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Background: Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. Methods/Design: In this study, using a cluster randomised controlled trial (RCT) in 56 general practices in the West Midlands, we plan to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice. Using an individual patient RCT nested in the Targeted arm, we plan also to compare the effectiveness and cost-effectiveness of Active case finding using a postal questionnaire (with supplementary opportunistic questionnaires), and Opportunistic-only case finding during routine surgery consultations. All ever-smoking patients aged 40-79 years, without a current diagnosis of COPD and registered with participating practices will be eligible. Patients in the Targeted arm who report positive respiratory symptoms (chronic cough or phlegm, wheeze or dyspnoea) using a brief questionnaire will be invited for further spirometric assessment to ascertain whether they have COPD or not. Post-bronchodilator spirometry will be conducted to ATS standards using an Easy One spirometer by trained research assistants. The primary outcomes will be new cases of COPD and cost per new case identified, comparing targeted case finding with routine care, and two types of targeted case finding (active versus opportunistic). A multilevel logistic regression model will be used to model the probability of detecting a new case of COPD for each treatment arm, with clustering of patients (by practice and household) accounted for using a multi-level structure. A trial-based analysis will be undertaken using costs and outcomes collected during the trial. Secondary outcomes include the feasibility, efficiency, long-term cost-effectiveness, patient and primary care staff views of each approach. Discussion: This will be the largest RCT of its kind, and should inform how best to identify undiagnosed patients with COPD in the UK and other similar healthcare systems. Sensitivity analyses will help local policy-makers decide which sub-groups of the population to target first. [ABSTRACT FROM AUTHOR]

Communication is a core component of a clinician's role; however, when clinicians conduct research, communicating the emerging findings and recommendations to different types of stakeholders can be unfamiliar territory. Communicating research to advocate for change can be even more challenging. Clinician researchers seeking to be agents for change need to conceive and craft specific, evidence-based messages and communicate these effectively to different stakeholders to negotiate action. As part of a global health research program, we developed and tested a novel game-based model to strengthen the communication skills of clinician researchers, from 4 countries, for improving services for chronic obstructive pulmonary disease. This model focused on communication with 3 key stakeholder groups for knowledge translation: Patients/carers, healthcare providers and policy makers/healthcare managers. Delivered through a series of facilitated, online meetings, this model consisted of 2 parts: developing and rehearsing advocacy messages with coaching support, and then testing them with a panel of 3 representative stakeholders, and an audience of fellow researchers. All the country teams reported increased confidence in crafting advocacy messages for specific stakeholders and have applied lessons learned from the model. Delivering this model within a global health research program requires mentoring, time, commitment, resources and translation support to address language barriers. It offers an exemplar to build the communication skills of clinician and non-clinician researchers so that they can go beyond dissemination toward translation of evidence into policy and practice., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J Correia-De-Sousa declares grant funding to his institution from AstraZeneca and GSK, advisory board and consulting fees paid to himself from Boheringer Ingelheim, GSK, AstraZeneca, Bial, Medinfar, Payment for lectures from GSK, AstraZeneca and Sanofi Pasteur, support for attending meetings from Mundipharma and Mylan, leadership role for International Primary Care Respiratory Group (IPCRG); A Dickens declares grant funding paid to his institution from NIHR GHR for current manuscript; A Farley declares grant funding paid to her institution from NIHR GHR for the present manuscript, grant funding from NIHR HTA, NIHR EME, MRC and Ethicon (Johnson and Johnson) for other work, membership on DMEC for NIHR funded e-cigarette trial (no honorarium), leadership role for International Primary Care Respiratory Group (IPCRG); R Jordan declares grant funding to her institution from NIHR, membership of Boehringer Ingelheim Primary Care Advisory Board, leadership role for International Primary Care Respiratory Group (IPCRG)—research sub-committee; S Martins declares leadership or fiduciary role in Brazilian Society of Medicine and Family and Community; ABC School of Medicine, GEPRAPS ( respiratory group of study and research in primary care), IPCRG (International Primary Care Respiratory Group); A Sitch declares grant funding to her institution from NIHR GHR for present manuscript, NIHR Birmingham BRC and AstraZeneca; A Turner declares grant funding to her institution from NIHR GHR for present manuscript, grant funding from AstraZeneca and Chiesi for other work, payment of honoraria from GSK and Boehringer, support for attending meetings and/or travel from AstraZeneca and Chiesi; S Williams declares grants from the University of Birmingham paid to her institution; G Fernandes, P Adab, R Adams, C Chi, A Enocson, T Maghlakelidze, M Maglakelidze, A Stamenova, K Stavrikj, R Stelmach, Z Pan, H Pang, and J Zhang have no conflicts to declare.