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ToolsHarwood, Rupert, Wincup, Chris, D’Cruz, David and Sloan, Melanie (2025) Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study. Lupus, 34 (8). pp. 819-831. ISSN 0961-2033
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Abstract
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.
| Item Type: | Article |
|---|---|
| Additional Information: | Data availability statement: Additional anonymised data, including that showing the development of concepts, is available on request. Funding information: This work was supported by the LUPUS UK provided funding towards the collection of the data (2018-2021) which this 2023 study analysed a purposely selected sample of. |
| Uncontrolled Keywords: | attribution,autoimmune,diagnostic overshadowing,lupus,misdiagnosis,rheumatology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2745 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Public Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 08 Sep 2025 14:30 |
| Last Modified: | 08 Sep 2025 14:30 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/100312 |
| DOI: | 10.1177/09612033251345184 |
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