Building the case for the use of gut feelings in cancer referrals: perspectives of patients referred to a non-specific symptoms pathway

Abstract

BackgroundGut feelings may be useful when dealing with uncertainty, which is ubiquitous in primary care. Both patients and GPs experience this uncertainty but patients’ views on gut feelings in the consultation have not been explored.AimTo explore patients’ perceptions of gut feelings in decision making, and to compare these perceptions with those of GPs.Design and settingQualitative interviews with 21 patients in Oxfordshire, UK.MethodPatients whose referral to a cancer pathway was based on their GP’s gut feeling were invited to participate. Semi-structured interviews were conducted from November 2019 to January 2020, face to face or over the telephone. Data were analysed with a thematic analysis and mind-mapping approach.ResultsSome patients described experiencing gut feelings about their own health but often their willingness to share this with their GP was dependent on an established doctor–patient relationship. Patients expressed similar perspectives on the use of gut feelings in consultations to those reported by GPs. Patients saw GPs’ gut feelings as grounded in their experience and generalist expertise, and part of a process of evidence gathering. Patients suggested that GPs were justified in using gut feelings because of their role in arranging access to investigations, the difficult ‘grey area’ of presentations, and the time- and resource-limited nature of primary care. When GPs communicated that they had a gut feeling, some saw this as an indication that they were being taken seriously.ConclusionPatients accepted that GPs use gut feelings to guide decision making. Future research on this topic should include more diverse samples and address the areas of concern shared by patients and GPs.

How patients in general practice voice and value their gut feelings about health: a qualitative interview study

“…Patients' impressions of the way GPs used their own gut feelings in clinical decision-making were similar to those reported by GPs. (25) Our study found that some Belgian patients seemed to be more reticent about informing their GP of their gut feelings than Dutch patients. This might be explained by cultural differences as indications for similar differences were found in an earlier study.…”

“…In a previous study that examined how patients perceived the role of GPs’ gut feelings in clinical decision making, some patients described their own gut feeling as ‘something is wrong’. 25 They explained that their gut feeling was based on the knowledge of their body and what was normal for them. This gut feeling led to action in the form of seeking medical help.…”

“…This previous study also found that patients’ impressions of the way GPs used their own gut feelings in clinical decision making were similar to those reported by GPs. 25 …”

Creating space for gut feelings in the diagnosis of cancer in primary care

“…In a series of recent BJGP articles, our group has explored GPs' gut feelings in relation to the decision to investigate for cancer. [1][2][3] Our first article, a systematic review and metaanalysis, indicated that GPs' gut feelings represent a rapid summing-up of multiple, often subtle, verbal and non-verbal cues noted in the consultation. This summingup could lead to a sense that a patient was seriously unwell, and when GPs had this gut feeling the odds of a cancer diagnosis were four times higher than when no gut feeling was recorded.…”

“…1 Two interview studies then explored gut feelings with GPs and patients, respectively, who had either made referrals or been referred for cancer investigation. 2,3 Both groups perceived gut feeling was gradually honed with increasing clinical experience and personal experience of the patient. Patients said that they thought the 'thorough GP' would validate this short-cut in clinical reasoning through further evidence gathering.…”