative care patient's probability of dying at home almost threefold, according to a McGill University-led study.
Previous surveys suggest most Canadians with a serious illness would prefer to spend the end of their lives at home. In Quebec, fewer than one-in-10 palliative care patients die at home, a rate that has remained largely unchanged for two decades and lags behind the Canadian average of 15 per cent.
Funded by Quebec's health ministry as part of its action plan for equitable access to quality palliative and end-of-life care, the study set out to find which factors matter most in helping patients avoid a transfer to a hospital or palliative care centre in their final days.
Respite care – professional help that allows family caregivers to take short breaks –emerged as the strongest predictor, with patients 2.7 times more likely to die at home when it was available.
Timely access to nursing care, support with hygiene such as bathing, and pain-relief services also were significant factors.
"An at-home palliative and end-of-life care approach that addresses the physical, psychological, spiritual and social needs of patients and their caregivers enables patients to remain at home longer and to die at home when that is their wish," said lead author Kelley Kilpatrick , Assistant Professor and Susan E. French Chair in Nursing Research and Innovative Practice at McGill's Ingram School of Nursing.
The researchers conclude that Quebec can achieve its equity goals by:
- investing in respite services
- reducing staff turnover in home care to build trust and continuity for patients
- standardizing services across the province so patients aren't disadvantaged by where they live
- mobilizing specialized nurse practitioners to provide support.
The findings are based on nearly 6,000 patient records from a Montreal at-home palliative care organization between 2015 and 2024, along with 73 interviews with patients, caregivers, service providers and decision-makers. On average, patients were 78 years old, nearly all had cancer and more than one-in-four lived alone.
About the study
" Factors that support home deaths for patients receiving at-home palliative and end-of-life care: a sequential mixed-methods explanatory study " by Kelley Kilpatrick and Eric Tchouaket et al., was published in BMC Palliative Care.
The research was funded by the Ministère de la Santé et des Services sociaux du Québec, the Newton Foundation and the Fonds de recherche du Québec – Santé. It was done in collaboration with the CIUSSS de l'Est-de-l'Île-de-Montréal and the Société des soins Palliatifs à Domicile du Grand Montréal.
