Background: Chronic obstructive pulmonary disease (COPD) is a chronic, debilitating lung condition with a high mortality rate. Our research has shown that healthcare for end-of-life COPD is poorly integrated and delivered. The involvement of those with severe COPD, their support people and health professionals in the design of healthcare services may improve the delivery of care for advanced COPD, including identifying system-level responsiveness to quality improvement.

Design: Focus group study including stakeholders of healthcare services (patients with end-of life COPD, support people, bereaved family members, Māori and Pasifika consumers, and community- or hospital-based health care professionals). 

Methods: We conducted qualitative analysis using structural and descriptive coding, then pattern coding. Findings were triangulated among investigators. The research positioned people with severe COPD, their support people and health professionals as experts in end-of-life care services for this population. Critical theory and Actor-Network theory informed the data coding analysis. 

Results: Seven focus groups involving 74 participants reported their experiences of end-of-life care for COPD. Five themes related to healthcare systems responses to improving care quality were described: governance, system integration, resource design and development, standardisation of processes and communication. 

Conclusion: Stakeholders provided multiple healthcare system-level responses to end-of-life care in COPD that could improve services. These improvements may inform health funders and providers when considering clinical quality improvement and system design for end-of-life COPD.