Abstract
Background
We explore the concept of ‘untimely diagnosis’, where the onset of a long-term condition occurs at a life stage which does not conform to traditional expectations, focusing on two conditions (asthma and arthritis) typically associated with a particular life stage (childhood and older adulthood, respectively). Previous literature has focused on the meaning of chronic illness in terms of life history and the biographical lens has been used in various ways to make sense of the experience. Less attention has been paid to the condition onset when it seems dissonant with chronological age.
Methods
Secondary analysis of two qualitative datasets (total 58 interviews) exploring the experiences of people with adult onset asthma and young people diagnosed with arthritis. Data from the original interview transcripts relating to diagnosis and symptom recognition were re-analysed using a ‘candidacy’ framework to examine how age and diagnosis intersect.
Results
People did not always assert their candidacy for either condition because of pre-conceived expectations around age. Similarly, health professionals sometimes failed to recognise patients’ candidacy, instead pursuing ‘age plausible’ possibilities. In some cases, participants were proactive in suggesting a diagnosis to the health professional where diagnosis was delayed
Conclusion
The diagnosis of adult onset asthma, and arthritis in young people, may be regarded as ‘untimely’. We suggest that being diagnosed with what is perceived to be a ‘childhood’ condition in adulthood, or ‘an older person’s’ condition in childhood, may be viewed as a ‘biographical paradox’ and an ‘untimely breach’ to the expected order.
We explore the concept of ‘untimely diagnosis’, where the onset of a long-term condition occurs at a life stage which does not conform to traditional expectations, focusing on two conditions (asthma and arthritis) typically associated with a particular life stage (childhood and older adulthood, respectively). Previous literature has focused on the meaning of chronic illness in terms of life history and the biographical lens has been used in various ways to make sense of the experience. Less attention has been paid to the condition onset when it seems dissonant with chronological age.
Methods
Secondary analysis of two qualitative datasets (total 58 interviews) exploring the experiences of people with adult onset asthma and young people diagnosed with arthritis. Data from the original interview transcripts relating to diagnosis and symptom recognition were re-analysed using a ‘candidacy’ framework to examine how age and diagnosis intersect.
Results
People did not always assert their candidacy for either condition because of pre-conceived expectations around age. Similarly, health professionals sometimes failed to recognise patients’ candidacy, instead pursuing ‘age plausible’ possibilities. In some cases, participants were proactive in suggesting a diagnosis to the health professional where diagnosis was delayed
Conclusion
The diagnosis of adult onset asthma, and arthritis in young people, may be regarded as ‘untimely’. We suggest that being diagnosed with what is perceived to be a ‘childhood’ condition in adulthood, or ‘an older person’s’ condition in childhood, may be viewed as a ‘biographical paradox’ and an ‘untimely breach’ to the expected order.
| Original language | English |
|---|---|
| Pages (from-to) | 730-740 |
| Number of pages | 11 |
| Journal | Health Expectations |
| Volume | 21 |
| Issue number | 4 |
| Early online date | 9 Feb 2018 |
| DOIs | |
| Publication status | Published - Aug 2018 |
Bibliographical note
Juvenile Arthritis study funded by Arthritis Research UK [project grant 19626]. Asthma study funded by NIHR as part of the iPEx programme [Programme Grants for Applied Research funding scheme (RP‐PG‐0608‐10147]. At the time of writing, LL was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford (CLAHRC) at Oxford Health NHS Foundation Trust and was employed by Nuffield Department of Primary Care Health Sciences at University of Oxford. AF was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. The views expressed in this manuscript are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.Keywords
- adult onset asthma
- young people with arthritis
- diagnosis
- age related expectations
- chronic illness
- age and diagnosis
- candidacy
- diagnostic delay
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Louise Locock
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Professor in Health Services Research
Person: Academic