Experts are calling for better home care and more family support to allow terminally-ill cancer patients to die comfortably in their own homes.
More than half of terminally ill people want to die at home
A team from King's College London says more than half of people in the UK with a progressive illness want to die at home but only one in five does so.
And end of life programmes still fall short despite a £12m boost, they say in a British Medical Journal report.
The Department of Health says it is increasing choice in end of life care.
Research leader Professor Irene Higginson, head of palliative care policy and rehabilitation at King's, said the prospect of a lonely hospital death was terrifying for many.
Her team found that despite this and extra investment, the proportion of home deaths for patients with cancer in the UK fell from 27% or 38,000 deaths to 22%, or 31,000 deaths, between 1993 and 2004.
She told the BBC News website it was "great" that money was going into end of life care but the contents of the programmes were clearly "falling short".
She said not enough intensive support or home care services were available to patients and that carers needed to be better supported.
"We really need to ensure that people can access these services and obtain the intensive care that they need.
"And that might mean care several times a day and during the night," she added.
She argued that there was not enough of an incentive for GPs to look after patients in their own homes.
Dr Barbara Gomes of charity the Cicely Saunders Foundation, which funded the research, said: "Evidence shows that many terminally ill patients, particularly those suffering from cancer, want to die naturally, with dignity, in familiar surroundings and with their families close by."
A new approach was needed to ensure those wishes were carried out, she said.
The team analysed 58 studies involving 1.5 million patients from 13 countries to determine what factors influenced where patients died.
The most important included to how limited patients were by their condition, the level of home care and the scale of family support.
The study then recommended a five-pronged approach to make it easier for people to choose to die at home if they wished.
As well as families having more say and support in what happened, there should be public education about the issue, better home care facilities, early risk assessment and palliative care training for nurses and home helps, it said.
A Department of Health spokeswoman said: "In the recent joint health and social care White Paper, the government reaffirmed its commitment to increase choice in end of life care, including the option for people who are dying to be treated at home.
"We have said we will establish end of life care networks to improve service co-ordination and help patients in need and ensure all staff who work with people who are dying will be properly trained."
Peter Cardy, chief executive of Macmillan Cancer Relief, said a recent Commons report highlighted that half of cancer patients died in hospital.
"This analysis shows conclusively for the first time that more can be done to enable patients to die at home if they wish and that careful assessment in plenty of time makes a big difference to whether their wishes are met."
Palliative care provision remained a postcode lottery, he said.
Sue Green, senior nurse with support charity CancerBACUP said: "Callers call our Helpline worried about what is going to happen when the person they are caring for is nearing death.
"It is important that people with cancer and their carers are given information about what emotional and practical support is available to help them make the right choices for them about where they want to be in the final stages of their illness."