Background Providing person-centred palliative and end-of-life care was severely challenged during the COVID-19 pandemic due to healthcare strain and infection control measures. Previous studies within the Swedish-Norwegian Palliative Quality Care COVID-19 multicenter project have highlighted these challenges from staff perspectives. However, how patient needs were addressed during their final phase of life in hospitals, irrespective of the cause of death—remains less explored. Aim To examine the extent and manner in which the principles of good person-centered palliative care were upheld in hospital end-of-life care during the pandemic. Methods A retrospective patient record review was conducted using a protocol based on WHO’s principles of person-centred palliative care, operationalised through the 6 S’s model (figure) and Swedish quality indicators for palliative care. From 1,458 hospital deaths (March 2020–February 2022), 150 COVID-19 positive patients were randomly selected and matched by age and sex with 150 COVID-19 negative patients. Data from 254 patients were analysed (114 COVID-19 positive, 140 COVID-19 negative). Results Of the 254 individuals, 60% were men and 40% women, with aged range 28 to 101 years. Documentation of person-centred dimensions was limited: Self-image 14%, Symptom relief 18%, Self-determination 32%, Social relationships 6%, Synthesis 4%, Strategies 7%, while information about relatives was almost always recorded (98%) (table). Group comparisons showed differences in symptom relief: respiratory symptoms were more frequent among COVID-19 patients, who received more targeted relief. Pain was more often documented and treated among non-COVID patients. Sleep problems occurred in both groups, but COVID-19 patients with sleep problems received less relief. Conclusion Patients’ psychosocial and existential needs were largely unmet, revealing serious deficiencies in providing holistic, person-centred, quality palliative care during the pandemic. Symptom relief varied depending on whether the patient was COVID-positive or COVID-negative: respiratory relief was prioritised for COVID-19 patients, while pain relief was more common among non-COVID patients.