Portugal is where fewer people die at home despite investment in palliatives

In the 2012-2013 time period, the percentage of deaths at home in the included countries was 30,1% (27,4% in Portugal)

Portugal is one of the countries where fewer people die at home, according to a study by Portuguese researchers that involved 32 countries and analyzed the impact of the pandemic on deaths at home.

Speaking to the Lusa agency, researcher from the university of Coimbra Bárbara Gomes explained that it was the largest study of international trends on the subject, and was also the first to show the impact of the pandemic at a global level in most of the countries studied, with a return to death at home.

The researcher considered that the data from Portugal are “a reflection of a very hospital-centric system” – with healthcare very centered on hospitals – and that they already showed lower percentages of deaths at home than in other countries before the pandemic.

«We were not surprised that, on the one hand, the percentage of deaths at home in Portugal was one of the lowest and that we had also observed a decrease in the percentage of deaths at home, both before and during the pandemic», said the expert, highlighting , however, that the researchers expected to find some change in the national data, which did not happen.

«We know that we have had an investment in the area of ​​palliative care, both at the level of the SNS [National Health Service] and also through some private initiatives, such as the Humaniza Program [from the 'la Caixa' Foundation] and, therefore, we would aspire to find some change in this sense, which does not seem to have existed», he explained.

The international study, led by the researcher from the University of Coimbra, and by Silvia Lopes, professor at the Universidade Nova de Lisboa (National School of Public Health), analyzed data relating to the deaths of more than 100 million people, aged over 18. , between 2012 and 2021.

In the 2012-2013 time frame, the percentage of deaths at home in the countries included was 30,1% (27,4% in Portugal), having increased to 30,9% in 2018-2019, before the pandemic, contrary to the which happened in Portugal, which saw the value drop to 24,9%.

In the last period analyzed (2020-2021), during the Covid-19 pandemic, the value continued to fall in Portugal (23,4%), a behavior contrary to that of the other countries, where the percentage of deaths at home rose to 32,2 ,two%.

«Especially in the area of ​​home palliative care, [the investment] may not be enough to significantly reach everyone in need», admitted Bárbara Gomes.

According to data released in December by the Público newspaper on national coverage of palliative care, estimates point to the need for 126 social workers, 128 psychologists, 181 doctors, 354 nurses and 92 operational assistants.

Regarding the causes of death at home, researcher Bárbara Gomes said that, contrary to what happened with most other deaths, cancer deaths at home increased in Portugal.

«In this group we registered an increase in deaths at home before and after the pandemic, which can be explained by cancer being a disease with a more predictable trajectory and also with access to palliative care, earlier and better integrated», he stated.

He also defended the need to start thinking about providing palliative care “to non-oncological patients”, such as, for example, people with dementia.

He considered it important to «reflect on Portugal's situation in the international context», ensuring that «health care effectively follows people where they want to be».

«If the change that we have seen in countries globally – of increasing deaths at home – is properly supported, aligned with preferences (…) and if it is associated with good results, with well-controlled symptoms, greater quality of life and comfort , then we will be on the right track», he said.

However – he recalled – «if, on the other hand, there are deficiencies in end-of-life care, with the risk of failing patients and their families at home, then we must rethink and improve end-of-life home support».