• Pat Mulcahy, Stephen Buetow, Liesl Osman, Gregor Coster, Yvonne Bray, Patrick White, and Helena Elkington.
• Department of General Practice and Primary Care, Kings College, Guy's, King's and St. Thomas' School of Medicine, London, UK. pat.mulcahy@laurencekirk.grampian.scot.nhs.uk
• Fam Pract. 2005 Oct 1;22(5):538-40.

BackgroundA palliative care approach, as used routinely in cancer, is also valid for incurable chronic illnesses such as chronic obstructive airways disease (COPD). However, a London study recently reported that general practitioners (GPs), who provide most end-stage care for COPD patients, do not routinely discuss prognosis with these patients.ObjectiveTo compare the views of GPs in Auckland, New Zealand (NZ) and London, United Kingdom (UK) on discussions of prognosis in severe COPD.MethodA postal questionnaire of 509 randomly selected Auckland GPs. The questionnaire was almost identical to the UK one. Comparisons were made with aggregated statistics for the London sample as reported in published findings and personal communication with the London authors.ResultsThe Auckland response rate of 56% was similar to that of the London study (55%). Most GPs in both samples stated that discussions on prognosis are necessary in severe COPD and that GPs have an important role in discussing prognosis. Smaller proportions of both samples reported usually having such discussions, although Auckland GPs (55.6%) were more likely to hold the discussions than were London counterparts (40.7%). Auckland GPs were also more likely to agree that patients with severe COPD want to discuss prognosis and that patients value these discussions. One-third of the Auckland GPs and nearly half the London GPs believe that some patients with severe COPD who want to discuss prognosis are not given the opportunity to do so.ConclusionAuckland GPs are more open than their London counterparts to discussing prognosis in severe COPD. There is increased scope for GPs in London to discuss prognosis with these patients. Further support is needed for GPs in both countries who do not routinely discuss prognosis in severe COPD, but consider it is necessary to have these discussions.

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