Place of death trends in single institution palliative care: 12-year retrospective impact study of service development

To analyse place of death (PoD) and associated factors in patients receiving palliative care at a university hospital in Argentina over a 12-year period.

Retrospective observational study of patients who died while receiving palliative care at a single university hospital in Argentina (2013-2024). Logistic regression was used to identify factors associated with PoD, including demographic variables, diagnosis, caregiver characteristics, 24-hour home nursing availability, distance to hospital, cohabitation with minors and period of care.

A total of 2117 patients were included. Overall, 72.2% died in hospital, 15.4% at home and 12.3% at other institutions. Hospital deaths increased from 65.0% in 2013 to 91.4% in 2024, with a marked inflection in 2021 following the opening of an inpatient palliative care unit. Availability of 24-hour home nursing was the strongest predictor of home death (OR 66.0, 95% CI 36.2 to 120.1, p<0.001); 89.7% of patients with this support died at home. Living with minors (OR 0.47, 95% CI 0.26 to 0.86, p=0.013) and care during the inpatient unit period (OR 0.21, p<0.001) were associated with lower likelihood of home death. Age, sex and cancer diagnosis were not significant predictors.

PoD was primarily determined by structural rather than clinical factors. Home death is highly achievable when adequate support is available, but limited access to home-based palliative care drives progressive institutionalisation.