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Research

GPs’ use of gut feelings when assessing cancer risk in primary care: A qualitative study

Claire Friedemann Smith, Benedikte Moller Kristensen, Rikke Sand Andersen, FD Richard Hobbs, Sue Ziebland and Brian D Nicholson
British Journal of General Practice 22 December 2020; bjgp21X714269. DOI: https://doi.org/10.3399/bjgp21X714269
Claire Friedemann Smith
1 Primary Care Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom
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  • For correspondence: claire.friedemann@phc.ox.ac.uk
Benedikte Moller Kristensen
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Rikke Sand Andersen
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FD Richard Hobbs
7 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Sue Ziebland
8 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Brian D Nicholson
9 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Abstract

Background: The use of gut feelings to guide clinical decision-making in primary care has been frequently described but is not considered a legitimate reason for cancer referral. Aim: To explore the role that gut feelings play in clinical decision-making in primary care. Design and Setting: Qualitative interview study with 19 General Practitioners (GPs) in Oxfordshire, UK. Methods: GPs who had referred patients to a cancer pathway allowing the use of gut feeling as a referral criterion were invited to participate. Interview transcripts were analysed using the One Sheet of Paper method. Results: Gut feeling was seen as an essential part of decision-making that facilitated appropriate and timely care. GPs distanced their gut feelings from descriptions that could be seen as unscientific, describing successful use as reliant on experience and clinical knowledge. This was especially true for patients who fell within a ‘grey-area’ where clinical guidelines did not match the GP’s assessment of cancer risk, either because the guidance inadequately represented the patient’s presentation, or the patient’s presentation was missing. GPs sought to legitimise their gut feelings by gathering objective clinical evidence, careful examination of referral procedures, and consultation with colleagues. Conclusion: The GPs described their gut feelings as important to decision-making in primary care and a necessary addition to clinical guidance. The steps taken to legitimise their gut feelings matched what would be expected in good clinical practice.

  • Clinical (general)
  • Diagnosis
  • International
  • Clinical (physical)
  • Cancer
  • Education and standards
  • Patient safety
  • Research methods
  • Epidemiology
  • Received July 28, 2020.
  • Accepted October 1, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
GPs’ use of gut feelings when assessing cancer risk in primary care: A qualitative study
Claire Friedemann Smith, Benedikte Moller Kristensen, Rikke Sand Andersen, FD Richard Hobbs, Sue Ziebland, Brian D Nicholson
British Journal of General Practice 22 December 2020; bjgp21X714269. DOI: 10.3399/bjgp21X714269

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Accepted Manuscript
GPs’ use of gut feelings when assessing cancer risk in primary care: A qualitative study
Claire Friedemann Smith, Benedikte Moller Kristensen, Rikke Sand Andersen, FD Richard Hobbs, Sue Ziebland, Brian D Nicholson
British Journal of General Practice 22 December 2020; bjgp21X714269. DOI: 10.3399/bjgp21X714269
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Keywords

  • Clinical (general)
  • Diagnosis
  • International
  • Clinical (physical)
  • Cancer
  • Education and standards
  • Patient safety
  • Research methods
  • Epidemiology

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Print ISSN: 0960-1643
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