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Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study

RUPERT HARWOOD, Chris Wincup, David D’Cruz, Melanie Sloan

Lupus, Volume: 34, Issue: 8, Pages: 819 - 831

Swansea University Author: RUPERT HARWOOD

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DOI (Published version): 10.1177/09612033251345184

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 sele...

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Published in: Lupus
ISSN: 0961-2033 1477-0962
Published: SAGE Publications 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69496
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.
Keywords: Autoimmune, lupus, misdiagnosis, attribution, diagnostic overshadowing
College: Faculty of Medicine, Health and Life Sciences
Funders: 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.
Issue: 8
Start Page: 819
End Page: 831

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