Relationship Between the Preferred Place of Death in the Patients’ Health Record and the Actual Location of Death in Home Palliative Care: A Retrospective Cohort Study

Background: Dying in the preferred place is considered an indicator of quality of end-of-life care. Advance care planning and home palliative care may increase the likelihood of dying at home. This study aimed to assess whether recording patients’ preferred place of care or death is associated with the actual place of death among patients followed by home palliative care teams. Methods: We conducted a retrospective observational study including adult patients who died in 2022 and were followed by a home palliative care team in Madrid, Spain. Sociodemographic and clinical variables, recorded preferred place of care or death, and actual place of death were extracted from electronic health records. Associations were analysed using bivariate tests and multivariable logistic regression. Results: A total of 464 patients were included (53% women; mean age 80.8 years). Overall, 82.5% died at home. A preferred place of care or death was recorded for 64% of patients; among them, 97.6% expressed a preference for home, and 89% of these patients died at home. In the multivariable analysis, older age and female sex were independently associated with death at home. Recording a preferred place of care or death was not independently associated with the place of death. Conclusions: Most patients followed by home palliative care teams died at home. Older age and female sex were associated with a higher probability of home death. Although most patients with a recorded preference for home died at home, recording preferences alone was not independently associated with the place of death. Systematic documentation of preferences may support advance care planning and patient-centred decision-making.