Evolution of home and outpatient palliative care in Poland: a single metropolitan centre comparison between 1994–1997 and 2024

Introduction: In Poland, legal requirements for the provision of palliative care and patients’ social conditions have changed since the hospice movement began in the 1980s. There has been a lack of comparative assessments regarding home-based hospice and outpatient palliative care over these years. This study aims to present the characteristics of hospice outpatient and home care at a single institution based on a retrospective chart review in 2024. Methods: These data were compared with historical Palliative Care Outpatient Clinic findings obtained between 1994 and 1997. The comparative characteristics of current 450 vs. historical 870 patients included sources of referral, waiting time, duration of care and causes of its termination. Patients’ demographics, primary diagnoses, illness stages, performance status, clinical situation awareness, reported problems and drug management were also analyzed. Results: The current services have twice as many employees, with a twofold higher daily patient load, performing 1,033 consultations monthly. The median waiting time in the palliative care clinic is 7 and in home care is 12 days, with 40% and 52% of admitted patients dying at home, respectively. The median reported symptom prevalence increased by 56% since the 1990s and strong opioids partially replaced weak ones, with increased consumption of non-opioid analgesics. Conclusions: Access to outpatient/home palliative care is currently more restricted; not all eligible patients receive reimbursed support and occasionally do not live long enough to be admitted. Palliative care is now more intensive, diverse, interdisciplinary and more focused on older people. Fewer patients die at home, hospital deaths are exceptional, and more patients are currently aware of their diagnosis/prognosis.