Building the case for the use of gut-feelings in cancer referrals: perspectives of patients referred to a non-specific symptoms pathway

Background: Gut-feelings may be useful when dealing with uncertainty that is ubiquitous in primary care. Both patients and GPs experience this uncertainty but patients’ views on gut-feelings in the consultation have not been explored. Aim: To explore patients’ perceptions of gut-feelings in decision-making, and compare these perceptions to those of GPs. Design and setting: Qualitative interviews with 21 patients in Oxfordshire, UK. Methods: Patients whose referral to a cancer pathway was based on their GP’s gut-feeling were invited to participate. Semi-structured interviews were conducted November 2019-January 2020 face-to-face or over the telephone. Data were analysed with a thematic analysis and mind mapping approach. Results: Some patients described experiencing gut-feelings about their own health but often their willingness to share this with their GP was dependent on an established doctor-patient relationship. Patients expressed similar perspectives on the use of gut-feelings in consultations to those reported by GPs. Patients saw GPs’ gut-feelings as grounded in their experience and generalist expertise, and part of a process of evidence gathering. Patients suggested that GPs were justified in using gut-feelings because of their role in arranging access to investigations, the difficult ‘grey-area’ of presentations, and the time and resource limited nature of primary care. When GPs communicated that they had a gut-feeling, some saw this as an indication that they were being taken seriously. Conclusion. Patients accepted that GPs use gut-feelings to guide decision-making. Future research on this topic should include more diverse samples and address the areas of concern shared by patients and GPs.