A groundbreaking study led by researchers at McGill University has shed new light on the crucial role of respite services in enabling palliative care patients to spend their final days in the comfort of their own homes. According to the research, the availability of professional respite care—temporary relief for family caregivers—nearly triples the likelihood that a patient receiving at-home palliative care will die at home rather than being transferred to a hospital or care facility. This finding carries profound implications for healthcare policy and service delivery models, especially in regions with persistently low rates of home deaths among terminally ill patients.
The study comes at a pivotal time, as surveys consistently reveal that a significant majority of Canadians with serious, life-limiting illnesses express a preference for dying at home. However, the reality in Quebec currently stands in stark contrast to this preference; fewer than 10 percent of palliative patients die at home, a figure that has remained stagnant for decades and falls below the Canadian national average of 15 percent. This disparity underscores systemic challenges and barriers unique to Quebec’s healthcare infrastructure and service provision.
Funded by Quebec’s Ministry of Health and Social Services as part of its strategic action plan to ensure equitable access to palliative and end-of-life care, this mixed-methods study was meticulously designed to identify the factors that most significantly contribute to patients’ ability to avoid hospitalization in their final days. By analyzing nearly 6,000 patient records alongside extensive interviews with patients, caregivers, healthcare providers, and policymakers, the research team constructed a comprehensive portrait of the at-home palliative care landscape.
One of the most striking findings from the study is the outsized influence of respite care on patient outcomes. Defined as temporary professional support that allows family caregivers to rest and recuperate, respite services emerged as the single strongest predictor of home death. Quantitatively, patients with ready access to respite care were found to be 2.7 times more likely to die at home compared to those without such services. This underscores not only the importance of direct patient care but also the need to sustain the well-being and capacity of informal family caregivers who are often the primary providers of support.
In addition to respite care, timely nursing interventions significantly bolstered the possibility of home death. Services focused on hygiene support—such as assistance with bathing—as well as effective pain management techniques, were identified as key contributors to maintaining patients’ comfort and dignity outside institutional settings. These findings highlight the multidimensional nature of palliative care delivery, which must integrate physical, psychological, spiritual, and social support systems to address the complex needs of both patients and their caregivers.
Kelley Kilpatrick, Assistant Professor at McGill’s Ingram School of Nursing and lead author of the study, emphasizes the holistic philosophy underpinning effective at-home palliative care. According to Kilpatrick, “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.” This comprehensive approach demands concerted efforts not only at the level of individual care but also through systemic reforms.
The researchers argue that achieving equity in palliative care across Quebec requires strategic investments and policy reforms. Central to these is the expansion and consistent funding of respite services, which directly alleviate caregiver burnout and enable sustained home care. Furthermore, addressing the chronic issue of staff turnover within home care services is critical. High turnover rates disrupt continuity and trust—two pillars essential for effective, patient-centered care—making it imperative to stabilize the workforce through improved training, support, and working conditions.
Standardization of home care services across the province was another key recommendation. The current variability in available services depending on geographic location results in inequities, as patients residing in rural or underserved areas face disproportionate challenges in accessing comprehensive at-home care. By implementing province-wide standards and guidelines, Quebec could mitigate these disparities and ensure more uniform quality and accessibility.
An innovative solution highlighted by the study is the mobilization of specialized nurse practitioners trained in palliative and end-of-life care. These healthcare professionals can provide advanced clinical support and act as vital links between patients, families, and the broader healthcare system. Their involvement enhances the capacity for timely interventions and tailored care planning, both crucial for managing complex symptom burdens and patient needs at home.
The research team’s comprehensive methodology included both quantitative analysis of extensive patient data from a Montreal-based at-home palliative care organization and qualitative insights drawn from interviews conducted between 2015 and 2024. Demographically, the patient cohort was primarily older adults (average age 78), predominantly diagnosed with cancer, and with over 25 percent living alone—features that underscore the vulnerability and diverse needs within this population.
Notably, the study also incorporated perspectives from family caregivers and service providers, recognizing their critical role in translating policy and clinical recommendations into real-world care. This inclusive approach yielded a nuanced understanding of the challenges faced on both sides of the care equation—from caregiver strain and logistical hurdles to systemic resource constraints and workforce dynamics.
Published in BMC Palliative Care, the study titled “Factors that support home deaths for patients receiving at-home palliative and end-of-life care: a sequential mixed-methods explanatory study,” represents a significant contribution to the field of palliative medicine. It not only quantifies key determinants of home death but also contextualizes these within the lived experiences of patients and caregivers, offering actionable insights for health services planners and policymakers.
As jurisdictions worldwide grapple with aging populations and increasing demand for palliative services, the findings from this Quebec-based study resonate broadly. They emphasize that achieving patient-centered end-of-life care requires a delicate balance of clinical expertise, compassionate support, and systemic investment. Ensuring that patients can die where they choose—often at home among loved ones—necessitates that healthcare systems elevate caregiver support mechanisms, stabilize frontline service provision, and foster creative workforce solutions.
In conclusion, the McGill-led research underscores the transformative potential of respite services within the palliative care continuum. By relieving family caregivers and integrating comprehensive nursing support, healthcare systems can substantially increase the likelihood that patients spend their final days in the familiar environments they prefer. The study’s policy recommendations point the way toward more equitable, sustainable, and person-centered palliative care models, setting a new benchmark for jurisdictions grappling with similar challenges. As the end-of-life landscape evolves, these evidence-based strategies offer hope for improved quality of dying and caregiver well-being, reframing home death not as a statistical rarity but as an achievable, dignified standard.
Subject of Research: People
Article Title: Factors that support home deaths for patients receiving at-home palliative and end-of-life care: a sequential mixed-methods explanatory study
News Publication Date: 12-Jul-2025
Web References: http://dx.doi.org/10.1186/s12904-025-01840-0
References: Kilpatrick K, Tchouaket E, et al. (2025). Factors that support home deaths for patients receiving at-home palliative and end-of-life care: a sequential mixed-methods explanatory study. BMC Palliative Care.
Keywords: Hospice care, palliative care, end-of-life care, respite services, home death, nursing care, caregiver support, Quebec health services
