Prospective Observational Study on the Prevalence and Diagnostic Value of General Practitioners’ Gut Feelings for Cancer and Serious Diseases

Oliva-Fanlo, Bernardino; March, Sebastià; Gadea-Ruiz, Cristina; Stolper, Erik; Esteva, María

doi:10.1007/s11606-021-07352-w

Cited by 5 publications

(4 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Continuity of care and contextual knowledge are key features of primary care and support the primary care professional when assessing the value of a patient's gut feeling as well as their own gut feelings. The PPV of GPs' gut feelings are moderate to good [4,5,24,25], but the absolute numbers of diagnostic value may be less important than the alerting role of gut feelings, both from professionals and patients, in starting up or triggering the clinical reasoning process of primary care professionals.…”

Section: In Comparison With Literaturementioning

confidence: 99%

See 1 more Smart Citation

Patients’ gut feelings seem useful in primary care professionals’ decision making

et al. 2022

View full text Add to dashboard Cite

Background Family physicians’ diagnostic gut feelings have proved to be valuable. But what about patients’ gut feelings? Research has shown that patients’ gut feelings may contribute to their physicians’ clinical reasoning. Dutch medical tribunals consider patients’ worry useful for doctors’ diagnostic process. However, how general practitioners and other primary care professionals recognize gut feelings of patients and deal with them in their decision making is yet unclear. We aim to explore how primary care professionals perceive patients’ gut feelings and use this information in their decision-making. Methods We interviewed 30 Dutch and Belgian primary care professionals, exploring how they recognize and value patients’ gut feelings. We coded all interviews using a descriptive content analysis in an iterative process. Data sufficiency was achieved. Results Primary care professionals acknowledged gut feelings in their patients, and most participants found them a useful source of information. Patients’ gut feelings might alert them to possible hidden problems and might provide quicker insight into patients’ perceptions. Primary care professionals listed a whole series of wordings relating to trusting or distrusting the situation or to any changes in normal patterns. A patient’s gut feeling was often a reason for the professionals to explore patients’ worries and to reconsider their own clinical reasoning. Conclusions Primary care professionals regularly considered patients’ gut feelings useful, as they might contribute to their clinical reasoning and to a deeper understanding of the patient’s problem. The next step could be to ask patients themselves about their gut feelings and explore their diagnostic value.

show abstract

Section: In Comparison With Literaturementioning

confidence: 99%

“…The role of gut feelings in the clinical reasoning of general practitioners (GPs) has been thoroughly examined and proved to be substantial [1][2][3][4][5]. An initial exploratory study of this topic among hospital specialists found comparable results [6].…”

Section: Introductionmentioning

confidence: 99%

Patients’ gut feelings seem useful in primary care professionals’ decision making

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Our justification for this links to the work of Oliva-Fanlo et al and Barais et al , where they found GPs’ gut feeling exists in almost all encounters and the prevalence of sense of reassurance (SR) is very high rather than SA (SR: 75.3%, SA: 21.3%). It follows that if SA was observed, the GP would register and record this 16 17…”

Section: Discussionmentioning

confidence: 99%

Gut feeling for the diagnosis of cancer in general practice: a diagnostic accuracy review

et al. 2023

View full text Add to dashboard Cite

ObjectivesDiagnostic delay in cancer is a challenge in primary care. Although screening tests are effective in diagnosing some cancers such as breast, colorectal and cervical cancers, symptom-based cancer diagnosis is often difficult due to its low incidence in primary care and the influence of patient anxiety, doctor–patient relationship and psychosocial context. A general practitioner’s gut feeling for cancer may play a role in the early diagnosis of cancer in primary care where diagnostic resources are limited. The aim of this study is to summarise existing evidence about the test accuracy of gut feeling (index test) in symptomatic adult patients presenting to general practice, compared with multidisciplinary team-confirmed diagnosis of cancer (reference standard).DesignDiagnostic accuracy review following Cochrane methods was performed.Data sourcesMEDLINE, EMBASE, Cochrane Library, the Database of Abstracts of Reviews of Effects and Medion databases.Eligibility criteriaCross-sectional, cohort and randomised studies of test accuracy that compared gut feeling (index test) with an appropriate cancer diagnosis (reference standard). No language or publication status restrictions were applied. We included all studies published before 25 March 2022.Data extraction and synthesisMethodological quality was appraised, using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Meta-analysis with hierarchical summary receiver operating characteristic (HSROC) models was used.ResultsOf 1286 potentially relevant studies identified, six met the inclusion criteria. For two of the six studies, data could not be extracted despite contacting authors. No studies satisfied all QUADAS-2 criteria. After meta-analysis of data from the remaining studies, the summary point of HSROC had a sensitivity of 0.40 (95% CI: 0.28, 0.53) and a specificity of 0.85 (95% CI: 0.75, 0.92).ConclusionsGut feeling for cancer when used in symptomatic adult patients in general practice has a relatively low sensitivity and high specificity. When the prevalence of cancer in the symptomatic population presenting in general practice exceeds 1.15%, the performance of gut feeling reaches the National Institute for Health and Care Excellence 3% positive predictive value threshold for action, which recommends urgent access to specialist care and further investigations. The findings support the continued and expanded use of gut feeling items in referral pathways.

show abstract

“…The questions were answered before the patient arrived at the ED and the responses could not be changed afterwards. The questionnaire was developed based on questionnaires from previous studies [12,14,[17][18][19][20][21][22][23][24][25], and adapted to be feasible in clinical practice in the ED. The questionnaire is shown in the supporting information (S1 Fig).…”

Section: Questionnairementioning

confidence: 99%

Acute internal medicine physicians’ clinical intuition based on acute care telephone referral: A prospective study

van Dam,

Lasso Peña,

Mommertz

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Introduction In the Netherlands, most emergency department (ED) patients are referred by a general practitioner (GP) or a hospital specialist. Early risk stratification during telephone referral could allow the physician to assess the severity of the patients’ illness in the prehospital setting. We aim to assess the discriminatory value of the acute internal medicine (AIM) physicians’ clinical intuition based on telephone referral of ED patients to predict short-term adverse outcomes, and to investigate on which information their predictions are based. Methods In this prospective study, we included adult ED patients who were referred for internal medicine by a GP or a hospital specialist. Primary outcomes were hospital admission and triage category according to the Manchester Triage System (MTS). Secondary outcome was 31-day mortality. The discriminatory performance of the clinical intuition was assessed using an area under the receiver operating characteristics curve (AUC). To identify which information is important to predict adverse outcomes, we performed univariate regression analysis. Agreement between predicted and observed MTS triage category was assessed using intraclass and Spearman’s correlation. Results We included 333 patients, of whom 172 (51.7%) were referred by a GP, 146 (43.8%) by a hospital specialist, and 12 (3.6%) by another health professional. The AIM physician’s clinical intuition showed good discriminatory performance regarding hospital admission (AUC 0.72, 95% CI: 0.66–0.78) and 31-day mortality (AUC 0.73, 95% CI: 0.64–0.81). Univariate regression analysis showed that age ≥65 years and a sense of alarm were significant predictors. The predicted and observed triage category were similar in 45.2%, but in 92.5% the prediction did not deviate by more than one category. Intraclass and Spearman’s correlation showed fair agreement between predicted and observed triage category (ICC 0.48, Spearman’s 0.29). Conclusion Clinical intuition based on relevant information during a telephone referral can be used to accurately predict short-term outcomes, allowing for early risk stratification in the prehospital setting and managing ED patient flow more effectively.

show abstract

Prospective Observational Study on the Prevalence and Diagnostic Value of General Practitioners’ Gut Feelings for Cancer and Serious Diseases

Cited by 5 publications

References 49 publications

Patients’ gut feelings seem useful in primary care professionals’ decision making

Patients’ gut feelings seem useful in primary care professionals’ decision making

Gut feeling for the diagnosis of cancer in general practice: a diagnostic accuracy review

Acute internal medicine physicians’ clinical intuition based on acute care telephone referral: A prospective study

Contact Info

Product

Resources

About