Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European
Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005.
Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative
care services between 2005 and 2019.
Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019.
Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of
variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the
variance. Income-level and sub-regional ANOVA analysis were undertaken.
Setting: 51 countries.
Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care
teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant
increase in all types of services (p <¿0.001), while low-to-middle-income countries showed significant increase only for inpatient
services. Central¿Eastern European countries showed significant improvement in home care teams and inpatient services, while
Western countries showed significant improvement in hospital support a