title: 'I knew before I was told': Breaches, cues and clues in the diagnostic assemblage.
abstract: Diagnosis can be both a 'diagnostic moment', but also a process over time. This paper uses secondary analysis of narrative interviews on ovarian cancer, antenatal screening and motor neurone disease to explore how people relate assembling procedural, spatial and interactional evidence before the formal diagnostic moment. We offer the idea of a diagnostic assemblage to capture the ways in which individuals connect to and re-order signs and events that come to be associated with their bodies. Building on the empirical work of Poole and Lyne (2000) in the field of breast cancer diagnosis, we identify how patients describe being alerted to their diagnosis, either through 'clues' they report picking up (often inadvertently) or through 'cues', perceived as a more intentional prompt given by a health professional, or an organisational process. For patients, these clues frequently represent a breach in the expected order of their encounter with healthcare. Even seemingly mundane episodes or behaviours take on meanings which health professionals may not themselves anticipate. Our findings speak to an emergent body of work demonstrating that experiences of formal healthcare during the lead-up to diagnosis shape patients' expectations, degree of trust in professionals, and even health outcomes.
authors.affiliation: Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom; NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: louise.locock@phc.ox.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Locock
authors.affiliation: Department of Sociology, Wentworth College, University of York, Heslington, York YO10 5DD, United Kingdom. Electronic address: Sarah.nettleton@york.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nettleton
authors.affiliation: Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom. Electronic address: Susan.kirkpatrick@phc.ox.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Kirkpatrick
authors.affiliation: Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom. Electronic address: Sara.ryan@phc.ox.ac.uk.
authors.forename: Sara
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom. Electronic address: Sue.ziebland@phc.ox.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Ziebland
mesh_terms: D003142:Communication; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D016472:Motor Neuron Disease / Q000175:diagnosis* / Q000523:psychology; D033262:Narration; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000523:psychology; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research
keywords: Diagnosis; Narrative; Patient experience; Qualitative research; Secondary analysis