In France, while 80% of the population wishes to die at home, most deaths occur in the hospital. To explore this discordance, we studied the factors influencing the place of death for cancer patients admitted to home hospitalization for palliative care.

Retrospective case-control study based on the cohort of patients receiving home-based palliative care from the Fondation Œuvre De La Croix Saint-Simon during the year 2022.

In this study, 385 patients were included. Among them, 49.9% died at home and 50.1% in the hospital. Multivariate analysis identified two factors associated with death at home: the primary caregiver's preference for home death (OR 8.53, 95% CI [4.73-15.87], p<0.001) and the existence of pre-emptive prescription (OR 15.07, 95% CI [5.81-47.40], p<0.001). With multiple imputation analysis, two additional variables were identified : patient's low functional status (Karnofsky score 10-30% vs 50-70%, OR 1.15, 95% CI [1.01-1.30], p=0.04) associated with death at home, and the prescription of home hospitalization by a palliative physician (vs hospital physician, OR 0.89, 95% CI [0.80-1.00], p=0.047) in favor of death in the hospital.

This study identified four factors influencing the place of death: the primary caregiver's preference, the existence of pre-emptive prescription, the patient's functional status, and the specialty of the physician prescribing home hospitalization. Understanding these factors is crucial to improve end-of-life communication between healthcare professionals, patients, and their families. In France, to meet the societal wish to pass away at home, it is essential to strengthen home palliative care by optimizing coordination among its various actors, reaffirming the central role of the general practitioner, and supporting the development of HADs.