RATIONALE: Little direction exists on how to integrate early palliative care in chronic obstructive pulmonary disease (COPD). OBJECTIVES: To identify patient and family caregiver early palliative care needs across stages of COPD severity. METHODS: As part of the Medical Research Council Framework developmental phase for intervention development, we conducted a formative evaluation study of patients with moderate to very severe COPD (FEV1/FVC < 70% and FEV1 < 80%-predicted) and their family caregivers. Validated surveys on quality of life (QOL), anxiety and depressive symptoms, and social isolation quantified symptom severity. Semi-structured interviews were analyzed for major themes on early palliative care and needs in patients and family caregivers and across COPD severity stages. RESULTS: Patients (n=10) were a mean (±SD) age of 60.4±7.5 years, 50% African American, and 70% male, with 30% having moderate COPD, 30% severe COPD, and 40% very severe COPD. Family caregivers (n=10) were a mean age of 58.3±8.7 years, 40% African American, and 10% male. Overall, 30% (n=6) of participants had poor QOL, 45% (n=9) had moderate-severe anxiety symptoms, 25% (n=5) had moderate-severe depressive symptoms, and 40% (n=8) reported social isolation. Only 30% had heard of palliative care, and most participants had misconceptions that palliative care was end-of-life care. All participants responded positively to a standardized description of early palliative care and were receptive to its integration as early as moderate stage. Five broad themes of early palliative care needs emerged: 1) coping with COPD; 2) emotional symptoms; 3) respiratory symptoms; 4) illness understanding; and 5) prognostic awareness. Coping with COPD and emotional symptoms were commonly shared early palliative care needs. Patients with very severe COPD and their family caregivers prioritized illness understanding and prognostic awareness compared to those with moderate-severe COPD. CONCLUSIONS: Patients with moderate to very severe COPD and their family caregivers found early palliative care acceptable and felt it should be integrated before end-stage disease. Of the five broad themes of early palliative care needs, coping with COPD and emotional symptoms were the highest priority, followed by respiratory symptoms, illness understanding, and prognostic awareness.