GPs' views of discussions of prognosis in severe COPD. Export

@article{citeulike:1219464, abstract = {BACKGROUND: Modern palliative care promotes open communication between doctor and patient, which includes access to information about prognosis. GPs play a major role in managing chronic obstructive pulmonary disease (COPD) patients in the final stages of illness. Their views of discussions of prognosis 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 prognosis 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 inner London Health Authority (n = 389) in April 1999. Questionnaire development 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 discussions of prognosis were often necessary or essential in severe COPD. The majority (82\%) felt that GPs have an important role in these discussions. However, only a minority (41\%) of GPs reported often or always discussing prognosis. Half the GPs were undecided as to whether most patients with COPD wanted to know about their prognosis. Among the GPs who reported rarely or never discussing prognosis (n = 33), a majority felt ill-prepared to discuss the subject (60\% reported that there was insufficient information in the primary care notes to be able to discuss prognosis, and 64\% found it hard to start discussions with patients). CONCLUSION: Although the majority of GPs acknowledged a need to discuss prognosis 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 the disease in primary care. Uncertainty among GPs as to how patients view the discussion of prognosis and inadequate preparation may pose potential barriers.}, address = {Department of General Practice and Primary Care, Guy's King's and St. Thomas' School of Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.}, author = {Elkington, H. and White, P. and Higgs, R. and Pettinari, C. J.}, citeulike-article-id = {1219464}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/11477053}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=11477053}, issn = {0263-2136}, journal = {Fam Pract}, keywords = {palliative-care, physician}, month = {August}, number = {4}, pages = {440--444}, posted-at = {2007-04-10 20:49:20}, priority = {0}, title = {GPs' views of discussions of prognosis in severe COPD.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/11477053}, volume = {18}, year = {2001} }

TY - JOUR ID - citeulike:1219464 L3 - citeulike-article-id:1219464 N2 - BACKGROUND: Modern palliative care promotes open communication between doctor and patient, which includes access to information about prognosis. GPs play a major role in managing chronic obstructive pulmonary disease (COPD) patients in the final stages of illness. Their views of discussions of prognosis 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 prognosis 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 inner London Health Authority (n = 389) in April 1999. Questionnaire development 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 discussions of prognosis were often necessary or essential in severe COPD. The majority (82%) felt that GPs have an important role in these discussions. However, only a minority (41%) of GPs reported often or always discussing prognosis. Half the GPs were undecided as to whether most patients with COPD wanted to know about their prognosis. Among the GPs who reported rarely or never discussing prognosis (n = 33), a majority felt ill-prepared to discuss the subject (60% reported that there was insufficient information in the primary care notes to be able to discuss prognosis, and 64% found it hard to start discussions with patients). CONCLUSION: Although the majority of GPs acknowledged a need to discuss prognosis 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 the disease in primary care. Uncertainty among GPs as to how patients view the discussion of prognosis and inadequate preparation may pose potential barriers. IS - 4 JF - Fam Pract SN - 0263-2136 AD - Department of General Practice and Primary Care, Guy's King's and St. Thomas' School of Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. EP - 444 TI - GPs' views of discussions of prognosis in severe COPD. VL - 18 SP - 440 KW - palliative-care KW - physician AU - Elkington, H AU - White, P AU - Higgs, R AU - Pettinari, CJ PY - 2001/08// UR - http://view.ncbi.nlm.nih.gov/pubmed/11477053 ER -