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• There is a significant level of support for these recommendations among healthcare practitioners and others working with people with COPD.
• The vast majority of respondents agreed that each of the recommendations would have the potential to improve quality of life for COPD patients.
• Respondents also expressed caution around ease of implementation of these recommendations, with only around half of respondents indicating that implementation would be straightforward in most cases.
• Concerns largely focus on the time and resources needed to implement these findings and, in particular, to respond appropriately to any unmet needs identified through more patient-focused and holistic analysis of patient and carer needs.
• There was also a notable dissatisfaction with 'tick box' or target-led approaches, so care would need to be taken to ensure that any adopted recommendations do not just add another item to the list of targets practitioners have to meet.
• Many respondents felt that they were already incorporating many elements of these recommendations into their existing practice, suggesting that, although there may be some challenges in implementing these recommendations, they are not insurmountable.

Chronic obstructive pulmonary disease (COPD) carries a high symptom burden. Management of patients with advanced COPD should address patients' symptoms and care needs, optimise daily functioning and stabilise health status. The Living with Breathlessness study explored the question of how patients' and carers' needs change along the trajectory of advanced COPD and how guidelines should be amended to meet these changing needs.

Six recommendations emerged from the study; we carried out an online survey of stakeholders who work with people living with advanced COPD in order to explore whether they agreed that the recommendations would improve care for people with COPD and what their opinions were on the ease of implementation of such recommendations in their place of work.

Overall there was high agreement that all of the recommendations would improve care and support for people with advanced COPD; however, the survey also revealed caution around the ease of implementing some of these recommendations, as well as variation in responses among professional groups and settings. Concerns largely focused on the time and resources needed to implement the recommendations and, in particular, the resources needed to respond appropriately to any unmet needs identified through the more patient-focused and holistic analysis of patient and carer needs that these recommendations represent.

The evidence from this survey suggests that there is a significant level of support for these recommendations among healthcare practitioners working with people with COPD. The vast majority of survey respondents agreed that each of the recommendations has the potential to improve the quality of life for COPD patients.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Findings

• Chapter Four

  Conclusions

• Chapter Five

  Appendix