2025-06-19 スウォンジー大学
持続的なDOS(診断の誤認)は、次のすべての条件が満たされた場合に発生するとされる:
- 未診断の病気の1つ以上の症状が、臨床医が患者の特性または患者が抱えていると信じている状態に誤って帰属される。
- これらの誤帰属の1つ以上が、複数の診療の場面で持続される(すなわち、考慮され却下されない)。
- ある診療場面での誤帰属が、その後の診療場面での同様の誤帰属に寄与する(例:紹介状で言及されることによって)。
- この誤帰属が、診断過程において重大な悪影響を与える(正しい診断までの時間に影響するなど)。
<関連情報>
- https://www.swansea.ac.uk/press-office/news-events/news/2025/06/up-to-40-years-to-get-diagnosed-with-lupus-research-highlights-devastating-impact-of-delays-on-patients—.php
- https://journals.sagepub.com/doi/full/10.1177/09612033251345184
全身性エリテマトーデス(SLE)における診断の影: 質的研究 Diagnostic overshadowing in systemic lupus erythematosus (SLE): A qualitative study
Rupert Harwood, Chris Wincup, […], and Melanie Sloan
Lupus Published:June 9, 2025
DOI:https://doi.org/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 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.
