Home death versus hospital death: a retrospective analysis of patients in palliative care.

Respecting the patient's preferred place of death is a key indicator of the quality of palliative care. However, clinical factors may influence this outcome. This study aimed to compare the clinical profiles, symptom burden, and medical interventions of patients who died at home versus those who died in an inpatient setting (hospital) within the context of a Brazilian public healthcare institution. A retrospective study was conducted involving 227 patients who were followed by the Palliative Care Team at the Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE). Sociodemographic and clinical variables, symptom control, and pharmacological interventions were analyzed using generalized linear mixed models (GLMMs). Of these patients, 59.47% (n=135) died in the hospital ward and 40.53% (n=92) died at home. No statistically significant differences were observed between age or sex and place of death. Hospitalized patients presented with a greater number of symptoms, although no significant differences were found for pain and dyspnea. Most of the patients also had multiple metastases. The use of oxygen was significantly higher in the inpatient setting, while oral and enteral feeding was more feasible at home. Although the total number of medications administered was higher in the hospital, there were no significant differences in the use of morphine and midazolam between the groups. In conclusion, clinical severity was a key factor influencing hospitalization until death. Despite equivalent symptom control between settings, expanding access to structured home-based palliative care could enable patients to experience end-of-life care aligned with their preferences.