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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
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last_indexed 2025-06-25T05:01:03Z
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spelling 2025-06-24T14:51:20.9511411 v2 69496 2025-05-12 Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study dd86f6440382422aff81e48faba9a002 RUPERT HARWOOD RUPERT HARWOOD true false 2025-05-12 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. Journal Article Lupus 34 8 819 831 SAGE Publications 0961-2033 1477-0962 Autoimmune, lupus, misdiagnosis, attribution, diagnostic overshadowing 1 7 2025 2025-07-01 10.1177/09612033251345184 COLLEGE NANME COLLEGE CODE Swansea University SU Library paid the OA fee (TA Institutional Deal) 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. 2025-06-24T14:51:20.9511411 2025-05-12T11:54:17.9978310 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science RUPERT HARWOOD 1 Chris Wincup 2 David D’Cruz 3 Melanie Sloan 4 69496__34564__a2d3cdf44dd9457f9d7cacf1e057ab30.pdf 69496.VOR.pdf 2025-06-24T14:49:06.8193009 Output 765658 application/pdf Version of Record true © The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (CC BY-NC). true eng https://creativecommons.org/licenses/by-nc/4.0/
title Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
spellingShingle Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
RUPERT HARWOOD
title_short Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
title_full Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
title_fullStr Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
title_full_unstemmed Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
title_sort Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
author_id_str_mv dd86f6440382422aff81e48faba9a002
author_id_fullname_str_mv dd86f6440382422aff81e48faba9a002_***_RUPERT HARWOOD
author RUPERT HARWOOD
author2 RUPERT HARWOOD
Chris Wincup
David D’Cruz
Melanie Sloan
format Journal article
container_title Lupus
container_volume 34
container_issue 8
container_start_page 819
publishDate 2025
institution Swansea University
issn 0961-2033
1477-0962
doi_str_mv 10.1177/09612033251345184
publisher SAGE Publications
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
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description 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.
published_date 2025-07-01T05:24:05Z
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