Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses.
Ann Hallyburton
PMID 35718951WHAT IT FOUND
Nurses should treat new physical symptoms in patients with mental illness as possible medical problems, not assume they are psychiatric.
The analysed literature describes stigma, record labels and provider bias as contributors to missed care.
Key findings
01The 25 analysed publications repeatedly describe stigma, underestimation and delayed appropriate care as features of diagnostic overshadowing.
02Provider bias, patient self-doubt and chart flagging are identified as antecedents that may lead to worsening physical conditions or death.
03Several included publications call for debiasing interventions and culture change as prevention messages.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a concept analysis of 25 publications, not a primary study of patients, so it does not measure how often diagnostic overshadowing occurs or how much it changes outcomes. The sample includes editorials, opinion pieces and theoretical discussions as well as empirical studies, so the themes are partly interpretive. Only English-language publications were included, and the formal analysis focused on works from 2007 onward, with older publications used only for history. The analysis excluded misattribution involving intellectual disability as a separate phenomenon, so it does not cover all uses of diagnostic overshadowing. It recommends debiasing, education, collaboration and charting changes, but does not test whether any intervention reduces diagnostic overshadowing or improves patient care.
Declared interests
The research received no external funding, and the author declares no conflict of interest.
The easy way to misread this
Do not read this as proof that any intervention reduces diagnostic overshadowing or improves mortality. It is a concept analysis of 25 publications and reports themes, possible causes and consequences, not tested patient outcomes.