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, which 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 to compare these perceptions with those of GPs. Design and setting Qualitative interviews with 21 patients in Oxfordshire, UK. Method Patients whose referral to a cancer pathway was based on their GP’s gut feeling were invited to participate. Semi-structured interviews were conducted from November 2019 to 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.