User-centered design of a COPD care pathway embedded in oncology care for patients receiving immune checkpoint inhibitors.

Abstract

1566 Background: Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities among patients treated with an immune checkpoint inhibitor (ICI) for cancer, and it is often underdiagnosed and undertreated. We aimed to assess COPD treatment burden among patients with cancer and design a scalable intervention. Methods: This mixed-methods study enrolled (1) patients with confirmed/suspected COPD and ICI-treated cancer, and (2) clinicians providing ambulatory cancer or COPD care. Semi-structured surveys assessed treatment burden, self-confidence in COPD care, and barriers. Interviews, guided tours, and focus groups informed the user-centered design of a novel COPD care pathway, and the primary endpoint was participant-perceived feasibility. Qualitative analysis used a matrix approach informed by interview-guide constructs and emergent concepts, with quotations synthesized iteratively. Results: Between Feb-Dec 2025, the study team screened 478 individuals to enroll the planned cohort of 100 participants, including 20 patients and 80 clinicians. Nearly all participants completed a survey (n = 96), and 36 completed either an interview, tour, or focus group. Most patients reported their diagnosis of COPD had been confirmed (90%), and all were ≥50 years old. Clinicians were nurses (47%), physicians (44%), or APPs (6%); 41% practiced at a community oncology clinic. Most patients would use COPD-related services if integrated into oncology visits (75%) and 65% felt they had effective treatment options for both cancer and COPD. Nearly all clinicians (97%) agreed that COPD increased the risk of complications during cancer treatments, and 59% agreed that COPD care should be addressed within oncology clinics. Although most reported feeling confident in managing COPD in patients with cancer (80%), many reported a lack of skills to do so (e.g., teaching inhaler technique, 34%). Commonly cited barriers were insufficient time (63%), limited availability of COPD providers (65%), and COPD medication costs (50%). Qualitative analysis identified key themes: limited awareness of COPD guidance in oncology; resource constraints in community clinics; reliance on specialist referrals; conditional willingness to implement a COPD pathway if it did not detract from cancer care; and needs for educational materials and interoperable electronic medical records. These integrated datasets informed the design of a COPD care pathway to be embedded within oncology infusion visits using flowchart-based decision support to stratify COPD control (green/yellow/red) and support self-management and targeted clinician education at the point of care. Conclusions: COPD imposes a substantial treatment burden on patients with cancer, but there are actionable opportunities for care delivery. A user-centered COPD care pathway was designed for feasibility in community oncology settings.