Patient–physician relationship and use of gut feeling in cancer diagnosis in primary care: a cross-sectional survey of patients and their general practitioners

Abstract

Objectives To examine whether the quality of the patient–physician relationship, assessed by the general practitioner (GP) and the patient, associates with GPs’ use of gut feeling (GF) in cancer diagnosis. Design Cross-sectional questionnaire survey of cancer patients and their GPs. Setting Danish primary care. Participants Newly diagnosed cancer patients and their GPs. Patients completed a questionnaire and provided the name of the GP to whom they have presented their symptoms. The named GP subsequently received a questionnaire. Primary and secondary outcome measures GPs’ use of GF in the diagnostic process for the particular patient. GPs who answered that they used their GF ‘to a high degree’ or ‘to a very high degree’ were categorised as ‘used their GF to a great extent’. GPs who answered that they used their GF ‘to some degree’, ‘to a limited degree’ or ‘not at all’ were categorised as ‘limited or no use of GF’. Results GPs were less likely to use GF when they assessed relational aspects of the patient encounter as difficult compared with less difficult (OR=0.67; 95% CI 0.46 to 0.97). The physician-reported level of empathy was positively associated with use of GF (OR=2.60; 95% CI 1.60 to 4.22). The lower use of GF in difficult encounters was not modified by level of empathy. Conclusions Experiencing relational aspects of patient encounter as difficult acted as a barrier for the use of GF in cancer diagnosis. Although physician-rated empathy increased use of GF, high empathy did not dissolve the low use of GF in difficult encounters. As diagnosis of cancer is a key challenge in primary care, it is important that GPs are aware that the sensitivity of cancer-related GF is compromised by a difficult patient–physician relationship.