{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:08:47Z","timestamp":1784365727146,"version":"3.55.0"},"reference-count":32,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000936","name":"Gordon and Betty Moore Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000936","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Patient Education and Counseling"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.pec.2026.109610","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:06:37Z","timestamp":1775099197000},"page":"109610","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Between doubt and diagnosis: Patient experiences of emotional harm from diagnostic delays"],"prefix":"10.1016","volume":"149","author":[{"given":"Sara","family":"McCleskey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Hero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Berdahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Schiff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divvy","family":"Upadhyay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0152-0369","authenticated-orcid":false,"given":"Sangeeta C.","family":"Ahluwalia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"10","key":"10.1016\/j.pec.2026.109610_bib1","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1001\/jama.2009.249","article-title":"Diagnostic errors\u2014the next frontier for patient safety","volume":"301","author":"Newman-Toker","year":"2009","journal-title":"Jama"},{"issue":"9","key":"10.1016\/j.pec.2026.109610_bib2","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1136\/bmjqs-2013-002627","article-title":"The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations","volume":"23","author":"Singh","year":"2014","journal-title":"BMJ Qual Saf"},{"issue":"2","key":"10.1016\/j.pec.2026.109610_bib3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1136\/bmjqs-2021-014130","article-title":"Burden of serious harms from diagnostic error in the USA","volume":"33","author":"Newman-Toker","year":"2024","journal-title":"BMJ Qual Saf"},{"key":"10.1016\/j.pec.2026.109610_bib4","series-title":"Improving diagnosis in health care","article-title":"Committee on diagnostic error in health care; Board on Health Care Services; Institute of Medicine","author":"Balogh","year":"2015"},{"issue":"8","key":"10.1016\/j.pec.2026.109610_bib5","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1097\/PTS.0000000000000999","article-title":"Defining diagnostic error: a scoping review to assess the impact of the national academies\u2019 report improving diagnosis in health care","volume":"18","author":"Giardina","year":"2022","journal-title":"J Patient Saf"},{"issue":"1","key":"10.1016\/j.pec.2026.109610_bib6","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1038\/bjc.2015.48","article-title":"Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review","volume":"112","author":"Neal","year":"2015","journal-title":"Br J Cancer"},{"key":"10.1016\/j.pec.2026.109610_bib7","doi-asserted-by":"crossref","DOI":"10.1016\/j.clim.2022.108931","article-title":"Health-related quality of life in primary immunodeficiencies: impact of delayed diagnosis and treatment burden","volume":"236","author":"Anderson","year":"2022","journal-title":"Clin Immunol"},{"issue":"1","key":"10.1016\/j.pec.2026.109610_bib8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.44531","article-title":"Characteristics of disease-specific and generic diagnostic pitfalls: a qualitative study","volume":"5","author":"Schiff","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"4","key":"10.1016\/j.pec.2026.109610_bib9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/PTS.0000000000000817","article-title":"What contributes to diagnostic error or delay? A qualitative exploration across diverse acute care settings in the United States","volume":"17","author":"Barwise","year":"2021","journal-title":"J Patient Saf"},{"issue":"5","key":"10.1016\/j.pec.2026.109610_bib10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-001539","article-title":"Identifying early warning signs for diagnostic errors in primary care: a qualitative study","volume":"2","author":"Balla","year":"2012","journal-title":"BMJ Open"},{"issue":"3","key":"10.1016\/j.pec.2026.109610_bib11","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1136\/bmjqs-2024-017506","article-title":"Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature","volume":"34","author":"Faugno","year":"2025","journal-title":"BMJ Qual Saf"},{"issue":"8","key":"10.1016\/j.pec.2026.109610_bib12","doi-asserted-by":"crossref","first-page":"e1759","DOI":"10.1097\/PTS.0000000000000642","article-title":"Patients\u2019 perspectives of diagnostic error: a qualitative study","volume":"17","author":"Sacco","year":"2021","journal-title":"J Patient Saf"},{"key":"10.1016\/j.pec.2026.109610_bib13","series-title":"The Illness Narratives: Suffering, healing, and the human condition","author":"Kleinman","year":"1988"},{"issue":"5","key":"10.1016\/j.pec.2026.109610_bib14","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.socscimed.2005.07.030","article-title":"I just want permission to be ill': towards a sociology of medically unexplained symptoms","volume":"62","author":"Nettleton","year":"2006","journal-title":"Soc Sci Med"},{"issue":"3","key":"10.1016\/j.pec.2026.109610_bib15","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.socscimed.2005.06.018","article-title":"Illnesses you have to fight to get: Facts as forces in uncertain, emergent illnesses","volume":"62","author":"Dumit","year":"2006","journal-title":"Soc Sci Med"},{"issue":"4","key":"10.1016\/j.pec.2026.109610_bib16","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1002\/ajmg.c.31935","article-title":"Patients with Ehlers-Danlos syndrome on the diagnostic odyssey: rethinking complexity and difficulty as a hero's journey","volume":"187","author":"Halverson","year":"2021","journal-title":"Am J Med Genet C Semin Med Genet"},{"issue":"4","key":"10.1016\/j.pec.2026.109610_bib17","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1525\/maq.1992.6.4.02a00030","article-title":"Suffering and the social construction of illness: the delegitimation of illness experience in chronic fatigue syndrome","volume":"6","author":"Ware","year":"1992","journal-title":"Med Anthropol Q"},{"issue":"4","key":"10.1016\/j.pec.2026.109610_bib18","doi-asserted-by":"crossref","DOI":"10.1016\/j.ymgme.2025.109283","article-title":"Undiagnosed Diseases Network; Bernstein JA, Wheeler MT, Halley MC. \"Nobody listened to us for years\": Parents' experiences of provider communication in the diagnostic odyssey","volume":"146","author":"Nguyen","year":"2025","journal-title":"Mol Genet Metab"},{"issue":"2","key":"10.1016\/j.pec.2026.109610_bib19","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s10897-014-9773-9","article-title":"Is it going to hurt?\": the impact of the diagnostic odyssey on children and their families","volume":"24","author":"Carmichael","year":"2015","journal-title":"J Genet Couns"},{"issue":"3","key":"10.1016\/j.pec.2026.109610_bib20","first-page":"237","article-title":"Gender bias in medicine","volume":"4","author":"Hamberg","year":"2008","journal-title":"Women\u2019s Health"},{"key":"10.1016\/j.pec.2026.109610_bib21","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/6358624","article-title":"\"Brave Men\" and \"Emotional Women\": a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain","volume":"2018","author":"Samulowitz","year":"2018","journal-title":"Pain Res Manag"},{"issue":"4","key":"10.1016\/j.pec.2026.109610_bib22","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1037\/bul0000473","article-title":"Ignored, dismissed, and minimized: Understanding the harmful consequences of invalidation in health care\u2014a systematic meta-synthesis of qualitative research","volume":"151","author":"Bontempo","year":"2025","journal-title":"Psychol Bull"},{"key":"10.1016\/j.pec.2026.109610_bib23","doi-asserted-by":"crossref","DOI":"10.1177\/25160435251341056","article-title":"Patient-reported measurement opportunities of diagnostic excellence: From whom, what, when, and where","author":"Dukhanin","year":"2025","journal-title":"J Patient Saf Risk Manag"},{"issue":"3","key":"10.1016\/j.pec.2026.109610_bib24","first-page":"631","article-title":"Narrative interviewing","volume":"38","author":"Anderson","year":"2016","journal-title":"Int J Clin Pharm"},{"key":"10.1016\/j.pec.2026.109610_bib25","first-page":"1072","article-title":"Narrative interviewing","volume":"1","author":"Kartch","year":"2017","journal-title":"SAGE Encycl Commun Res Methods"},{"issue":"1","key":"10.1016\/j.pec.2026.109610_bib26","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J Adv Nurs"},{"issue":"8","key":"10.1016\/j.pec.2026.109610_bib27","doi-asserted-by":"crossref","first-page":"e1759","DOI":"10.1097\/PTS.0000000000000642","article-title":"Patients\u2019 perspectives of diagnostic error: a qualitative study","volume":"17","author":"Sacco","year":"2021","journal-title":"J Patient Saf"},{"issue":"3","key":"10.1016\/j.pec.2026.109610_bib28","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.2218","article-title":"Developing a framework and electronic tool for communicating diagnostic uncertainty in primary care: a qualitative study","volume":"6","author":"Khazen","year":"2023","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.pec.2026.109610_bib29","unstructured":"Agency for Healthcare Research and Quality. Toolkit for Engaging Patients To Improve Diagnostic Safety Rockville, MD2025 [Available from: \u3008https:\/\/www.ahrq.gov\/diagnostic-safety\/tools\/engaging-patients-improve.html\u3009."},{"key":"10.1016\/j.pec.2026.109610_bib30","doi-asserted-by":"crossref","DOI":"10.1016\/j.mcpdig.2025.100242","article-title":"Artificial intelligence in digital self-diagnosis tools: a narrative overview of reviews","author":"Mentzou","year":"2025","journal-title":"Mayo Clin Proc Digit Health"},{"key":"10.1016\/j.pec.2026.109610_bib31","article-title":"From E-patients to AI patients: the tidal wave empowering patients, redefining clinical relationships, and transforming care","author":"S Woods","year":"2025","journal-title":"JMIR Publ Tor Can"},{"key":"10.1016\/j.pec.2026.109610_bib32","first-page":"643","article-title":"Ten principles for more conservative, care-full diagnosis","author":"Schiff","year":"2018","journal-title":"Am Coll Physicians"}],"container-title":["Patient Education and Counseling"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0738399126001436?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0738399126001436?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T20:40:54Z","timestamp":1782420054000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0738399126001436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":32,"alternative-id":["S0738399126001436"],"URL":"https:\/\/doi.org\/10.1016\/j.pec.2026.109610","relation":{},"ISSN":["0738-3991"],"issn-type":[{"value":"0738-3991","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Between doubt and diagnosis: Patient experiences of emotional harm from diagnostic delays","name":"articletitle","label":"Article Title"},{"value":"Patient Education and Counseling","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pec.2026.109610","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 RAND Corporation. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"109610"}}