Patient–physician relationship and use of gut feeling in cancer diagnosis in primary care: a cross-sectional survey of patients and their general practitioners

Abstract

ObjectivesTo examine whether the quality of the patient–physician relationship, assessed by the general practitioner (GP) and the patient, associates with GPs’ use of gut feeling (GF) in cancer diagnosis.DesignCross-sectional questionnaire survey of cancer patients and their GPs.SettingDanish primary care.ParticipantsNewly diagnosed cancer patients and their GPs. Patients completed a questionnaire and provided the name of the GP to whom they have presented their symptoms. The named GP subsequently received a questionnaire.Primary and secondary outcome measuresGPs’ use of GF in the diagnostic process for the particular patient. GPs who answered that they used their GF ‘to a high degree’ or ‘to a very high degree’ were categorised as ‘used their GF to a great extent’. GPs who answered that they used their GF ‘to some degree’, ‘to a limited degree’ or ‘not at all’ were categorised as ‘limited or no use of GF’.ResultsGPs were less likely to use GF when they assessed relational aspects of the patient encounter as difficult compared with less difficult (OR=0.67; 95% CI 0.46 to 0.97). The physician-reported level of empathy was positively associated with use of GF (OR=2.60; 95% CI 1.60 to 4.22). The lower use of GF in difficult encounters was not modified by level of empathy.ConclusionsExperiencing relational aspects of patient encounter as difficult acted as a barrier for the use of GF in cancer diagnosis. Although physician-rated empathy increased use of GF, high empathy did not dissolve the low use of GF in difficult encounters. As diagnosis of cancer is a key challenge in primary care, it is important that GPs are aware that the sensitivity of cancer-related GF is compromised by a difficult patient–physician relationship.

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

“…Twelve articles were included, as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart ( Figure 1 ). Four of the included articles originated from the UK, 29 – 32 one was a multicentre European study, 33 one stemmed from the Netherlands, 20 three from Denmark, 34 – 36 one was from Spain, 37 and two were from Norway. 38 , 39 The included articles comprised six qualitative studies, 29 – 32 , 37 , 39 four prospective cohort studies, 20 , 33 , 34 , 38 and two cross-sectional studies.…”

“… 38 , 39 The included articles comprised six qualitative studies, 29 – 32 , 37 , 39 four prospective cohort studies, 20 , 33 , 34 , 38 and two cross-sectional studies. 35 , 36 Characteristics of the included studies are detailed in Table 1 .…”

“…20,30,37 This was noted in Bankhead's (2005) Only one study reported that GPs were less likely to rely on gut feelings if they had good knowledge of their patient. 36 Non-verbal cues in children included bad moods, irritability, or lack of enthusiasm. 30 Such cues may well prove difficult to articulate or rationalise and, so, are consistent with Stolper's definition.…”

“…20 Furthermore, for every year increase in the GP's age, the positive predictive value (PPV) of gut feelings for cancer increased by 3%. 20 In addition, GPs who rated their empathy levels highly were more likely to report using gut feelings; 36 however, some warned that overconfidence in gut feelings could lead to missed cues or reaching the wrong conclusion, especially in GPs who were less experienced. 32…”

<p>Effects of Patients’ Perceptions of Physician–Patient Relational Empathy on an Inflammation Marker in Patients with Crohn’s Disease: The Intermediary Roles of Anxiety, Self-Efficacy, and Sleep Quality</p>

“…For instance, Pedersen et al found that physician-reported empathy was associated with gut feeling positively in cancer diagnosis. 17 Weiss et al confirmed that when negative mood was expressed by the patients, if physicians responded empathically, patients would feel less anxiety. 18 In our past research, we have found that empathy between patients and medical professionals had a positive effect on cancer patients and ulcerative colitis patients.…”