Table 1.

The five stages of the BEAMS study

	Time period	Detail
Stage 0	2 days	Baseline assessments: Diary entries for 2 days to provide stable baseline data and to become accustomed to data collection tools Baseline demographic data, physical assessment, research team mediated questionnaires, assessments and testing Fitbit assessment of baseline function Provided with handheld fan and practical advice on managing breathlessness
Stage 1	1 week	First randomisation: Randomisation 1:1:1 to receive either placebo or 8 mg ER morphine or 16 mg ER morphine Participants receiving ER morphine will also receive docusate with senna. Placebo arm will receive identical placebo laxative Fitbit assessment of function
Stage 2	1 week	Second randomisation: While continuing in arm assigned at first randomisation, add second randomised treatment. 1:1 randomisation to the addition of either placebo or 8 mg ER morphine Blinded docusate with senna will replace laxative placebo for those newly randomised to receive ER morphine.
Stage 3	1 week	Third randomisation: While continuing in arms assigned at first and second randomisation, add third randomised treatment. 1:1 randomisation to addition of either placebo or 8 mg ER morphine Blinded docusate with senna will replace laxative placebo for those newly randomised to receive ER morphine. Fitbit assessment of function
Stage 4	Up to 6 months	Optional extension study: Participant may continue blinded treatment for up to 6 months on the final dose to which they were titrated. Assessments establishing long-term net effects of study medication

BEAMS, Breathlessness, Exertion And Morphine Sulfate; ER, extended release.