What are the barriers and facilitators to clinicians' ability to meet the needs of patients with advanced COPD and their informal carers?

Talk Code: 

The problem

Chronic obstructive pulmonary disease (COPD) is a progressive condition with high symptom burden. Advanced COPD management should relieve symptoms, optimise daily functioning and reduce carer burden, yet we know little about clinician barriers and facilitators to meeting the needs of these patients and their informal carers.

The approach

Audio-recorded qualitative topic-guided interviews with 45 clinicians nominated by a population-based cohort of patients with advanced COPD participating in the multiple-perspective mixed-method Living with Breathlessness study. Verbatim transcripts analysed using a framework approach.


Participating clinicians included specialists and generalists from medicine and nursing, and across primary and secondary care. Clinician-identified barriers to meeting needs included: managing co-morbidities, lack of referable services, lack of regular or structured patient assessments, communication difficulties, and limited engagement with carers. The lack of clinician knowledge of the presence and needs of informal carers was noteworthy. Clinician-identified facilitators included: trust, communication skills, their educational role and accessibility. Some clinicians described the facilitative effect of the research interview in enabling reflection on their professional practice.


A number of barriers and facilitators to meeting needs in advanced COPD exist for clinicians. Strategies to address these barriers are required in order to improve care and support of patients and their informal carers living with advanced COPD. The Living with Breathlessness study seeks to achieve this through working with stakeholders, including clinicians, to co-develop actionable responses to the study's multiple-perspective findings.


  • Caroline Moore, Kings College, London, UK
  • Morag Farquhar, Kings College, London, UK
  • Carole Gardener, Kings College, London, UK
  • Hanne Holt Butcher, Kings College, London, UK
  • Gail Ewing, Kings College, London, UK
  • Patrick White, Cambridge Community Services, Cambridge, UK
  • Sophie Howson, Cambridge University Hospitals NHDS Foundation Trust, Cambridge, UK
  • Sarah Booth, Rand Europe, Cambridge, UK
  • Ravi Mahadeva, Rand Europe, Cambridge, UK
  • Peter Burge