The attributions by pupils for difficult classroom behaviour differ markedly from those obtained in studies of teachers. Policy and practice initiatives which do not attend to conflicting attributional styles are unlikely to succeed in improving levels of pupil behaviour in schools.

ObjectivesThe importance of palliative care in those with advanced fibrotic interstitial lung diseases (F-ILD) is recognised, but the palliative care requirements of patients and caregivers affected by F-ILD regardless of disease course are not established. We set out to explore this and identify optimal solutions in meeting the needs of a F-ILD population in Ireland.MethodsImplementing a World-Café qualitative research approach, we captured insights evolving, iteratively in interactive small group discussions in response to six predefined topics on palliative care and planning for the future. Thirty-nine stakeholders participated in the World-Café including 12 patients, 13 caregivers, 9 healthcare professionals, 4 industry representatives and 1 representative of the clergy.ResultsPalliative care emerged as fundamental to the care and treatment of F-ILDs, regardless of disease progression. Unmet palliative care needs were identified as psychological and social support, disease education, inclusion of caregivers and practical/legal advice for disease progression and end-of-life planning. Participants identified diagnosis as a particularly distressing time for patients and families. They called for the introduction of palliative care discussions at this early-stage alongside improvements in integrated care, specifically increasing the involvement of primary care practitioners in referrals to palliative services.ConclusionPatients and caregivers need discussions on palliative care associated with F-ILD to be included at the point of diagnosis. This approach may address persisting inadequacies in service provision previously identified over the course of the last decade in the UK, Ireland and European F-ILD patient charters.

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Discussion Examination of data available demonstrates that patients with ILD achieve the minimum important difference of the ISWT (>47.5 m) and were close to achieving the minimum important difference of the SGRQ (>4). ILD patients have a greater benefit in terms of reduction in symptoms as measured by SGRQ, than the cohort as a whole. Limitations to generalisation of conclusions due to small sample size are acknowledged. Conclusion ILD patients who completed a 6-week community based, PR programme within a mixed respiratory disease cohort demonstrate a clinically significant improvement in exercise capacity and make gains in health related quality of life.