Patients’ and GPs’ gut feeling for cancer
Research type
Research Study
Full title
Gut feeLings for cANCEr in general practice (GLANCE): an interview study with patients and GPs.
IRAS ID
250642
Contact name
Claire Friedemann Smith
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
0 years, 9 months, 30 days
Research summary
Summary of Research
General Practitioners (GPs) sometimes describe getting an uneasy feeling called a “gut feeling” that makes them think that their patient could be seriously unwell with an illness such as cancer. Sometimes patients, family members, or friends also experience a gut feeling that something is wrong that leads the patient to visit the GP. Identifying cancer in primary care can be challenging as non-specific symptoms can be caused by a range of underlying conditions. Studies show that gut feeling can be a reliable clue that investigations for cancer are needed. At present, no guidelines recommend that GPs should rely on their gut feeling when choosing to refer patients for testing for cancer.Aim
To understand GP and patient definitions and experiences of gut feeling, what contributes to them, and how they respond to them.Method
We propose in-depth interviews, by experienced qualitative researchers, with around 25 GPs who have referred patients to the Oxford Suspected CANcer (SCAN) Pathway, and around 25 patients who were referred to the SCAN Pathway based on gut feeling. Interviews will be informed by a systematic review, and patient and public involvement.This study is part of a wider programme that includes a systematic review of published literature on GP use of gut feeling, and an analysis of the Oxford Suspected CANcer (SCAN) Pathway database. The aim of the whole programme is to establish what gut feelings are, how they develop, and how useful they are as a referral criterion for diagnostic tests for cancer.
Findings from the study will be fed back to Cancer Research UK and organisations who make guidelines for GPs, with the aim that they will be used in GP education and patient information to improve cancer diagnosis. We will submit our findings for peer-reviewed publication.
Summary of Results
Research has reported that general practitioners (GPs) can experience a 'gut feeling' for when their patient is seriously ill and that GPs' gut feelings can predict which patients will go on to be diagnosed with cancer or another serious illness. In spite of this, using gut feelings to make decisions about a patient's care has been criticised because it does not seem to fit with science-based medicine.We held interviews with GPs who had made a referral to an urgent cancer investigations service based on a gut feeling, and with patients who had been referred to the urgent cancer service based on a gut feeling of their GP. We asked GPs about what caused their gut feeling and how they used it when making decisions about how to care for their patients. We asked patients how they felt about their GP using a gut feeling to make decisions about their care.
GPs told us that they did not make decisions based only on their gut feelings but instead used them as a sign that they should think more carefully about what could be making their patient ill, and to do more tests so that they had more evidence to support their concern for their patient's health. GPs said that they believed being able to use their gut feelings well was part of what made a good GP, especially because they have to make decisions without the types of information available to hospital doctors from more sophisticated scans and tests. GPs said that they believed their gut feelings got more reliable with more experience.
The patients we spoke to told us that they supported their GPs using their gut feeling if it meant that they were sent for tests that would look for cancer. Patients talked about how difficult it could be for GPs to fit their patients in the ‘tick boxes’ so that they could be referred for testing, and they agreed with the GPs that gut feelings were important and should be used because GPs do not have access to the same resources as hospital doctors. The patients said that they believed that if they had known their GP for a long time that their gut feelings would be more reliable and said that if their GP were to have a gut feeling about their health they would feel like they were being taken seriously.
Summary of Results
Research has reported that general practitioners (GPs) can experience a 'gut feeling' for when their patient is seriously ill and that GPs' gut feelings can predict which patients will go on to be diagnosed with cancer or another serious illness. In spite of this, using gut feelings to make decisions about a patient's care has been criticised because it does not seem to fit with science-based medicine.We held interviews with GPs who had made a referral to an urgent cancer investigations service based on a gut feeling, and with patients who had been referred to the urgent cancer service based on a gut feeling of their GP. We asked GPs about what caused their gut feeling and how they used it when making decisions about how to care for their patients. We asked patients how they felt about their GP using a gut feeling to make decisions about their care.
GPs told us that they did not make decisions based only on their gut feelings but instead used them as a sign that they should think more carefully about what could be making their patient ill, and to do more tests so that they had more evidence to support their concern for their patient's health. GPs said that they believed being able to use their gut feelings well was part of what made a good GP, especially because they have to make decisions without the types of information available to hospital doctors from more sophisticated scans and tests. GPs said that they believed their gut feelings got more reliable with more experience.
The patients we spoke to told us that they supported their GPs using their gut feeling if it meant that they were sent for tests that would look for cancer. Patients talked about how difficult it could be for GPs to fit their patients in the ‘tick boxes’ so that they could be referred for testing, and they agreed with the GPs that gut feelings were important and should be used because GPs do not have access to the same resources as hospital doctors. The patients said that they believed that if they had known their GP for a long time that their gut feelings would be more reliable and said that if their GP were to have a gut feeling about their health they would feel like they were being taken seriously.
REC name
Wales REC 6
REC reference
18/WA/0409
Date of REC Opinion
22 Nov 2018
REC opinion
Favourable Opinion