Study A – Research synthesis: No synthesis or review of the literature surrounding the role of the district nurse (or home based nurses in other countries) in palliative care provision currently exists. A realist synthesis of the literature is planned. The scope and purpose of the review will be further clarified by exploratory literature searching, guided by all three research questions. An exploratory theoretically based evaluative framework will then be developed. Evidence will be gathered, appraised, and extracted, and conclusions drawn with reference to the theoretical framework. 

Patients and their carers will be sampled from the population of palliative care patients on district nurse caseloads.  The approach to data collection will be flexible to take account of the different ways care is provided to patients. Observation of the interactions between patients, carers, district nurses, and other care professionals, and the care given and received will form the core data collection method. In-depth interviews with patients, informal carers, district nurses and other involved professionals will follow observation, to explore understandings of observational data.

Study C – Survey of palliative care patients on district nursing caseloads and comparison to the ‘population’ of those who died from cancer during the study period: