Sample and setting
The sample for this study comprised nine individuals, consec- utively drawn from among those attending a hospice in a northern city in England. Inclusion criteria included: at least 18 years of age; self-reported experience of tiredness, fatigue or exhaustion; considered to be in the palliative stage of an illness (where the patient has active, progressive or advanced disease and the focus of care is quality of life); able to provide informed consent; resident in a selected city in northern England for 10 years and sufficient energy to participate in a half hour recruitment interview and two interviews lasting up to 45 min each. Cultural and racial diversity were welcomed with the proviso that all selection criteria were satisfied. Individuals were excluded if they were unable to read and write English. In keeping with standard practice in qualitative studies, the sample size was determined by saturation of analytic categories. Participants were added to the study until all analytic categories were saturated and no new information was obtained.