Gauging the Feasibility of Recommendations from the Living with Breathlessness Study

woman in oxygen mask


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, carried out by the University of Cambridge, 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. The findings from the different strands of the Living with Breathlessness research programme led to six emerging recommendations for improving care and support of patients with advanced COPD and their informal carers.


RAND Europe was commissioned by the University of Cambridge to answer two key questions:

  • Do stakeholders who work with people living with advanced COPD agree that the emerging recommendations from the Living with Breathlessness Study would improve care for people with COPD?
  • How easy do stakeholders who work with people living with advanced COPD consider it would be to implement the Living with Breathlessness recommendations in their place of work?


The recommendations from the study were road-tested in a stakeholder workshop at the end of October 2015. Following the workshop, the project team carried out an online survey of wider stakeholders who work with people living with advanced COPD in order to explore further 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.


  • 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.


  • Ensure that each recommendation is clearly targeted at the most relevant groups for implementation.
  • Consider and address the concerns of stakeholders expressed in the free-text survey responses received.
  • Consider focal changes to, and professional copyediting of, the wording of some recommendations before they are used in the future.


Project Team

Katie Saunders
Peter Burge
Morag Farquhar
Sarah Grand-Clement
Susan Guthrie
Tom Ling