The GLANCE study: Patients’ and GPs’ views on the use of gut feelings for cancer in primary care

Objectives: Gut feelings, often described as a sense of alarm or reassurance for a patient’s health that may not be based on clinical evidence, are increasingly recognised as a feature of primary care practice. Studies have shown they help avoid missed diagnoses in disease areas including respiratory tract infections, heart disease, and cancer. Their use, however, in clinical decision making is contentious due to concerns over their subjectivity and difficulties in rationalising, articulating, and incorporating them into standardised medical practice. Our objective is to explore what GPs’ and patients’ gut feeling about cancer is, and how the transformation of feeling into gut feeling is shaped by particular terrains of experiences, fields of practices and sociocultural contexts. We investigate this through exploring GPs’ and patients experiences of using gut feelings for cancer suspicion, their understanding of what constitutes gut feelings, and the acceptability of using gut feelings as a referral criterion. Method: Recruitment began in October 2019 and is ongoing. Interview participants were identified from the Suspected CANcer (SCAN) Pathway database. Patients who were referred either entirely or partly based on a gut feeling and attended their first clinic visit within a year of the start of recruitment were contacted with a patient information leaflet and an invitation to take part in an interview. GPs who had referred at least one patient to the SCAN pathway were also sent an information leaflet and invitation to take part. We did not require GPs to have referred based on a gut feeling in an attempt to gain a range of views on the topic. Up to 50 interviews will be conducted, 25 patient and 25 GP interviews. Interviews will transcribed verbatim and analysed thematically using the NVivo software package. Results: To date, 13 patient and 10 GP interviews have been conducted, including two patients who were diagnosed with cancer through the SCAN Pathway. Initial results suggest that both GPs and patients are supportive of the use of gut feelings for cancer and see it as a manifestation of accumulated clinical expertise. GPs found SCAN useful because it provides a route to diagnosis for patients with no localising symptoms, who previously would have been referred to multiple organ specific two-week-wait pathways until a cause for their symptoms was found. GPs have described gut feeling as a sense that something is not right with the clinical picture, while patients have drawn an analogy between gut feeling and an immediate sense of dislike that may occur when meeting someone for the first time. Patients also acknowledged that GPs operate under uncertainty and as such felt that gut feelings are an important diagnostic tool. Conclusions: To the best of our knowledge, this is the first study that has discussed gut feelings for cancer with both clinicians and patients. Furthermore, that our participants have recently either been referred, or had the option to make a referral, based on a gut feeling for cancer lends a unique perspective and relevance to the discussions. Initial results suggest that gut feelings are experienced by patients and clinicians, and both are supportive of its use in primary care. Further data will be collected during January 2020, and understanding, use, and the risks and benefits of using gut feelings for the suspicion of cancer will be explored during the full analysis of the data.