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Cited by 89Clinical Reasoning and Diagnostic SkillsPatient-Provider Communication in HealthcarePrimary Care and Health Outcomes

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

Open access
Smith, Claire Friedemann, Drew, Sarah, Ziebland, Sue, Nicholson, Brian D·2020·British Journal of General Practice
DOI 10.3399/bjgp20x712301PMC PMC7449376
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Abstract

Background: Growing evidence for the role of GPs’ gut feelings in cancer diagnosis raises questions about their origin and role in clinical practice. Aim: To explore the origins of GPs’ gut feelings for cancer, their use, and their diagnostic utility. Design and setting: Systematic review and meta-analysis of international research on GPs’ gut feelings in primary care. Method: Six 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. Results: Twelve 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. Conclusion: GPs’ 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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  • Clinicians described over-riding such systems because they had a gut feeling that a seemingly minor aspect of the history could indicate serious illness or because they had safety-netting concerns that a particular patient should be checked more frequently than the recommended interval.

    “Clinicians described over-riding such systems (for example when triaging e-consultations) because they had a gut feeling that a seemingly minor aspect of the history could indicate serious illness (45) or because they had safety-netting concerns that a particular patient should be checked more frequently than the recommended interval.”

    From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [45]

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1 of the 60 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [29]Bankhead CR Identifying potentially significant diagnostic factors for ovarian cancer in primary care: a qualitative and quantitative study [PhD thesis/dissertation]. 2005 https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.427901 (accessed 5 Aug 2020).

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Authors
Smith, C. F., Drew, S., Ziebland, S., & Nicholson, B. D.
Affiliations
  • University of Oxford (GB)
  • London School of Economics and Political Science (GB)
ORCID
Venue
British Journal of General Practice
Publisher
Royal College of General Practitioners
Published
2020-08-24
Volume
70
Issue
698
Pages
e612-e621
ISSN
  • 0960-1643 (ISSN-L)
  • 1478-5242
DOI
10.3399/bjgp20x712301
PMC
PMC7449376
OpenAlex
W3081287754
Cited by
87
References
60
Citations by year
2026: 7 · 2025: 12 · 2024: 8 · 2023: 10 · 2022: 22 · 2021: 23 · 2020: 5
FWCI
3.17
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of General Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
Funders
  • Cancer Research UK (25617, 17663, EDAG C50916)
  • National Institute for Health and Care Research (NF-SI-0616-10027)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
gut feelings, cancer diagnosis, general practitioners, primary care, clinical intuition, nonverbal cues, clinical experience, continuity of care, referral letters, diagnostic accuracy, clinical decision-making
MeSH terms
Attitude of Health Personnel, Emotions, Humans, Neoplasms, Primary Health Care, Referral and Consultation, Qualitative Research, General Practitioners

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