Abstract
BackgroundDelayed cancer diagnosis leads to poorer patient outcomes. During short consultations, General Practitioners (GPs) make quick decisions about likelihood of cancer. Patients’ facial cues are processed rapidly and may influence diagnosis.AimTo investigate whether patients’ facial characteristics influence immediate perception of cancer risk by GPs.Design and settingWeb-based binary forced choice experiment with GPs from Northeast Scotland.MethodGPs were presented with a series of pairs of face prototypes and asked to quickly select the patient more likely to have cancer. Faces were modified with respect to age, gender, and ethnicity. Choices were analysed using Chi-squared goodness-of-fit statistics with Bonferroni corrections.ResultsEighty-two GPs participated. GPs were significantly more likely to suspect cancer in older patients. Gender influenced GP cancer suspicion, but this was modified by age: the male face was chosen as more likely to have cancer than the female face for young (72% of GPs;95% CI 61.0–87.0) and middle-aged faces (65.9%; 95% CI 54.7–75.5); but 63.4% (95% CI 52.2–73.3) decided the older female was more likely to have cancer than the older male (p = 0.015). GPs were significantly more likely to suspect cancer in the young Caucasian male (65.9% (95% CI 54.7, 75.5)) compared to the young Asian male (p = 0.004).ConclusionGPs’ first impressions about cancer risk are influenced by patient age, gender, and ethnicity. Tackling GP cognitive biases could be a promising way of reducing cancer diagnostic delays, particularly for younger patients.
Highlights
Delays in cancer diagnosis lead to poorer cancer outcomes [1] and cause patients distress [2]
Gender influenced General Practitioners (GPs) cancer suspicion, but this was modified by age: the male face was chosen as more likely to have cancer than the female face for young (72% of GPs;95% Confidence Intervals (CI) 61.0–87.0) and middle-aged faces (65.9%; 95% CI 54.7–75.5); but 63.4% decided the older female was more likely to have cancer than the older
GPs were significantly more likely to suspect cancer in the young Caucasian male (65.9%) compared to the young Asian male (p = 0.004)
Summary
Delays in cancer diagnosis lead to poorer cancer outcomes [1] and cause patients distress [2]. It is important to understand factors influencing these early intuitive suspicions In their experimental study, Kostopoulou et al [10] presented GPs with cancer and non-cancer written scenarios and used a think-aloud and active information search (participants request information in a step-by-step fashion) methodology to explore their decision making. If cancer was articulated as a diagnostic possibility early in the consultation, the patient was significantly more likely to be appropriately referred. While this suggests that early cues within the content of clinical consultations can influence decisions, other non-verbal cues detected on meeting the patient occur earlier than verbal cues and may have an automatic and potent influence. Delayed cancer diagnosis leads to poorer patient outcomes. Patients’ facial cues are processed rapidly and may influence diagnosis
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