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

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.