title: The trajectory to diagnosis with pulmonary arterial hypertension: a qualitative study.
abstract: OBJECTIVE
  To investigate the patient's experience of the trajectory to receiving a diagnosis of pulmonary arterial hypertension (PAH) and inform the provision of care for this patient group.
  
  
  METHODS
  Qualitative study using in-depth one-to-one interviews and pictorial representations. Data were analysed using thematic analysis.
  
  
  METHODS
  Participants were interviewed in their own homes across England.
  
  
  METHODS
  30 patients with a diagnosis of pulmonary hypertension (18 participants were women, mean age 56 and range 26-80 years and time since diagnosis ranged from a few months to more than 12 years) participated.
  
  
  RESULTS
  All participants, regardless of the time since diagnosis, vividly described the process from manifestation of symptoms to receiving a confirmed diagnosis. The authors present data using three major themes: (i) making sense of symptoms, (ii) process of elimination and (iii) being diagnosed with PAH. Making sense of symptoms represented an early period of perseverance-people tried to carry-on as usual despite 'unexplained breathlessness'. As time progressed, this period was punctuated by critical events that triggered seeking medical advice. Once medical contact had been made, patients described a period of 'elimination' and convoluted contact with the medical profession. Dyspnoea misdiagnosis was a key factor that delayed the PAH diagnosis. Diagnosis disclosure by some medical professionals was also viewed as lacking empathy. More positive experiences were relayed when the medical team disclosing the diagnosis acknowledged previous limitations.
  
  
  CONCLUSIONS
  A lack of awareness of this illness from both the sufferer themselves and the medical profession emerged as a central theme and led to prolonged periods of being misdiagnosed. The application of a diagnostic pathway for unexplained dyspnoea that alerts practitioners to rare conditions could expedite the process of correct diagnosis.
authors.affiliation: Department of Pulmonary Vascular Disease, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Armstrong
authors.forename: Nikki
authors.initials: N
authors.lastname: Rochnia
authors.forename: Carl
authors.initials: C
authors.lastname: Harries
authors.forename: Sarah
authors.initials: S
authors.lastname: Bundock
authors.forename: Janelle
authors.initials: J
authors.lastname: Yorke