TY - JOUR

T1 - Patient-physician relationship and use of gut feeling in cancer diagnosis in primary care

T2 - a cross-sectional survey of patients and their general practitioners

AU - Pedersen, Anette Fischer

AU - Andersen, Christina Maar

AU - Ingeman, Mads Lind

AU - Vedsted, Peter

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/8

Y1 - 2019/8

N2 - 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.

AB - 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.

KW - adult oncology

KW - mental health

KW - primary care

KW - public health

U2 - 10.1136/bmjopen-2018-027288

DO - 10.1136/bmjopen-2018-027288

M3 - Journal article

C2 - 31289073

VL - 9

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 7

M1 - e027288

ER -