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

Abstract

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.

Faecal haemoglobin concentration thresholds for reassurance and urgent investigation for colorectal cancer based on a faecal immunochemical test in symptomatic patients in primary care

“…It is also important to recognize the clinical experience and expertise of GPs in assessing the nature and severity of symptoms: 'gut feelings for cancer' can be conceptualized as a rapid summing up of multiple verbal and non-verbal patient cues. 36 Thus, f-Hb should not be used by secondary care to refuse requests from GPs to have a patient investigated, but rather it should be used by the GPs themselves to assist in reaching an objective decision as to whether or not to refer for further investigation. Unsurprisingly, the focus of research into FIT for symptomatic patients has been on the 'reassurance' f-Hb threshold as this affects demand for bowel investigation.…”

How child health care physicians struggle from gut feelings to managing suspicions of child abuse

“…There have been many studies, showing the positive predictive value of gut feelings that lead to working hypotheses such as cancer, lung embolism and serious childhood infections. [26][27][28] Child abuse is often hidden, and a gut feeling might be an important signal to become suspicious, to observe more closely and to examine the child better.…”

Time for a little self-love?

“…GP intuition is apparently a good way of diagnosing cancer. 2 But is it just cancer? It is known that experienced GPs get better results on several measures of efficiency and healthcare competence.…”