Breathlessness is just a symptom, not a diagnosis." Perceptions of the diagnostic pathway from people with breathlessness without a diagnosis and clinicians

Clinical Research Results Abstract Introduction: Breathlessness is a common and distressing symptom. There are known delays in patients presenting with chronic breathlessness in primary care and associated challenges for clinicians in reaching a diagnosis. We aimed to explore the diagnostic journey for adults presenting with breathlessness to primary care yet to receive a diagnosis, and the experience of clinicians managing this presentation.Methods: Semi-structured interviews with patients presenting with chronic breathlessness, and clinicians in primary care in Leicestershire, UK. All participants were enrolled in a feasibility study evaluating diagnostic pathways for breathlessness; eligible patients were aged over 40 years, breathless for over two months and without a diagnosis for their symptoms. The interview guide explored experience of breathlessness, the diagnostic process and associated healthcare. Interview data were analysed thematically to generate key themes.Results: 34 patients (mean [range] age 68 [45-89] years, 55% female) and 10 clinicians (mean [range] 17 [6-28] years of experience) were interviewed between November 2019 and October 2021. Patients described symptom driven expectations and experiences, in contrast to a disease driven response from clinicians. The findings are presented under four broad themes; 1) Recognising and validating symptoms of breathlessness is the first step in the process for patients and clinicians; 2) Communication and effective responsiveness of clinicians to breathlessness impacts on patient experience; 3) Difficult conversations arise when a meaningful diagnostic label is not confirmed; 4) Disease management rather than breathlessness symptom management was prioritised by clinicians. Discussion: The experience of ‘usual care’ for patients presenting with breathlessness in primary care in this study varies widely and is impacted by symptom validation, responsiveness of their clinician and communication style. Clinicians strive to find a pathophysiological cause and appropriate treatment for breathlessness, but may feel less confident about the symptom management of patients where a disease label is absent. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest The authors declare no competing interests.This work was funded by a NIHR Clinician Scientist Fellowship (CS-2016-16-020) awarded to Dr Rachael A Evans. Professor Natalie Armstrong is supported by a Health Foundation Improvement Science Fellowship and also by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health.The wider feasibility trial has been registered on the ISRCTN website (ISRCTN14483247). References and Clinical Trial Registry Information