Setting
The study took place in two regions in England. The first, Lancaster and South Cumbria, covered a large semi-rural area serving a largely dispersed population. The second, the Midlands, was a socio-demographically varied area with a dense and varied population in urban districts, as well as a more dispersed population in rural areas. In each of the two geographic areas, two community nursing teams, involving district nurses and specialist palliative care nurses, and two care homes for older people registered to provide nursing care (i.e. nursing homes) were invited to take part using a convenience sampling approach. We employed a recruitment approach used successfully in a previous study of end-of-life care in care homes, namely, working with key local end-of-life care stakeholders to publicise the study, identify potentially participating sites and then invite participation via the team leader or care home senior nurse.