Development and applicability of a dignity-centred palliative care programme for people with idiopathic pulmonary fibrosis: A qualitative-driven mixed methods study.

Only 12 participants completed the programme, and there was no control group, so changes cannot be separated from time, usual care, or the natural course of IPF. Purposive sampling and a high rate of acute exacerbations, deaths and dropouts during recruitment may have introduced selection bias. The same nurse delivered the intervention and evaluated it, which could have introduced bias. The programme lasted 4 to 8 weeks, which may be too brief for life review compared with programmes of at least 10 weeks. The session and programme satisfaction questionnaires were original and not psychometrically tested. All participants had anxiety and depression scores at or above 20 on the total scale, so the findings may not apply to people with lower distress. Participants were Japanese outpatients able to read and write Japanese and endure sessions, so results may not generalise to people with cognitive decline, inability to attend, or other settings.

The authors declared no conflicts of interest.

Do not conclude that this programme improves self-esteem, anxiety or depression. The primary self-esteem outcome was not significant, and the study had no control group.