GP discussion of prognosis with patients with severe chronic obstructive pulmonary disease: a qualitative study.

Background: Recent research shows that health professionals do not communicate about prognosis with patients with chronic obstructive pulmonary disease (COPD) as openly as with patients who have cancer. Aim: To idendtify strategies that general practitioners (GFs) can use to facilitate discussion of prognosis with patients who have COPD.

Design of study: Telephone interviews of 15 GPs and five respiratory consultants on the topic of discussing prognosis with patients who have severe COPD.

Setting. Participating doctors worked in the Auckland region of New Zealand

Method. GPs and consultants were selected purposively to detect unique and shared patterns from diversiy in how prognosis is discussed with patients with severe COPD. An interview guide was developed from a literature review and results of our earlier postal survey of GPs. Transcripts of audiotaped interviews were analysed independently and then together by three authors, using a general inductive approach.

Results Seven strategies were identified that GPs had used or could use to facilitate discussion of prognosis with patients with COPD. These were be aware of implications of diagnosis, use uncertainty to ease discussion; build relationship with patients; be caring and respectful; begin discussion early in disease course; identify and use opportunities to discuss prognosis, and work as a team.

Conclusion: A number of suggested strategies can he used to facilitate discussion of prognosis with patients who have severe COPD.