First, whereas professionals reviewed all questions, patients were only asked selected questions as deemed appropriate from within the DT protocol framework. Second, due to repeated words or phrases, the questions may appear more similar than they actually are. Finally, patients might appreciate the chance to build on their responses, based on questions

that are thematically linked. Adjustments: None. (5) ‘Inappropriate words/phrases’ Professionals, and to a lesser extent patients, noted a number of instances Inhibitors,research,lifescience,medical of inappropriate wording in the Danish translation of the DTQP. Recommendation: Despite the modifications listed below, some patients may still need rewording or explanation for comprehension of specific questions. Dignity Therapy should always be offered in a fashion that makes it accessible and comfortable, irrespective of the cultural context Inhibitors,research,lifescience,medical or language in which it is being conducted. Adjustments: The terms ‘specific’, ‘particular’ and ‘would want’ (questions 3, 7, and 9) were removed from the Danish version to make these questions less formal and less complex. To deemphasize the term ‘roles’ (question 4) – which is an uncommon Danish term – and to create more awareness of the examples, the word ‘roles’ and the brackets were removed from the examples ‘e.g. in Inhibitors,research,lifescience,medical the family, job wise or in the community etc’. To shorten question 7, the formulation ‘take the time to’ was removed. Inhibitors,research,lifescience,medical “Other things” in question 12 became

“more” in the Danish version, which is considered to be more inclusive. (6) Interference with the lives of others Both professionals and patients reacted to particular words in question 10 and 11 that were considered to be too interfering or demanding on the relatives. This was not the original intent

of the questions, which were designed to give patients an opportunity to provide their family members messages of comfort and support. Adjustments: Inhibitors,research,lifescience,medical To make the issue of passing on comforting and helpful messages more clear, the first part of question 11 including the word ‘instructions’ was changed into “Is there anything you could say.” Questions 1, 5, 8, and 10 were not changed in the Danish version as there was no support of the professionals’ concerns in the patient data and as we wanted to make adaptations to the DTQP only when necessary. Adaptation of DT in general Even though several enough Danish patients questioned the term ‘dignity’, it is important to note that the term ‘dignity’ is not referenced in the DTQP. While it was beyond the scope of this study to address this issue adequately, the patients response suggests that a future study of Dignity Therapy would demand that careful attention be paid to how DT is this website introduced, ensuring that the language used and the rationale provided not be overly existentially confrontative. In practice, the title would also have to be deemphasized when presenting the intervention, and more emphasis be placed on the content of the intervention.