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

Abstract

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 identify strategies that general practitioners (GPs) 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 diversity 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 be used to facilitate discussion of prognosis with patients who have severe COPD.