GPs' views of discussions of prognosis in severe COPD

Background. Modern palliative care promotes open communication between doct or and patient, which includes access to information about prognosis. GPs p lay a major role in managing chronic obstructive pulmonary disease (COPD) p atients in the final stages of illness. Their views of discussions of progn osis are therefore important if the principles of palliative care are to be extended to COPD. Objective. Our aim was to investigate the role that discussions of prognosi s play in GPs' management of patients with severe COPD and the factors that influence those discussions. Methods. We conducted a questionnaire survey of all GP principals of one in ner London Health Authority (n = 389) in April 1999. Questionnaire developm ent involved a literature review to identify Issues of importance to GPs in the discussion of prognosis in COPD, and in-depth interviews with five GPs . Results. Of the 214 respondents (55% response), 72.5% thought that discussi ons of prognosis were often necessary or essential in severe COPD. The majo rity (82%) felt that GPs have an important role in these discussions. Howev er, only a minority (41%) of GPs reported often or always discussing progno sis. Half the GPs were undecided as to whether most patients with COPD want ed to know about their prognosis. Among the GPs who reported rarely or neve r discussing prognosis (n = 33), a majority felt ill-prepared to discuss th e subject (60% reported that there was insufficient Information in the prim ary care notes to be able to discuss prognosis, and 64% found it hard to st art discussions with patients). Conclusion. Although the majority of GPs acknowledged a need to discuss pro gnosis in severe COPD, this was not reflected in their reported behaviour. It appears that the palliative care approach of open communication, whilst seen to be relevant to severe COPD, is not applied routinely in managing th e disease in primary care. Uncertainty among GPs as to how patients view th e discussion of prognosis and inadequate preparation may pose potential bar riers.