Rural palliative care access breaks down as a pathway and workforce problem, not simply a shortage of beds, systematic review finds

A mixed-methods systematic review of 34 studies, searched to 15 March 2026, applied an access framework to rural palliative care Synthesis. It found access breaks down cumulatively across four stages — recognition, entry, reach, and use or continuity — with distance, transport, workforce shortages and weak links between specialist and generalist services identified as the drivers of the “reach” barrier specifically. The review concludes that rural palliative care access is fundamentally a pathway and service-configuration problem, not simply a shortage of specialist beds or capacity.

UK-based primary studies were a minority of the 34 included, so the review does not establish which specific service configuration performs best in a dispersed, predominantly rural setting comparable to English rural areas.

The practical implication is that strengthening the links between specialist palliative care and generalist community services — rather than adding specialist bed capacity alone — is the evidence-based lever for improving rural palliative care access, an approach relevant well beyond any single health system.