The work, conducted alongside the Morphine and BrEathLessness (MABEL) trial of the clinical effectiveness and safety of regular low-dose oral modified release morphine, examined how clinicians’ experiences, attitudes and practices shape the prescription of morphine for the symptomatic reduction of chronic breathlessness.
Chronic breathlessness is a substantial problem: the study’s background notes that shortness of breath affects almost 10% of the general population, particularly people with lung or heart disease receiving palliative care. Reducing breathlessness by implementing effective pharmacological and non-pharmacological treatment is described as vital for relieving the physical and mental suffering associated with chronic illness.
The researchers designed the implementation study using Normalisation Process Theory to inform the survey and interview components. It combined three components: a Learning Needs Assessment survey offering an early indication of clinicians’ experiences and knowledge; the Normalisation Measurement instrument (NoMAD) survey at two time points, measuring the extent to which morphine prescribing fitted with current practice; and semi-structured interviews with clinicians exploring perspectives on safe morphine use.
Participation was drawn from clinicians at participating trial sites. The Learning Needs Assessment included 75 respondents, of whom 43% were doctors, 51% nurses and 6% other or not stated. The first NoMAD survey included 64 participants (45% doctors, 50% nurses, 5% other), and the second included 27 (41% doctors, 52% nurses, 9% other). Eight clinicians took part in interviews, five doctors and three nurses.
The survey results revealed a striking gap between acceptance of the practice and preparation for it. Two-thirds of Learning Needs Assessment respondents agreed they had learning needs about the use of morphine for breathlessness. In the NoMAD surveys, 92% viewed morphine for breathlessness as a legitimate part of their role, but only 36% thought sufficient training about its use was provided.
The NoMAD surveys also revealed a gap between clinicians' confidence in their own ability to embed the practice and their confidence in colleagues. While 81% of respondents stated they could integrate the use of morphine for breathlessness into their existing work, only 39% had confidence in colleagues to do so. That asymmetry, in which individual clinicians feel capable but doubt the wider team, emerged as a central barrier to implementation.
The interviews reinforced the survey findings and added a richer picture of how implementation actually works. Communication and co-ordination across settings and specialisms were found to underpin whether morphine prescribing for breathlessness could be delivered safely, pointing to the organisational rather than purely individual nature of the challenge.
The study’s conclusions draw the threads together. Morphine prescription for breathlessness management is seen by clinicians as a legitimate part of their role, but a lack of training opportunities, resources, and confidence in the skills of others impedes successful implementation. Robust communication and shared decision-making between clinicians, and between clinicians and patients, across settings and specialisms can support the delivery of a safe, effective approach when morphine is being considered for breathlessness.
The findings come from the implementation strand of a registered trial, ISRCTN87329095, registered on 25 February 2019, with EudraCT number 2019-002479-33. As an implementation study of clinicians at trial sites, the results describe the attitudes and practices of the participating workforce rather than the clinical effects of morphine itself, which are the subject of the parent MABEL trial. The article was published as open access research on 28 October 2026, with the author team including M. Pearson, A. Mohamed, S. Bajwah, M.T. Fallon, K. Date, B. Williams, D.C. Currow and M.J. Johnson.
Subject of Research: Implementation of safe morphine prescribing and monitoring for chronic breathlessness among clinicians
Article Title: What enables the safe prescription and monitoring of morphine for chronic breathlessness? Insights from a Normalisation Process Theory-informed implementation survey and interviews with clinicians
Article References: Pearson, M., Mohamed, A., Bajwah, S., Fallon, M. T., Date, K., Williams, B., Currow, D. C., & Johnson, M. J. (2026). What enables the safe prescription and monitoring of morphine for chronic breathlessness? Insights from a Normalisation Process Theory-informed implementation survey and interviews with clinicians. BMC Palliative Care. https://doi.org/10.1186/s12904-026-02337-0
Image Credits: AI Generated
DOI: 10.1186/s12904-026-02337-0
Keywords: morphine, chronic breathlessness, palliative care, implementation science, Normalisation Process Theory, NoMAD survey, clinician training, MABEL trial, prescribing safety, interdisciplinary communication, BMC Palliative Care, enables
News Source: Ophelia Keating. (October 28, 2026). Clinicians back morphine for chronic breathlessness but warn training and trust fall short. Scienmag.
