Do patients’ faces influence General Practitioners’ cancer suspicions? A test of automatic processing of sociodemographic information

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.背景：癌症诊断延迟会导致患者预后更差。在简短的问诊过程中，全科医师（General Practitioners, GPs）需快速判断患者罹患癌症的可能性。全科医师会快速处理患者的面部线索，此类线索或对诊断结果产生影响。 研究目的：本研究旨在探讨患者的面部特征是否会影响全科医师对癌症风险的即时判断。 研究设计与研究场景：针对苏格兰东北部全科医师开展的网络二元迫选实验。 研究方法：向参与研究的全科医师展示一系列面部原型配对图像，并要求其快速选出更有可能患有癌症的受试者。所有面部原型均针对年龄、性别与种族进行了调整。研究采用卡方拟合优度检验结合邦费罗尼校正（Bonferroni corrections）对受试者的选择结果进行统计分析。 研究结果：本次研究共纳入82名全科医师参与。结果显示，全科医师显著更倾向于怀疑老年患者罹患癌症。性别会对全科医师的癌症怀疑倾向产生影响，但该影响受年龄调节：针对年轻面部原型，72%的全科医师选择男性面孔（95%置信区间[Confidence Interval, CI] 61.0–87.0）；针对中年面部原型，65.9%的全科医师选择男性面孔（95%CI 54.7–75.5），此时男性面孔被认为比女性面孔更有可能患有癌症；但针对老年面部原型，63.4%的全科医师认为老年女性面孔比老年男性面孔更有可能患有癌症（p=0.015）。相较于年轻亚裔男性面孔，全科医师更倾向于怀疑年轻白人男性面孔罹患癌症（65.9%，95%CI 54.7–75.5；p=0.004）。 研究结论：全科医师针对癌症风险的第一印象会受到患者年龄、性别与种族的影响。针对性干预全科医师的认知偏差，或可成为降低癌症诊断延迟的有效途径，尤其针对年轻患者群体。