The report said provision of palliative care was 'inconsistent'
A national plan to improve palliative care provision has been promised by the Scottish Government after concerns over treatment for the terminally ill.
The pledge came after a report from Audit Scotland highlighted "inconsistencies" in care for different illnesses and access to services.
The report said remote communities were not served as well as the central belt.
Health Secretary Nicola Sturgeon said health boards were already making changes but more needed to be done.
Audit Scotland found that 90% of specialist care was delivered to cancer patients, although the disease accounted for fewer than 30% of deaths.
And it concluded that people with other conditions, such as organ or respiratory failure or dementia, may have complex palliative care needs but were less likely to get specialist palliative care.
Pointing out that more than 55,000 people died in Scotland each year, deputy auditor general Caroline Gardner said: "Palliative care should be an integral part of the support given to patients and their families and carers during the last months, days and hours of their lives.
"In many areas of Scotland, the voluntary sector and the health service provide excellent and much appreciated care. But access to good quality palliative care varies across the country."
The report went on to warn that generalists involved in palliative care needed the support and guidance of specialists, and that good practice guidelines for palliative care were not being applied across the board.
The Scottish Government is due to publish its action plan in October.
Speaking to BBC Scotland, Ms Sturgeon said the plan would provide better care outside the central belt of Scotland.
She said: "There are many examples across the country of NHS boards and the voluntary sector working together to improve services.
"This is a process that is already under way, but there's no doubt we have to accelerate that progress."
The report was welcomed by the cancer charities Marie Curie and Macmillan, which said the findings showed a national strategy was vital.
Labour said it would "seriously challenge" the SNP to build on progress already made, while Conservative public health spokesman, Jackson Carlaw, said the government and health boards had to act to ensure a uniform approach.
Although the full cost of providing palliative care is unknown, Audit Scotland said about £59m was spent on specialist care in 2006-07 - with almost half the money coming from the voluntary sector.