Public understanding of palliative care and preferences for place of end-of-life care and death: A national population-based latent class analysis.

Abstract

Background: Dying in the preferred place is associated with improved wellbeing. Preferences may be shaped by personal characteristics, health, prior experiences, and understanding of palliative care.

Objectives: To investigate preferences for place of end-of-life care and death in the Swedish adult population and specifically, to identify subgroups characterised by different understanding of palliative care and examine how preferences vary across these subgroups.

Design: This study was based on a cross-sectional population-level survey.

Methods: A simple random sample of 3,750 16-90-year-old individuals, selected from the Swedish Population Register. Latent class analysis identified distinct subgroups based on participants' understanding of palliative care. Predictors of subgroup membership were examined using multinomial logistic regression.

Results: A total of 1,752 individuals responded (48%). Of them, 59.6% preferred end-of-life care at home, and 54.2% preferred home death. Latent Class Analysis identified five distinct subgroups: comprehensive understanding, some understanding, limited understanding, misunderstanding, and no opinion. Comprehensive understanding, such as believing that palliative care supports families and alleviates suffering, was associated with preferences for home or hospice care. Misunderstanding, such as believing that palliative care hastens death, was associated with preferences for hospital or nursing home. The comprehensive understanding group included more women (57.6%), older (mean [SD] age: 57 [18] years), and university-educated individuals (48.2%).

Conclusion: Although the most preferred place for both care and death were home, preferences varied across subgroups defined by differing levels of understanding of palliative care and sociodemographic characteristics.