Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
Rupert Harwood, Chris Wincup, David D’Cruz, and Melanie Sloan
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Objectives
SLE diagnostic journeys can be protracted, with negative impacts on long-term health. This study explored the role of diagnostic overshadowing (DOS) in delaying SLE diagnoses.
Methods
A qualitative analysis of 268 completed SLE patient surveys and 25 in-depth interviews purposively selected from the 2018-2021 Cambridge University Systemic Autoimmune Rheumatic Disease (SARD) studies.
Results
The majority of participants appear to have experienced DOS and there were indications that sustained DOS (S-DOS) may add years to some SLE diagnostic journeys.
Symptom misattributions which contributed to S-DOS included:
Conclusion
Our data suggests that DOS may be an important factor in diagnostic delay in patients with SLE.
Link | PDF (Lupus) [Open Access]
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Requested to be posted by @Utsikt.
Rupert Harwood, Chris Wincup, David D’Cruz, and Melanie Sloan
[Line breaks added]
Objectives
SLE diagnostic journeys can be protracted, with negative impacts on long-term health. This study explored the role of diagnostic overshadowing (DOS) in delaying SLE diagnoses.
Methods
A qualitative analysis of 268 completed SLE patient surveys and 25 in-depth interviews purposively selected from the 2018-2021 Cambridge University Systemic Autoimmune Rheumatic Disease (SARD) studies.
Results
The majority of participants appear to have experienced DOS and there were indications that sustained DOS (S-DOS) may add years to some SLE diagnostic journeys.
Symptom misattributions which contributed to S-DOS included:
(1) “Medical mystery”, particularly when the clinician indicated that it was too expensive to keep investigating.
(2) Negative misattributions (e.g. “nothing seriously wrong”), often due to a failure to connect multiple symptoms as possible indicators of an underlying condition.
(3) Diagnostic roadblocks, including, in the case of some participants, a mental health, psychosomatic, ME/CFS or fibromyalgia (mis)diagnosis.
(4) Moral misattributions, such as to “malingering”, which could undermine patient help-seeking and/or clinician help-giving.
Conclusion
Our data suggests that DOS may be an important factor in diagnostic delay in patients with SLE.
Link | PDF (Lupus) [Open Access]
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Requested to be posted by @Utsikt.
