Gut feelings in the diagnostic process of Spanish GPs: a focus group study

Oliva, Bernardino; March, Sebastià; Gadea, Cristina; Stolper, Erik; Esteva, Magdalena

doi:10.1136/bmjopen-2016-012847

Cited by 24 publications

(56 citation statements)

References 28 publications

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“…35 The Danish cancer pathway for patients with Denmark Cross-sectional 1278 patients Cancer serious non-specific symptoms and signs of cancer -a cross-sectional study of patient characteristics and cancer probability Johansen et al (2012) 39 How does the thought of cancer arise in Norway Qualitative interviews 11 GPs Cancer a general practice consultation? Interviews with GPs Oliva et al (2016) 37 Gut feelings in the diagnostic process of Spain Qualitative focus 20 GPs Cancer Spanish GPs: a focus group study groups RevMan (version 5.3). Finally, qualitative and quantitative data were combined into a descriptive overview of findings.…”

Section: How This Fits Inmentioning

confidence: 99%

Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence

et al. 2020

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BackgroundGrowing evidence for the role of GPs’ gut feelings in cancer diagnosis raises questions about their origin and role in clinical practice.AimTo explore the origins of GPs’ gut feelings for cancer, their use, and their diagnostic utility.Design and settingSystematic review and meta-analysis of international research on GPs’ gut feelings in primary care.MethodSix databases were searched from inception to July 2019, and internet searches were conducted. A segregated method was used to analyse, then combine, quantitative and qualitative findings.ResultsTwelve articles and four online resources were included that described varied conceptualisations of gut feelings. Gut feelings were often initially associated with patients being unwell, rather than with a suspicion of cancer, and were commonly experienced in response to symptoms and non-verbal cues. The pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded (OR 4.24, 95% confidence interval = 2.26 to 7.94); they became more predictive of cancer as clinical experience and familiarity with the patient increased. Despite being included in some clinical guidelines, GPs had varying experiences of acting on gut feelings as some specialists questioned their diagnostic value. Consequently, some GPs ignored or omitted gut feelings from referral letters, or chose investigations that did not require specialist approval.ConclusionGPs’ gut feelings for cancer were conceptualised as a rapid summing up of multiple verbal and non-verbal patient cues in the context of the GPs’ clinical knowledge and experience. Triggers of gut feelings not included in referral guidance deserve further investigation as predictors of cancer. Non-verbal cues that trigger gut feelings appear to be reliant on continuity of care and clinical experience; they tend to remain poorly recorded and are, therefore, inaccessible to researchers.

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Section: How This Fits Inmentioning

confidence: 99%

Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence

et al. 2020

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“…However, child abuse is often more hidden, and the signals are vague. Diagnostic reasoning is generally a mixture of analytical and non-analytical, intuitive aspects, where gut feelings help GPs to navigate safely in uncertain situations [17][18][19]. Previous research among GPs in Europe showed that they acknowledge gut feelings a valuable diagnostic tool [17,19,20].…”

Section: Introductionmentioning

confidence: 99%

GPs’ suspicion of child abuse: how does it arise and what is the follow-up?

Stolper

Verdenius²,

Dinant

et al. 2020

Scandinavian Journal of Primary Health Care

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Background: Child abuse is widespread, occurs in all cultures and communities, remains undiscovered in 90% of cases and has serious long-term effects. Physicians generally underidentify and underreport child abuse. To understand this low reporting rate and how the suspicion of child abuse arises, we examined GPs' experiences. Research questions: How does the suspicion of child abuse arise in GPs' diagnostic reasoning? How do they act upon their suspicion and which barriers do they encounter in their management? Methods: Twenty-six GPs participated in four focus groups. We used purposive sampling to include GPs with different levels of experience. We performed a thematic content analysis. Results: Suspicion of child abuse arose from common triggers and a gut feeling that 'something is wrong here'. GPs acted upon their suspicion by gathering more data, through history taking and physical examination. They often found it difficult to decide whether a child was abused, because parents, despite good intentions, may simply lack parenting skills and have different values. Clear signs of sexual abuse and physical violence were institutionally reported by GPs, whereas in less clear-cut cases they followed them up and built a supporting network of professionals around the family. Conclusions: A low child abuse reporting rate by GPs to CACRC does not mean a low detection rate. In trying to improve a child's situation, GPs make use of patients' trust in their doctor by involving other professionals. Awareness of the role of gut feelings in developing a suspicion may increase early detection and preventive actions. KEY POINTS Physicians generally underidentify and underreport child abuse. Suspicion of child abuse arose from common triggers and a gut feeling that 'something is wrong here'. GPs acted upon their suspicion by gathering more data, through history taking and physical examination. GPs found it difficult to decide whether a child was abused, because parents, despite good intentions, may lack parenting skills.

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“…When they do so, they have to ask more specific questions, adopt an even more attentive attitude and observe more accurately to identify the trigger that gave them the sense of alarm. The role of GFs in the GP’s diagnostic process has been studied in countries such as the Netherlands, Belgium, France and Spain 6–9. These studies show two types of GF.…”

Section: Introductionmentioning

confidence: 99%

“…The sense of alarm arises especially when diffuse symptoms are suspected to hide a neoplasm 6 7 9. The role of GFs in the diagnosis of cancer has been little studied so far.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and diagnostic value of GPs’ gut feelings for cancer and serious diseases: protocol for a prospective observational study of diagnostic validity

et al. 2019

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IntroductionCancer diagnosis in primary care is an important challenge for general practitioners (GPs) due to the relatively low frequency of any single type of cancer and the heterogeneous signs and symptoms that can be present. In addition to analytical reasoning, GPs may become aware of gut feelings (GFs) as they suspect that a patient may have cancer or another serious disease. We aimed to investigate the prevalence and the predictive value of GFs for the diagnosis of cancer and serious diseases.Methods and analysisProspective observational study of diagnostic validity. Participation will be offered to GPs from Majorca and Zaragoza (Spain). They will recruit all patients with a new reason for encounter during one or two workdays. GPs will complete the Gut Feelings Questionnaire (GFQ). Variables regarding patient, GP and consultation will be collected. Two and 6 months after the first visit, incident diagnoses of cancer or other serious diseases, diagnostic tests performed, referrals and new visits will be recorded. Analysis will include a descriptive analysis of the variables and prevalence of GFs, and the sensitivity, specificity, predictive values and likelihood ratios of the GFs (sense of alarm and sense of reassurance) for diagnosing cancer and other serious diseases, as measured with the GFQ.Ethics and disseminationThe study has obtained approval from the Majorcan Primary Care Research Committee and from the Balearic Islands Ethical Committee, with reference number IB 3210/16 PI. The results may help GPs to make more accurate decisions about which patients need further examinations to rule out or to confirm a diagnosis of cancer or a serious disease, and which ones do not. The results will be published as part of the PhD project of the first author and in open access journals, and will be presented at medical conferences.

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Gut feelings in the diagnostic process of Spanish GPs: a focus group study

Cited by 24 publications

References 28 publications

Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence

Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence

GPs’ suspicion of child abuse: how does it arise and what is the follow-up?

Prevalence and diagnostic value of GPs’ gut feelings for cancer and serious diseases: protocol for a prospective observational study of diagnostic validity

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