An exploratory, sequential mixed methods study will be conducted involving a qualitative and quantitative study (DCE) [34]. In an exploratory sequential design, data are first collected and analyzed through qualitative investigation, followed by further exploration of themes derived from the qualitative data via a quantitative investigation. The results from both sets of data are then integrated and interpreted [35]. The attributes of the DCE will be identified from a literature review and the qualitative survey based on previous pilot study results [29]. The results of the qualitative and quantitative study phases will be compared to determine the degree of consistency. This study, which is expected to be completed within 1 year, will be divided into three phases, which are illustrated in the procedural diagram (Figure 1): (1) an update of the existing evidence [23] on the efficacy, safety, economic benefits, and patient satisfaction related to TCM in treating COPD (phase 1; 3 months); (2) a qualitative investigation involving semistructured interviews to explore the perception of COPD, expectations of interventions, and attitudes toward TCM, among other aspects (phase 2; 3 months); and (3) a cross-sectional DCE, which aims to understand participants’ preferences for the TCM interventions and assess the relative importance of different attributes of treatment scenarios through a questionnaire (phase 3; 4 months).

Patients aged ≥18 years with a diagnosis of COPD based on The Global Initiative for Chronic Obstructive Lung Disease criteria assessed by a clinical specialist [19] who currently prescribes or has previously prescribed TCM and is able to communicate in Mandarin will be included. Patients with evidence of mental illness, who are judged unable to cooperate or complete the survey, or who are receiving TCM to treat other diseases but not COPD will be excluded. There are no restrictions on the stage and severity of the condition, and a broad range of participants is expected to be enrolled to draw comprehensive conclusions.

Preferences can be diverse in patients from different hospital backgrounds. Recruitment of participants will be conducted based on sufficiently broad background characteristics. Therefore, patients will be recruited from various hospitals. Additional participants will be recruited through newsletters, flyers, or advertisements or when they return for a hospital visit. Participants who have taken part in the interviews will also be invited to take part in the subsequent survey.

All participants will be informed about the study and will sign a consent form before undergoing study procedures.

This study will be conducted in a private room at the hospital rather than in the clinic so that patients can relax and openly discuss the interview questions or complete the questionnaires.

The sample size for the semistructured interviews will be determined through data saturation, and representative participants will be identified using a purposeful sampling strategy. Data saturation will be reached when no additional novel themes emerge from interviews with participants after data analysis and a sufficient number of participants with different characteristics have been interviewed. Between 10 and 20 potential participants will be included in each site considering the diversity of hospitals.

Multiple factors should be considered in the sample size estimation of the DCE survey, such as the heterogeneity of participants, the structure of the DCE questions, the items of the questionnaire, and the expected precision of the results. A sufficiently large sample size is crucial for capturing significant preference changes in the observed population and distinguishing different preferences among subgroups. However, large-scale studies require substantial resources. The thumb formula is a method proposed by Johnson and Orme [36] to calculate the minimum sample size. Considering the limited resources of this study, we used this formula to calculate the minimum sample size required for the DCE main-effects model. In this formula, 500 is a fixed variable, c is the maximum number of levels in any attribute, t is the number of DCE questions per questionnaire, and a refers to the number of options included in each DCE question:

This study was reviewed and determined to be exempt from full ethical review by the ethics committee of Guangdong Provincial Hospital of Traditional Chinese Medicine on November 6, 2023 (ZM2023-405). Informed consent will be obtained from all participants.

In this study, we seek to understand the treatment preferences and needs of patients with COPD regarding TCM. Our findings are anticipated to provide new insights into how patients’ personal values and experiences shape treatment choices, helping physicians tailor clinical decisions to individual characteristics and needs.

EBM is defined as “the conscientious, explicit, and judicious use of the current best evidence to make medical decisions for individual patients” [40]. True EBM prioritizes individualized patient care by integrating clinical evidence with the unique contexts, experiences, and preferences of patients [41]. However, over the years, investigators have been committed to addressing patient population and subgroup-specific issues when designing and conducting clinical studies, often at the expense of individual patient differences to achieve more generalized findings and broader application prospects. Nevertheless, contemporary research, guideline development, and even clinical decision-making continue to insufficiently reflect individual patients’ values and preferences [42,43].

The personal experience of patients is extremely important and difficult to standardize, and conclusions drawn from studies on general patient populations should not outweigh those drawn by individual patients through their own experiences. Therefore, recent advances in EBM call for a more balanced approach that integrates critical evidence appraisal with patients’ values and preferences through SDM [44]. Achieving this integration requires clinicians to invest substantial time and effort in explaining, discussing, and negotiating treatment options with patients.

Previous studies on the treatment preferences of patients with COPD have mainly focused on conventional therapies such as inhalers, pharmacotherapy, and lung transplantation [45,46]. A pilot study by our team suggested that preferences for TCM may be influenced by perceived efficacy, side effects, and cost, but these findings require validation in larger samples [29]. Moreover, previous research has rarely examined patient perceptions of specific TCM interventions or accounted for individual values, experiences, and cultural factors.

This study has several strengths. First, it comprehensively captures the preferences and needs of patients with COPD regarding TCM through an exploratory sequential mixed methods study design that allows for a comparative analysis examining the relationship between patient preferences and individual backgrounds, helping identify patterns of homogeneity or divergence in treatment inclinations. Second, the use of narrative medicine in the interviews enables a deeper exploration of patients’ true experiences and perceptions, mitigating biases that arise when patients favor previously used treatments even when there is new evidence suggesting alternatives [47]. Finally, including patients from diverse hospital backgrounds and with diverse treatment experiences ensures that multiple perspectives are represented.

However, several limitations should be acknowledged. Patient preferences may still be influenced by cognitive perceptions, social determinants, environmental factors, or previous experiences, which could limit generalizability. Future multicenter studies with larger samples are needed to validate and extend these findings.

The findings will be shared at national and international conferences focused on respiratory and integrative medicine. For scientific publication, results will be submitted to peer-reviewed journals related to respiratory care, patient-centered medicine, or integrative medicine. To reach patients and caregivers, summaries will be disseminated via patient organizations, hospital newsletters, and social media channels. These efforts aim to ensure that the study results are accessible and understandable to both the scientific community and the wider public.

In conclusion, this exploratory sequential mixed methods study will generate empirical evidence on the treatment preferences of patients with COPD regarding TCM, offering a foundation for SDM and patient-centered COPD care. The anticipated findings will contribute to personalized treatment strategies; inform integrative guideline development; support SDM; and, ultimately, improve patient adherence and satisfaction. Future work will extend recruitment across multiple regions and countries to enhance generalizability and explore digital health applications that integrate patient preference modeling into clinical decision support systems.