Healthcare professionals' challenges and solutions in providing palliative care to patients with severe chronic obstructive pulmonary disease

Palliative care significantly improves the quality of life for individuals with advanced chronic diseases. However, access in Malaysia remains limited, particularly for patients with non-malignant conditions such as chronic obstructive pulmonary disease (COPD). Here, we discuss the barriers and solutions identified through a nine hour in-person stakeholder workshop to co-develop practical initiatives for integrating palliative care into the management of severe COPD. Key challenges in the assessment of severe COPD included limited training in holistic care, resource constraints, and fragmented care pathways. In management, issues included low awareness and availability of pulmonary rehabilitation, uncertainty in initiating palliative care and difficulty accessing opioids, limited provider training, and patient-level barriers such as stigma and low health literacy. Proposed solutions included cascade training, decentralised care models, strengthened communication skills, and integrated care pathways. This workshop highlighted the need for multidisciplinary training, system-level integration, and culturally responsive care models to improve palliative access for patients with severe COPD. It also underscored the importance of policy engagement to address structural barriers such as opioid regulation and fragmented care. This approach offers a promising model for capacity building in other resource-limited settings.