Glance: Gut feelings for cancer in general practice

Uncertainty is very common in primary care and often general practitioners (GPs) must make decisions in a short amount of time and without information like test results. Gut feelings or clinical intuition has been suggested as one way that GPs are able to make decisions about which patients should be tested further. The purpose of the GLANCE study was describe what we already know about gut feelings, and to find out more about how they are used, and how they are viewed by GPs and patients.

We found that gut feelings are used often and patients that trigger a gut feeling in their GP are more likely to have a serious illness like cancer. GPs and patients thought that gut feelings were important, and the ability to use them well was a sign of a good GP and was linked to the GP having more clinical experience and empathy with their patient.

GPs sometimes describe getting an uneasy feeling called a gut feeling that makes them think that their patient could be seriously unwell, even if the patient has no other obvious symptoms that would point to a serious illness. Previous research has suggested that gut feelings are an effective tool in identifying patients who need further tests and investigations, but there are also concerns that GPs’ gut feelings may be too subjective and prone to error. The GLANCE study aimed to understand how GPs develop and use their gut feelings when making decisions about how to treat patients who they suspect may have cancer, including decisions about whether to refer them to specialist services for further testing. It also explored patient experiences of being referred to services based on their GP’s gut feeling.

This study was made up of three sub-projects:

1. A systematic review and meta-analysis of research that explored the use of gut feelings in the diagnosis of cancer which provided us with information about what is already known on the topic.
2. Interviews with GPs who had referred patients to the SCAN Pathway, a cancer pathway in Oxfordshire, which allows GPs to refer patients for investigations based on a gut feeling. During these interviews we asked GPs how their gut feelings develop, how they influence GPs’ decisions about how to treat patients, and what the benefits and difficulties were with using them.
3. Interviews with patients who had been referred to the SCAN Pathway based on their GPs’ gut feelings. During the interviews we asked patients about their views on being referred based on a gut feeling and the role that their own gut feelings played in making decisions about whether to visit their GP.

This work has been presented at national and international conferences and has been turned into materials for trainee GPs to help them pay attention to their own intuition.