Determinants of general practitioner's cancer-related gut feelings—a prospective cohort study

Donker, Gé; Hoek, L. van der; Heins, M.

doi:10.1136/bmjopen-2016-012511

Cited by 34 publications

(83 citation statements)

References 17 publications

(31 reference statements)

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“…Studies have shown that family physicians' gut feeling, or intuition, can be highly predictive of cancer in patients with nonspecific symptoms as well as palpable tumors and abdominal symptoms and that the ability improves with the physician's age and experience. [21,26,27]. Consultancy frequency represents another criterion of interest for further study; an increased frequency of consultancies has been documented during the year prior to a diagnosis of cancer [28,29].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

et al. 2019

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Background: Fast-track referral is an increasingly used method for diagnostic evaluation of patients suspected of having cancer. This approach is challenging and not used as often for patients with only nonspecific symptoms. In order to expedite the diagnostics for these patients, we established Sweden's first Diagnostic Center (DC) focusing on outcomes related to diagnoses and diagnostic time intervals. Material and Methods: The study was designed as a prospective cohort study. Patients aged 18 years who presented in primary care with nonspecific symptoms of a serious disease were eligible for referral to the DC after having completed an initial investigation. Acceptable diagnostic time intervals were defined to be a maximum of 15 days in primary care and 22 days at the DC. Diagnostic outcome, length of diagnostic time intervals and patient satisfaction were evaluated. Results: A total of 290 patients were included in the study. Cancer was diagnosed in 22.1%, other diseases in 64.1%, and no diagnosis was identified in 13.8% of these patients. Patients diagnosed with cancer were older, had shorter patient interval (time from first symptom to help-seeking), shorter DCinterval (time from referral decision in primary care to diagnosis) and showed a greater number of symptoms compared to patients with no diagnosis. The median primary care interval was 21 days and the median DC interval was 11 days. Few symptoms, no diagnosis, female sex, longer patient interval, and incomplete investigations were associated with prolonged diagnostic time intervals. Patient satisfaction was high; 86% of patients reported a positive degree of satisfaction with the diagnostic procedures. Conclusions: We demonstrated that the DC concept is feasible with a diagnosis reached in 86.2% of the patients in addition to favorable diagnostic time intervals at the DC and a high degree of patient satisfaction. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

et al. 2019

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“… 1 Two other studies have reported positive predictive values (PPVs) of GPs gut feelings on 3%–35% concerning diagnoses of cancer. 2 3 These PPVs are comparable or substantial higher than the PPVs of most cancer alarm symptoms presented in primary care, which are mostly below 3%. 4 …”

Section: Introductionmentioning

confidence: 90%

Empathy, burn-out and the use of gut feeling: a cross-sectional survey of Danish general practitioners

2018

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ObjectiveResearch has suggested that physicians’ gut feelings are associated with parents’ concerns for the well-being of their children. Gut feeling is particularly important in diagnosis of serious low-incidence diseases in primary care. Therefore, the aim of this study was to examine whether empathy, that is, the ability to understand what another person is experiencing, relates to general practitioners’ (GPs) use of gut feelings. Since empathy is associated with burn-out, we also examined whether the hypothesised influence of empathy on gut feeling use is dependent on level of burn-out.DesignCross-sectional questionnaire survey. Participants completed the Jefferson Scale of Physician Empathy and The Maslach Burnout Inventory.SettingPrimary care.Participants588 active GPs in Central Denmark Region (response rate=70%).Primary outcome measuresSelf-reported use of gut feelings in clinical practice.ResultsGPs who scored in the highest quartile of the empathy scale had fourfold the odds of increased use of gut feelings compared with GPs in the lowest empathy quartile (OR 3.99, 95% CI 2.51 to 6.34) when adjusting for the influence of possible confounders. Burn-out was not statistically significantly associated with use of gut feelings (OR 1.29, 95% CI 0.90 to 1.83), and no significant interaction effects between empathy and burn-out were revealed.ConclusionsPhysician empathy, but not burn-out, was strongly associated with use of gut feelings in primary care. As preliminary results suggest that gut feelings have diagnostic value, these findings highlight the importance of incorporating empathy and interpersonal skills into medical training to increase sensitivity to patient concern and thereby increase the use and reliability of gut feeling.

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“…In addition, patients may be referred based on their GP’s clinical suspicion of cancer or serious disease (their ‘gut feeling’). 25 26 GPs are also requested to indicate their suspicion of malignancy at this stage. The essential referral criteria are: There is no other urgent referral pathway suitable for this clinical scenario.…”

Section: Aimmentioning

confidence: 99%

The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

et al. 2018

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IntroductionCancer survival in England lags behind most European countries, due partly to lower rates of early stage diagnosis. We report the protocol for the evaluation of a multidisciplinary diagnostic centre-based pathway for the investigation of ‘low-risk but not no-risk’ cancer symptoms called the Suspected CANcer (SCAN) pathway. SCAN is a new standard of care being implemented in Oxfordshire; one of a number of pathways implemented during the second wave of the Accelerate, Coordinate, Evaluate (ACE) programme, an initiative which aims to improve England’s cancer survival rates through establishing effective routes to early diagnosis.Methods and analysisTo evaluate SCAN, we are collating a prospective database of patients referred onto the pathway by their general practitioner (GP). Patients aged over 40 years, with non-specific symptoms such as weight loss or fatigue, who do not meet urgent cancer referral criteria or for whom symptom causation remains unclear after investigation via other existing pathways, can be referred to SCAN. SCAN provides rapid CT scanning, laboratory testing and clinic review within 2 weeks. We will follow all patients in the primary and secondary care record for at least 2 years. The data will be used to understand the diagnostic yield of the SCAN pathway in the short term (28 days) and the long term (2 years). Routinely collected primary and secondary care data from patients not referred to SCAN but with similar symptoms will also be used to evaluate SCAN. We will map the routes to diagnosis for patients referred to SCAN to assess cost-effectiveness. Acceptability will be evaluated using patient and GP surveys.Ethics and disseminationThe Oxford Joint Research Office Study Classification Group has judged this to be a service evaluation and so outside of research governance. The results of this project will be disseminated by peer-reviewed publication and presentation at conferences.

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Determinants of general practitioner's cancer-related gut feelings—a prospective cohort study

Cited by 34 publications

References 17 publications

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

Empathy, burn-out and the use of gut feeling: a cross-sectional survey of Danish general practitioners

The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

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