Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence

Clinician gut feelings are an acknowledged part of clinical decision making, but the literature on gut feelings lacks consistency. Thus, this systematic review explored the origins of GPs’ gut feelings for cancer, their use, and their diagnostic utility. GPs’ gut feelings for cancer were conceptualised as a rapid summing up of multiple verbal and non-verbal patient cues. Moreover, the pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded and became more predictive of cancer as clinical experience and familiarity with the patient increased. However, despite being included in some clinical guidelines, GPs had varying experiences of acting on gut feelings as some specialists questioned their diagnostic value. Consequently, some GPs ignored or omitted gut feelings from referral letters, or chose investigations that did not require specialist approval. It is possible that gut feelings triggered by clinical features outside of cancer guidelines highlight the limitations of current referral criteria. Future research should focus on scenarios when gut feeling is triggered by combinations of patient characteristics, risk factors, and clinical features that are not included in current guidelines, especially if subsequent investigation leads to a cancer diagnosis

Read Full Text