Cluster Analysis of Palliative Care Patients' Trajectories in Primary Care: Hospitalization Yes, but Home and Nursing Home Care Above All

Background: Understanding the environment in which patients live at the end of their lives is essential to improving palliative care for these patients and their families.Objectives: We aimed to explore the different living places and trajectories of palliative care patients in the last three months of life in primary care and to identify patient characteristics associated with these trajectories.Methods: This retrospective national study was carried out among a population of adult patients who died a non-sudden death. The trajectories were modeled and classified using sequence analysis, optimal matching, and hierarchical ascendant clustering. Univariate and multivariate multinomial logistic regression compared patient characteristics associated with these trajectories. The focus was on primary care. Patients had to have spent at least one day at home or in a nursing home in the last three months before their death. The research took place between November 2020 and November 2021 in mainland France.Results: Three hundred adult patients were included in the study. Cluster analysis revealed three main trajectories during the last three months of life: "staying at home" (57%), "staying in a nursing home" (29%), and "moving from home to hospital" (14%). Dementia and having children limited hospitalization. Not having an informal caregiver and having dementia were associated with staying in a nursing home.Conclusions: Palliative care patients' living situations and transitions can be tracked using primary care practice data. This study highlights the unique needs of palliative care in home and nursing home settings. Additionally, factors such as dementia and family dynamics play a significant role in determining where patients live, which can help inform clinical practices and research strategies in palliative care.