Feasibility study.

• Marie Barais reports the progress of the FS in France, the Netherlands, Belgium and Germany. Based on the results up till now we conclude that the Gut Feelings Questionnaire (GFQ) is feasible. The second part of the study shows that the Tel Aviv consensus on the GFQ including some adaptations have worked out very well and hardly any problems were found. Based on the remarks in the interviews we decide to change item 8 a bit: What diagnoses (or diagnosis) do you have in mind? An extended and precise guidance to explain how we define GF and what the aim of the GFQ is including instructions about filling in the list seems very important. This guidance will be composed on the base what we learned from the participants in the interviews. We need one guidance for different languages taking in account the national health care organisations and the specific semantic aspects of the items, e.g. the first dot of item 9 regarding the significance of ‘wait and see’. The guidance should explain what the definitions of the sense of alarm and the sense of reassurance are, how the 6 items derive from these definitions, how to fill in item 8 and how to understand the questionnaire. Future users of the GFQ can used the reverse site of the list to make explaining comments if any about their diagnostic reasoning process.
• Johannes Hauswaldt presents the first results of the German part of the FS. German participants filled out 30 questionnaires each. We then decide that 5 German participants will be sufficient for finalizing the FS.
• Quantitative data of the GFQ: we discuss how to deal with all data we got from the received questionnaires. What kind of questions can be analysed to consider the feasibility of the list? Marie Barais will take up this question.

Linguistic validation procedure in Spain: Bernardino Fanlo explains how the procedure has been done translating the GFQ into Spanish and Catalan. The next step could be a construct validation procedure but we advise against doing so for three reasons: the results of the focus group study in Spain covers almost completely the outcome in the Netherlands (focus groups study) and in France (Delphi consensus study), so the GF-concept is cross bordering. The second reason is that the linguistic validation procedure into English, French, German, Polish and Spanish and Catalan has been performed in the same accurate way. The third reason is that the results of a construct validation procedure must be done then in each country and may lead to adaptations for each language, and to different and incomparable questionnaires. Then maybe we have perfect questionnaires but they are no longer appropriate for meta-ethnographic studies

The GF patients study: Erik Stolper presents the results of this study up till now (literature, the view of GPs, practice-nurses and triagistes in out-of-office centers in the Netherlands and Belgium, the view of disciplinary medical tribunals, the first interviews with patients themselves). Paul Van Royen shows the preliminary results of 12 interviews with Flemish patients in general practice about intuition. Perhaps the process of GF emerging differs in mothers or fathers as to their children or in adults about themselves (empathy, mirror neuron cells, observing differences, own pain can disturb the rational reasoning process etc.). The process of emerging GF in caregivers can be compared to that of GPs and that might be explain that GPs seem to take caregivers GF more seriously than those of adults about themselves. We decide to extend the search in literature using other searching terms patients use about their health situation. We need more interviews with patients in the Netherlands and Belgium.

Because of time limitation we skip the presentations of the finalised hospital specialist gut feelings study in the Netherlands and Belgium and the ongoing study about the role of GF in the detection of child abuse by general practitioners and youth health care physicians in the Netherlands.

Updating the glossary. Norbert Donner-Banzhoff asked for an adaption of the item ‘uncertainty’. Others suggested to add terms like inductive foraging, risk, error and error prevention, regret and anticipated regret. We discuss these requests considering that new terms must have a clear connection with the topic of our research. The new formulation of ‘uncertainty’ should follow the same consensus procedure as before when composing the glossary. Johannes will contact Norbert and Marie and Erik will search the literature about risk and threshold. We decide to discuss the updating of the glossary yearly.

PhD-studies. Marie Barais informs us about the progress of her main study in France (GF in thoracic pain) and Bernardino Fanlo about the design of his main study in Spain (GF and the diagnoses cancer or serious diseases).

Future of COGITA:

• In Tel-Aviv (2016) we decided not to confine our network to general practitioners but to ask hospital doctors and nurses to participate. A Dutch nurse preparing her PhD on the role of GF in nursing is a member of our group now. We discuss the possibilities of attracting doctors and nurses in each country and decide that we will contact some colleagues and nurses.
• Next meeting (2018). In 2015, in Marburg, we had a two days meeting with the Clinical Decision Making (CDM) European network of clinical psychologists after a separate COGITA day. In March 2018, the next CDM workshop will be in Gottingen (Germany). The question is whether we may have again a common meeting or do as usual joining in the EGPRN conference (May, Lille in France). We decide to choose for Gottingen if we can reach agreement on the theme of a common conference. Our proposal is to focus on the process of diagnostic reasoning (DR) and not on the outcome. How does it work? How successful is the process in terms of e.g. avoiding tunnel vision or in finding a good balance between analytical reasoning and intuitive thinking ? Can we make this process more transparent? How can a patient GF attribute to this process? How balanced is the DR process of hospital specialists? Erik will contact Cilia Witteman of CDM.

Presentations on the EGPRN conference:

• Marie Barais presents the Feasibility Study. In the discussion there is a question about the awareness effect of the GFQ, i.e. a participating GP might become more aware of his/her GF by using the list which can cause bias.
• Bernardino Fanlo presents the design of his main study. A suggestion is to include the cancer stage after establishing the diagnosis.
• Erik Stolper presents the GF-patient study in the Netherlands and Belgium. Someone is surprised about the small amount of publications around the topic in the literature. How come?