BMJ supportive & palliative care · 2026
Place of death trends in single institution palliative care: 12-year retrospective impact study of service development.
СтатьяНазвание и аннотация: Перевод в очереди
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Mutto Eduardo Mario, Iturri Agustina, Najún Matias, Dóvidas Marcelo Nicolás, Alonso-Babarro Alberto
Аннотация
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.