title: Australian children living with rare diseases: experiences of diagnosis and perceived consequences of diagnostic delays.
abstract: Children and families living with rare disease often experience significant health, psychosocial, economic burdens and diagnostic delays. Experiences appear to be constant, regardless of the specific rare disease diagnosis. Systematically collected Australian data to support policy response on rare diseases are scarce. We address this gap by providing survey results about 462 children aged <19 years living with approximately 200 different rare diseases.
  
  
  
  Of 462 children, 96% were born in Australia, 55% were male, median age was 8.9 years (0-18.2). Four-hundred-and-twenty-eight (93%) had received a definitive diagnosis but 29 (7%) remained undiagnosed. Before receiving the correct diagnosis 38% consulted ≥ 6 different doctors. Among those with a diagnosis, 37% believed the diagnosis was delayed and 27% initially received a wrong diagnosis. Consequences of delayed diagnosis include anxiety, loss of reproductive confidence because of an ill-defined genetic risk, frustration and stress (54%), disease progression (37%), delays in treatment (25%) and inappropriate treatments (10%). Perceived reasons for diagnostic delays included lack of knowledge about the disease among health professionals (69.2%), lack of symptom awareness by the family (21.2%) and difficulties accessing tests (17.9%). Children with inborn errors of metabolism were less likely to have a delayed diagnosis compared with other disease groups (Chi-Sq = 17.1; P < 0.0001), most likely due to well-established and accessible biochemical screening processes. Diagnosis was given in person in 74% of cases, telephone in 18.5% and via a letter in 3.5%. Some families (16%) were dissatisfied with the way the diagnosis was delivered, citing lack of empathy and lack of information from health professionals. Psychological support at diagnosis was provided to 47.5%, but 86.2% believed that it should always be provided. Although 74.9% of parents believed that the diagnosis could have an impact on future family planning, only 44.8% received genetic counselling.
  
  
  
  Parents of children living with rare chronic and complex diseases have called for better education, resourcing of health professionals to prevent avoidable diagnostic delays, and to facilitate access to early interventions and treatments. Access to psychological support and genetic counselling should be available to all parents receiving a life-changing diagnosis for their child.
authors.affiliation: Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, NSW, 2145, Australia. yvonne.zurynski@health.nsw.gov.au.|Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2145, Australia. yvonne.zurynski@health.nsw.gov.au.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Zurynski
authors.affiliation: Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, NSW, 2145, Australia.|Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2145, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Deverell
authors.affiliation: Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, NSW, 2145, Australia.|Genetic Metabolic Disorders Service, Sydney Children's Hospitals Network (Westmead), Westmead, NSW, 2145, Australia.
authors.forename: Troy
authors.initials: T
authors.lastname: Dalkeith
authors.affiliation: Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2145, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, Sydney Children's Hospitals Network (Westmead), Westmead, NSW, 2145, Australia.|Discipline of Child and Adolescent Health, and Discipline of Genetic Medicine, Sydney Medical School, The University of Sydney, Sydney, Australia.|Murdoch Children's Research Institute and Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, 3052, Australia.|Department of Paediatrics, University of Melbourne, Parkville, Vic, 3010, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Christodoulou
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Crawley, WA, 6009, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Leonard
authors.affiliation: Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, NSW, 2145, Australia.|Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, 2145, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D035583:Rare Diseases / Q000175:diagnosis*
keywords: Australian; Child; Diagnosis; Diagnostic delays; Experiences; Families; Rare diseases