End-of-life care in the rural and coastal communities of the South West

A participatory realist evaluation
Carer touching the hand of a hospitalised elderly person in a bed

End-of-life care in the rural and coastal communities of the South West

A participatory realist evaluation
Title: Care of people at the end of their lives in the rural and coastal communities of the South West Peninsula of England: A participatory realist evaluation
Funded by: NIHR
Funding amount: £1,259,713.31
Location: South West England
Dates: October 2025 – January 2028
University of Plymouth PI: Dr Susie Pearce
Collaborating staff: Dr Saskie Dorman, Mr Simon Chant, Mrs Keziah Lagor, Ms Victoria Bartlett, Professor Katrina Wyatt, Professor Mark Pearson, Professor Richard Harding
 
The significance of high-quality care in the last year of life cannot be underestimated, yet there are significant inequalities in access to end-of-life (EoL) care, including geographical inequality. Evidence suggests that people living in rural and coastal areas may find it harder to access the care they want at the end of their lives. The South West Peninsula region of England is a largely rural area with an extensive coastline – it also has some of the oldest populations and projected need for EoL care in the UK.
This project aims to identify inequalities in access to – and experiences of – EoL care in the South West Peninsula, to inform decision-making about EoL care services in coastal and rural communities across the UK. 
EoL care is defined as the care of people in their last 12 months of life, with a focus on supporting physical, emotional, and spiritual needs. While we know there are problems in accessing EoL care, there has been little research into understanding why these problems exist and how we can improve EoL care in these areas. 
The importance of this study became clear during the extensive engagement work we did in 2023, where we spoke with 45 health and care professionals and 18 individuals who were nearing the end of their life, and their carers or bereaved family members.  
 
 
 

Aims

This study is looking at how people in Devon, Cornwall and Somerset are cared for and supported at the end of their lives, particularly in rural and coastal areas.

Objectives

  • Map and understand inequalities in EoL care in coastal and rural communities.
  • Understand the conditions that generate good care at the EoL and factors driving inequalities.
  • Explore access and outcomes associated with different pathways of service provision for people at the EoL.
  • Build (with stakeholders) contextualised explanations of how inequalities in service provision and delivery can be addressed locally through actionable insights and commissioning.
  • Use programme theories and strategic intelligence to inform and influence strategy and system impact and contribute to wider policy and evidence development to address geographical inequalities in EoL care.
  • Develop a platform of work to contribute to the local, national, and international evidence base on EoL, including how strategic intelligence can be better deployed to support future commissioning.
Elderly man on a mobility scooter by the sea

Method

Work package one

Case studies
We will undertake case studies in six geographical areas in Devon, Cornwall and Somerset to understand EoL care. We will also study six different populations, such as rural farmers, older people and people who are homeless. The case studies will involve observations, focus groups, and interviews with people at the EoL, their families, professionals who care for them, the voluntary sector, and those organising services.

Work package two

Survey and systematic review
We will survey people responsible for EoL care across the UK and interview local, regional, and national EoL leaders to understand the challenges rural and coastal areas face in delivering accessible EoL care for everyone. We will host regular online discussions with stakeholders from local, regional, and national groups. We will conduct a systematic review of global innovations to address challenges to providing EoL care in rural and coastal areas.

Work package three

Data analysis
We will use existing NHS data, collected both nationally and locally, to explore and better understand reasons for difference in care during the last 12 months of life.

Work package four

Development and refinement
We will collate our findings from the first three work packages. Our research team, alongside a patient and family stakeholder group and a professional stakeholder group, will meet to help confirm and develop our understanding. Six workshops will take place with stakeholder groups to support development and refinement of programme theory, stakeholder involvement, knowledge exchange, and policy impact.

Centre for Coastal Communities

Finding solutions to the challenges facing coastal communities
The University of Plymouth is one of the few UK Higher Education Institutions with a critical mass of academics with a proven track record of research on coastal communities. The Centre for Coastal Communities brings together researchers looking at coastal economic performance, deprivation, migration, educational underperformance, displaced populations, health and social care, the blue economy (renewable energy, fisheries, aquaculture, tourism, recreation and leisure), plastic pollution and economic, social and environmental policy for coastal communities.
 
Fishing nets