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Barriers and facilitators in diagnosing axial spondyloarthritis: a qualitative study

Hay, Charles A; Packham, Jon; Prior, James A; Mallen, Christian D; Ryan, Sarah


Jon Packham

Sarah Ryan


Diagnosis of axial spondyloarthritis (axSpA) is frequently delayed for years after symptom onset. However, little is known about patient and healthcare professional (HCP) perspectives on barriers and facilitators in axSpA diagnosis. This study explored the experiences and perceptions of both groups regarding the factors affecting the timely diagnosis of axSpA. Semi-structured interviews with patients with axSpA and axSpA-interested HCPs from the United Kingdom (UK) were performed by telephone or Microsoft Teams and focussed on the individuals' perspective of the diagnostic journey for axSpA. Interview transcripts were thematically analysed. Fourteen patients with axSpA (10 female, 4 male) and 14 UK based HCPs were recruited, the latter comprising of 5 physiotherapists, 4 General Practitioners, 3 rheumatologists, a nurse, and an occupational therapist. Barriers to diagnosis identified by patients and HCPs were: difficult to diagnose, a lack of awareness, unclear referral pathways, patient behaviour and patient/HCP communication. Patient-identified facilitators of diagnosis were patient advocacy, clear referral processes and pathways, increased awareness, and serendipity. HCPs identified promoting awareness as a facilitator of diagnosis, along with symptom recognition, improvements to healthcare practice and patient/HCP communications. Poor communication and a lack of understanding of axSpA in the professional and public spheres undermine progress towards timely diagnosis of axSpA. Improving communication and awareness for patients and HCPs, along with systemic changes in healthcare (such as improved referral pathways) could reduce diagnostic delay. [Abstract copyright: © 2024. The Author(s).]

Journal Article Type Article
Acceptance Date Jan 31, 2024
Online Publication Date Mar 12, 2024
Publication Date 2024-05
Deposit Date Apr 9, 2024
Journal Rheumatology international
Print ISSN 0172-8172
Electronic ISSN 1437-160X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 44
Pages 863–884
Keywords Qualitative, Axial spondyloarthritis, Diagnosis, Ankylosing spondylitis