Can the Mentally Ill Label Create Prejudice Peer Review

Introduction

Worldwide there has been an increase in the use of diagnostic labels for both physical and psychological diagnoses (one, 2). Diagnoses reflects the procedure of classifying an individual who presents with certain signs and symptoms as having, or not having, a particular disease (three). The diagnostic process can involve various assessments and tests, still, culminates to a "diagnostic label" that is communicated to the individual (four). The term "diagnostic characterization" will be used to indicate diagnosis or labelling of health conditions listed in current diagnostic manuals (5, 6). Diagnostic definitions and criteria continue to expand and, with this, individuals who are asymptomatic or feel mild symptoms are increasingly likely to receive a diagnostic label (seven, 8). Information technology is acknowledged that the consequences of a diagnostic label are likely private, and how each is perceived is dependent on numerous internal (e.g., medical history, historic period, sex, culture) and external (eastward.g., service availability, country) factors, and differs past perspective (9). Motivation for expanding disease definitions and increased labelling includes the presumed benefits such as validation of health concerns, access to interventions, and increased support (3, 10). Withal, often less considered are the problematic or negative consequences of a diagnostic characterization. This may include increased psychological distress, preference for invasive treatments, greater sick part behaviour, and restriction of independence (11–14). Additionally, research indicates the impact of a label is diverse and varies depending on your perspective equally an private labelled (15, sixteen), family/caregiver (15, 17, 18), or healthcare professional (fifteen, 19).

Psychosocial theories, including social constructionism, labelling theory, and modified labelling theory, take attempted to explain the varied influence of labels on an individuals' well-being and identity germination, in improver to society's role in perpetuating assumptions and necessity of item labels (iii, 20–22). In terms of quantifying this affect, research to appointment has examined the touch of changes to diagnostic criteria (due east.thou., cut-points/thresholds), how and when diagnoses are provided (e.grand., tests used, detection through screening, or symptom investigation), the prevalence of diagnoses, or handling methods and outcomes (4, 23–26). Withal, clinicians and researchers accept paid relatively less attention to the consequences a diagnostic label has on psychological well-existence, access to services, and perceived health. Of particular concern, are the implications of a diagnostic label for people who are asymptomatic or nowadays with mild signs and symptoms are of critical importance as it is this group of people who are less likely to benefit from treatments and are at greater risk of harm (iv, 27).

The limited work in this expanse has reported on private diagnostic labels, used hypothetical case scenarios, or failed to differentiate betwixt condition symptoms and status label (28, 29). Few studies have synthesised the existent-earth consequences of diagnostic labelling, with existing syntheses restricted to a specific condition or express in the methodological approach used (e.g., hypothetical example-studies) (30–32). This suggests a paucity of information available for individuals, their family/caregivers, healthcare professionals, and community members to empathise the potential consequences of being given a diagnostic characterization. Therefore, the aim of this scoping review is to place and synthesise the potential consequences of a diagnostic label from the perspective of an individual who is labelled, their family unit/caregiver, healthcare professional, and community members.

Methods

Pattern

This systematic scoping review was conducted and reported in accordance with the published protocol (33), the Joanna Briggs Methodology for Scoping Reviews (34), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (35). Originally, nosotros proposed to report the results of both qualitative and quantitative studies together, yet, due to the large volume of included studies and the richness of the data, but results from the qualitative studies are reported in this newspaper. Results from quantitative studies will be reported separately. Later on, this article presents the results of the qualitative synthesis.

Search Strategy

An electronic database search was conducted in PubMed, Embase, PsycINFO, Cochrane, and CINAHL from database inception to viii June 2020. The search strategy combined medical subject headings and primal discussion terms related to "diagnosis" and "upshot" (run into PubMed Search Strategy in Supplementary Material). Frontwards and backward citation searching was conducted to place additional studies non found by the database search.

Inclusion Criteria

Nosotros included peer reviewed publications, both chief studies and systematic or literature reviews, that reported on consequences of a diagnostic characterization for a non-cancer diagnosis. Included studies could report consequences from the perspectives of the individual, their family, friends, and/or caregivers, healthcare professional, or community member.

Studies reporting labelling of cancer conditions were excluded as existing research suggests that individuals labelled every bit having a cancer condition may report dissimilar experiences, for example, associating the condition with lethality, or desiring invasive treatments, to those labelled with other physical (e.g., diabetes, polycystic ovarian syndrome) or psychological (e.g., autism spectrum disorder, dementia) diagnoses (36–39). Similarly, hypothetical scenarios, or labelling of individuals with intellectual disabilities and/or attributes such every bit race, sexual identity, or sexual orientation were besides excluded.

Study Selection

Published studies retrieved by database searches were exported to EndNote and deduplicated. 2 reviewers (RS, LK) independently screened ~10% of studies and achieved an interrater reliability of kappa 0.92. Disagreements were resolved by discussion or additional reviewers (RT, ZAM) equally necessary. The remaining screening was completed by one reviewer (RS), with studies identified every bit unclear for inclusion reviewed past boosted reviewers (RT, ZAM) as required.

Preliminary Framework Evolution

Prior to starting time of this scoping review, a poll was conducted on social media (Twitter, Facebook) request a single question about people'due south experiences of receiving a diagnostic label and whatsoever associated consequences. A preliminary framework was developed and agreed upon past members of the enquiry team from the responses received from 46 people. The preliminary framework included five master themes and vii sub-themes detailed in the published protocol (33). This preliminary framework was used equally a starting indicate from which to iteratively develop and synthesise the range of consequences that emerged from the studies included in this review.

Data Extraction and Analysis

One time eligible articles were identified, data was extracted and analysed from randomly selected articles using a three-phase process. The starting time phase (i.due east., kickoff third of randomly selected manufactures) was used to iteratively develop the framework. The second stage (i.eastward., second third of randomly selected manufactures) was used to examine the framework for completeness and explore the extracted data for thematic saturation. The concluding 3rd of included studies was to be extracted and analysed merely if saturation had not occurred. Thematic saturation was defined as the non-emergence of new themes that would consequence in revision of the framework (40).

Three authors (RS, RT, and ZAM) independently extracted data from ten% of the first third of included studies and mapped this to the preliminary framework. As new consequences were identified the framework was revised and subthemes emerged. Conflicts were resolved through discussion. One reviewer (RS) completed extraction of the remaining studies in the start third. Reflexivity was accomplished through regular discussions with an additional reviewer (RT or ZAM) to ensure manufactures were relevant, coding was reliable, and homogeneity existed between data extracted to major themes and subthemes (41, 42). When data extraction was completed, two additional reviewers (RT and ZAM) examined the extracted data and disagreements in coding were resolved through discussion.

Extracted data included study characteristics (author, journal, year of publication, report state, and setting), participant characteristics (number of participants, age, diagnostic label), and abstracted themes and relevant supporting quotes identified by the authors of the included studies that pertained to the consequences of a diagnostic label. Direct quotes were non extracted in isolation to preserve the author's pregnant and ensure contextual understanding from the chief study was retained. These qualitative meta-analysis techniques have been described elsewhere (43–45).

Results

Search Results

Searches identified 16,014 unique records which nosotros screened for inclusion. Full texts were retrieved for 191 qualitative studies, of which 146 (128 studies, 18 reviews) were included in this systematic scoping review (Figure i). Information extraction was completed using the staged processed described in a higher place. Saturation of themes was achieved by the conclusion of the 2nd stage of data extraction. Therefore, 97 studies (of which 13 were reviews) directly informed our results.

Figure 1. PRISMA-ScR flow diagram.

Of the studies that directly informed the coding framework, 61 examined physical diagnostic labels (eastward.chiliad., diabetes, female reproductive disorders) and 36 examined psychological diagnostic labels (east.yard., autism spectrum disorder, dementia). Over half of the studies (58%, 56/97) reported individual perspectives on being labelled with a diagnostic label, nine% (9/97) reported on family/caregiver perspectives, xiv% (14/97) reported healthcare professional perspectives, and 19% (eighteen/97) reported multiple (including community) perspectives. Key characteristics of the included studies are provided in Table i.

Table one. Key characteristics of extracted qualitative studies and reviews.

The 44 studies and five reviews includable in our review merely not subjected to information extraction due to thematic saturation (terminal third), had a like pattern to those used: 28 explored physical and 21 explored psychological diagnostic labels; well-nigh reported individual perspectives (76%, 37/49), significantly less reported multiple (12%, half dozen/49) or family unit/caregiver perspectives (10%, five/49), and ane (2%) reported healthcare professional or community perspectives. References of these studies are provided in References not subjected to qualitative analyses in Supplementary Material.

Thematic Synthesis

Qualitative synthesis of included studies identified v overarching themes: psychosocial impact (8 subthemes), support (6 subthemes), time to come planning, behaviour, and treatment expectations (two subthemes each). Tabular array ii reports the number and proportion of records that supported each theme for each of the four perspectives while Table 3 reports the themes and subthemes supported by each included study. Due to the breadth of results, only themes which were supported past >25% of studies, are reported in the text, with themes supported past <25% of articles presented only in tables. Detailed descriptions of all themes and subthemes, with supporting quotes from the private perspective, are reported in Table 4. Findings from the perspective of family/caregiver, healthcare professionals and customs members are briefly reported in text, with details of these themes and supporting quotes reported in Supplementary Tables i–3, respectively.

Table 2. Proportion of records supporting each theme from the various perspectives.

Table iii. Themes and subthemes supported by each tape.

Table 4. Major and subthemes arising as consequences for the individual.

Individual Perspective

Psychosocial Impact

Psychosocial impact was identified every bit the most prevalent theme impacting individuals following being labelled with a diagnostic label. Within this major theme, eight subthemes emerged. Negative psychological impact, positive psychological impact, and psychological accommodation were developed with over 50% of studies preferencing the individual's perspective. Subthemes developed with <l% of included articles were self-identity (44%), social identity (39%), social stigma (32%), medicalisation (25%), and mixed psychological impact (13%) (meet Table 2 for overview and Table iv for details).

Negative and Positive Psychological Touch on

Both positive and negative consequences of diagnostic labelling to individuals were reported. Well-nigh 72% of studies describing consequences of labelling from the individual's perspective reported negative psychological consequences including resistance, shock, anxiety, confusion, bereavement, abandonment, fright, sadness, and anger ofttimes reported (46, 50–52, 56, 57, 59–63, 65, 66, 68–70, 74, 75, 81, 82, 85, 88, 92, 95–97, 99, 103–106, 108, 112, 113, 126, 136, 138, 139). Conversely, 61% of studies reported a positive psychological impact of existence provided with a diagnostic characterization. For instance, many individuals reported that receiving a diagnostic label produced feelings of relief, validation, legitimisation, and empowerment (31, 46, 57, 60, 66, 72, 77, 79, 80, 83, 84, 86–89, 91, 92, 96, 97, 99, 105–109, 111, 113, 120, 121, 126, 133, 134, 136, 139). Other studies reported individuals described diagnostic labels as providing promise and removing uncertainty (93, 95, 96, 112, 121, 130, 134, 136, 137), facilitating communication with others (98, 130), and increasing self-understanding (97, 131, 138).

Psychological Adaptation

Upon receipt of a diagnostic characterization, 52% of included studies from an individual's perspective reported a need to modify their cognitions and emotions. Included studies reported individuals described adaptive (e.chiliad., using humour) and maladaptive (east.g., suicidality) coping mechanisms (46, 48, 50, 57, 61, 67–69, 71, 74, 82, 85, 88, 98, 105, 107–109, 111, 112, 114, 136, 138, 139), adapting to new condition-specific knowledge (62, 79, 87, 88, 121), rejecting negative perceptions (50, 51, 70, 104, 138), and accentuating positive elements of the condition (51, 52, 61, 86, 105, 111). These adaptations were reported to be centred effectually living fulfilling lives post diagnostic labelling (70, 83, 88, 107).

Changes to self-identity was reported by individuals in 44% of included studies. These studies reported individuals experienced a disruption to their perception of cocky and previously held identities (46, 51, 57, 59, 61, 78, 81, 103, 104, 107, 113, 136, 137, 139). Some of these changes were viewed constructively, including reported perceptions of empowerment, transformation, and self-reinforcement (51, 67, 83, 88, 107, 109, 121, 137–139). Others, however, reported negative impacts such as enforced separation from those who did non take a characterization, and perceptions of themselves as unwell and less competent (31, 51, 52, threescore, 63, 76, 88, 105–107, 109, 111–113, 121, 136, 138, 139).

Changes to social identity and experiences of social stigma were reported in 39% and 32% of included studies, respectively. Within newly adult social identities, mentorship and support groups were frequently reported as benign (31, 46, 51, 56, 57, 68, 69, 81, 85–88, 97, 107, 109, 111, 113, 134, 138, 139), although sometimes non (61, 85, 107, 113). In some studies, individuals perceived increased stigmatisation, including judgement, bullying, powerlessness, isolation, and discrimination, from families, friends, and society (31, 51, 61, 63, 74, 78, 85, 98, 105, 107, 108, 121, 133, 137, 138), and healthcare professionals (88, 133). Few studies reported individuals perceived their diagnostic label negatively impacted employment (71, 76, 138).

A quarter of the studies reporting individual perspectives, referenced the concept of medicalisation at various points along the diagnostic labelling pathway. For case, at the point of diagnostic labelling, some individuals described the diagnostic characterization as medicalising their asymptomatic diagnosis (71, 76, 138), others struggled with differentiating normal and aberrant experiences (99, 111), while others attributed all symptoms and behaviours to the provided diagnostic label (85, 86, 121, 133).

Support

Within this major theme, six subthemes emerged. The most frequently reported was individuals' interactions with healthcare professionals in 45% of included studies. Fewer studies reported on disclosure (37%), or changes in the perceived or actual support received following receipt of a diagnostic label with loss of support reported in 37% of studies and increased back up reported in 27% of studies. Close relationships and secondary gains were less prevalent themes reported in <25% of included studies.

Healthcare professional interactions were reported to occur forth a spectrum from individuals feeling adequately supported and reassured (31, 46, 51, 59, 60, 87, 93, 95, 96, 131) through to individuals feeling dismissed and non listened to (31, 59, 61, 72, 78, 80, 84–86, 89, 91, 93, 95, 97, 98, 104–107, 120). Perception of interactions with healthcare professionals often reflected the individual's understanding of the healthcare professionals': part [e.g., responsible for correcting the diagnosis, open up discussion between professional and individual (47, 109)]; the perceived level of skill, knowledge and competency (95, 97); and communication skills (47, 91, 112).

Individuals disclosing their diagnostic label to others was a dilemma reported in 37% of included studies. Concerns about whether, when and to whom to disclose where frequently reported (46, 47, 57, 61, 104, 105, 132, 134, 139, 140). Reasons for hesitation included worry, shame, and embarrassment (65, 81), fear of rejection or loss of support (52, 61, 65, 68, 74, 105, 108), anticipation of stigma (65, 68, 86, 88, 89, 105, 121); loss of pre-diagnostic labelled self (82, 107, 113, 138), and fear of losing employment (74, 86, 138). Disclosure was frequently reported to occur out of a "sense of obligation" (68, 91, 126, 134, 138).

As a result of the diagnostic label, individuals in the included studies reported similar, increased, and decreased emotional support. Some individuals reported others became more emotionally and physically distant, either overtly or covertly, and more stigmatising (48, 51, 56, 69, 71, 73–76, 81, 88, 89, 105, 107, 108, 133, 134, 136, 138) following characterization disclosure, some experienced breakdowns of romantic relationships and marriages (52, 66, 105, 107), and some perceived a reduction in support from healthcare professionals following diagnostic labelling (46, 56, 86, 106, 132, 133, 136, 139). In contrast, others indicated no modify or an increase in support from family, friends, and communities, reporting credence, tolerance, and strengthened relationships (31, 46, 48, 50, 55, 57, 68, 69, 73, 74, 86, 91, 105, 107, 113, 130, 134, 138, 140).

Hereafter Planning

Inside this major theme, two subthemes emerged which were related to the certainty of futurity aspirations and planning: uncertainty (28%) and action (imminent demand or ability to respond, 17%).

Individuals who reported uncertainty about their time to come wellness and lifestyles reported fearfulness, worry, stress, anxiety, and passivity effectually their futures (57, 69, 88, 97), with these emotions related to changes to life-plans (66, 69, 77, 108, 138), including reproductive abilities (57, 59, 60, 105), potential complications due to the diagnostic label and/or its treatment (52, 57, 62, 63, 69, 81), and unclear affliction progressions (31, 77, 78, 85, 87, 93).

Behaviour Modification

Behaviour modification was reported equally either benign to greater overall health and well-being (reported in 30% of included studies) or detrimental and perpetuated or exacerbated condition difficulties (reported in 32%).

Beneficial behaviour modifications included greater ownership of health (51, 82, 109, 136) and positive changes to physical activity practises, dietary choices, self-awareness, and risk management (48, fifty, 51, 55–57, 59, 62, 67, 81–83, 87, 88, 104, 105, 107, 109, 113, 136, 138). While detrimental behaviour modifications were reported as activity restriction (46, 51, 66, 88, 105, 107, 112, 133), reduction in employment and educational opportunities (63, 81, 107, 133, 138), and withdrawal from social interactions and relationships (51, 61, 66, 74, 75, 81, 95, 96, 105). Other individuals indicated increased hypervigilance (51, 57, 75, 112) and boosted confusing and risk-taking behaviours (50, 57, 70, 82, 98) and suicide attempts (70, 107, 138).

Post-obit receipt of a diagnostic label, treatment expectations were reported by some individuals as both positive (reported in 28% of included studies) and negative treatment experiences (42%). Some individuals reported condition labelling facilitated admission to treatment, monitoring, and support (31, 55, 57, 59, 62, 69, 86, 106, 112, 133, 136–138), which produced hope, empowerment, and perceived command (31, 80, 83, 88, 97, 105, 139) and contributed to positive treatment experiences. Contributing to negative treatment experiences, notwithstanding, others indicated the labels failed to guide handling (31, 57, 59, 77, fourscore, 86, 89, 95, 105, 114, 132), and that treatments were ineffective, difficult to sustain, and had detrimental furnishings (46, l, 52, 55, 56, 77, fourscore–83, 88, 91, 105, 107–109, 113, 120, 131, 138); and lack of command over (72, 107, 140), or rejection from services (31, 95, 130–132).

Perspectives of Family/Caregivers, Healthcare Professionals, and Community Members

Fewer studies reported consequences of a diagnostic label from the perspectives of family unit/caregivers (northward = 19 studies), healthcare professionals (n = 21 studies) and community perspectives (n = 3 studies; Tabular array two for overview and Supplementary Tables one–3, respectively, for details). Family/caregivers primarily reported negative psychological impacts of diagnostic labelling (53%). Other subthemes comprised evidence from <50% of included articles, including detrimental behaviour modifications (47%), psychological adaptation and close relationships (42%), social identity (32%), and positive psychological impact, social stigma, healthcare professional interactions/relationships, increase/maintained emotional support, and negative treatment experiences (all 26%).

Healthcare professionals predominantly reported on their interactions/relationships (62%) with patients following diagnostic labelling, the potential negative psychological impact (33%) a diagnostic label would have and how this could atomic number 82 to medicalisation (29%) of symptoms.

Although the community perspective was least ofttimes reported, two-thirds of the included studies (67%) reported the diagnostic label had an touch on the social identity of the individual labelled. Unmarried studies from the community perspective reported themes of social identity, social stigma, increased/maintained emotional support, reduced/express emotional support, detrimental/unhelpful behaviour modifications, and negative treatment experiences (all 33%). No studies from the customs perspective supported the remaining 14 subthemes.

Discussion

The findings from our systematic scoping review identified a diverse range of consequences of being labelled with a diagnostic label that vary depending on the perspective. V primary themes emerged: psychosocial impact, support, future planning, behaviour, and treatment expectations, with each theme having multiple subthemes. All 5 primary themes were reported from each perspective: individual; family/caregiver; healthcare professional person; or community member. Within each principal theme there were examples of both positive and negative impacts of the diagnostic label.

However, the developed framework suggests that receiving a diagnostic label is not solely benign. For instance, of the studies in our review which reported a psychosocial consequence of a diagnostic label, threescore% of these reported negative psychological impacts, compared with 46% that reported positive psychological impacts. The results of this review also suggest many individuals feel changes in their relationships with healthcare providers (and the latter agreed), lost emotional back up, and experienced a mix of both benign and detrimental changes in behaviour due to the diagnostic characterization.

Strengths and Limitations

A forcefulness of the current review is the inclusivity of consumers in the development of the initial framework through social media polling, which increased the breadth of the search strategy, and embedded consumers perspective into the developed framework. Inclusion of both concrete and psychological diagnostic labels and data from multiple perspectives (i.e., individual, family/caregiver, healthcare professional, community members) addresses limitations of previous studies and increases the generalisability of the findings (thirty–32). Further, examining varied perspectives highlighted the various impact of diagnostic labelling and both common and lesser reported or explored consequences. The staged process of data extraction provided an opportunity to refine and validate the framework, with separate reporting of qualitative and quantitative results allowing for a more thorough give-and-take of findings. The random process used to extract data resulted in studies selected for extraction having similar characteristics (eastward.g., physical, psychological, proportion reporting on each perspective) to those articles which were not selected (i.eastward., last 3rd). Therefore, the articles synthesised in the framework are representative of all manufactures included in the review.

There are several limitations which might impact the interpretations of our results. Offset, the book of retrieved and included studies in this review resulted in pragmatic decisions regarding the separation of reporting qualitative and quantitative findings. As this is a scoping review, the methodological quality of included studies was non assessed which may touch the interpretation of these results. Although our scoping review did not include greyness literature and non-peer reviewed research (e.g., dissertations), we believe the volume of included studies and achievement of data saturation for the thematic coding brand novel findings from these sources unlikely. While our findings tin be generalised to a large number physical and psychological diagnoses, they cannot exist extended to cancer diagnoses. The decision to exclude cancer diagnoses was due to an existing trunk of literature that documents consequences of cancer diagnoses, the increased perceived severity and lethality of cancer diagnoses, and assumptions of increased invasiveness of treatments (37–39). Considering the expanse of research available in the field of cancer, and the potential for this literature to dominate the articles included and synthesised in this review, cancer diagnoses were excluded (37–39). Lastly, time since diagnostic labelling could not exist adamant in many of the studies included in this review. Time since diagnostic labelling may have various impacts on diagnostic characterization consequences, with the potential for consequences to increase, and/or decrease, in severity over time.

Individual perspectives of the consequences of diagnostic labelling have been more thoroughly researched than the perspectives of family/caregivers, healthcare professionals or community members. Although one could argue this is reasonable, the paucity of research exploring healthcare professional perspectives is surprising given these individuals are currently primarily responsible for the provision of diagnostic labels. Failure to thoroughly examine consequences of diagnostic labelling from these perspectives may serve to perpetuate harms, including stigma and overtreatment, for certain diagnoses. Exploring the consequences from these lesser represented perspectives would be a valuable area for future research.

Report Results in Relation to Other Reviews

The findings of our review ostend and expand those of other reviews, including highlighting the range of psychological impacts of receiving a diagnostic label (eastward.yard., positive, negative, mixed), changes to cocky-identity of the individual labelled, and the questioning of condition prognosis (fifteen, 142). While the current review excluded cancer conditions, the results of our review confirm those of Nickel et al. (39) who plant that, in hypothetical instance scenarios of medicalized, compared to descriptive, terminology for both cancer and non-cancer diagnoses, the provision of a diagnostic label may take detrimental psychological impacts, including increased anxiety, increased perceived severity of the diagnosis, and preference for more than invasive treatments. Further, existing reviews investigating the impact of cancer diagnosis on individuals and family unit members (143, 144) back up findings of the current review, including the varied psychological impacts and impacts on support and treatment decisions. Our review also extends these findings first, across multiple diagnostic labels (due east.g., diabetes, musculoskeletal, and autism spectrum disorder) and second, using real-world experiences (39). Our review also confirms the precedents proposed by social constructionism, labelling, and modified labelling theories, which suggest diagnostic labelling activates multifaceted responses, including impacting multiple areas of an individuals' well-being and identity as well every bit evoking a range of societal assumptions (3, 20–22).

Clinical Implications

Overall, at that place is a demand for individuals, family/caregivers, healthcare professionals and community members to be more than enlightened of the potential consequences of diagnostic labels in addition to increased discussion of these impacts at the betoken of, or prior to, provision of diagnostic labels. While normative practise may overlook the impact receiving a diagnostic characterization, increasing sensation of the potential consequences, both positive and negative, may increase judicious utilise of diagnostic labels to ensure greatest do good and least impairment, for individuals, families and caregivers, and wider health systems. In the context of overdiagnosis and expanding disease definitions, such give-and-take, and decided utilise of, diagnostic labels is especially pertinent for individuals being diagnosed with mild symptoms or characteristics indicative of asymptomatic diagnostic labels.

With further evaluation, it is anticipated that our framework could form the basis for discussions prior to the provision of a diagnostic label to increase individuals' awareness of the potential psychosocial, behavioural and relationship changes, expectations about treatments, and hereafter planning associated with the diagnostic characterization. Elements of the framework, in conjunction with the Checklist to Guide Modification of Disease Definitions, developed by Doust et al. (145), may also be used by panels to consider the impacts of a diagnostic characterization before modifying existing diagnostic criteria, especially when planning to lower thresholds for diagnosis. Farther, researchers' consideration of the developed framework may allow for increasingly targeted research objectives, inclusive of broad-ranging possible impacts, which serve to inform modifications to diagnostic criteria, handling guidelines, and healthcare professional grooming programs. Considering the diverse consequences associated with a diagnostic characterization, a word to review how healthcare services and back up are allocated, for example, channelling resources away from condition-specific allotment and toward a needs-based allocation, is worthwhile.

Additionally, there is a office for shared decision making (SDM) at the point of diagnostic labelling for individuals who are asymptomatic or present with mild symptoms. In such instances, information about the consequences of receiving a diagnostic label could be provided to the private and their family unit/caregiver as a discussion aid, a tool that can facilitate SDM, prior to the provision of a diagnostic characterization. This data would potentially enable a word to ensue about whether (or not) diagnostic characterization is necessary and benign given the individual's circumstances (146, 147). Such a word between the private and healthcare professional may effectively circumvent an individual receiving a diagnostic label, or prepare an individual for the potential psychosocial, relational, behavioural, and treatment consequences following receipt of a diagnostic label.

Future Research

The developed framework proposes a range of potential consequences of diagnostic labelling. Still, additional research is required to continue to validate and develop the framework, peculiarly from healthcare professional and community perspectives. It would exist interesting to examine these less explored perspectives every bit further insights into the experience of diagnostic labelling may provide boosted aspects to the developed framework.

Further research is required to decide the impact of wellness symptom severity and prognosis on receiving a diagnostic label. Synthesis of research exploring the consequences of receiving a cancer diagnosis (not addressed in this review) will determine the applicability of the framework to cancer conditions and examine the similarities and differences betwixt labelling cancer and non-cancer condition, potentially adding to the current framework. As we excluded studies that explored the consequences of a cancer diagnosis (oftentimes thought to be life-threatening diagnoses), we do not know whether consequences of "life-threatening" diagnostic labelling differ from other diagnostic labels. Exploration of these areas may be beneficial in further developing the framework and considering its generalisability.

The framework developed in our systematic scoping review synthesises the consequences of a diagnostic label that are applicable to both physical and psychological diagnostic labels. The findings of this review promote the demand for individuals, family unit/caregivers, healthcare professionals, and community members to be more enlightened of, and openly discuss, the consequences of a diagnostic label before a diagnosis is made. In a fourth dimension when diagnostic labels are often quickly and ofttimes provided, and healthcare resources are increasingly scarce, there is a growing need to promote the judicious employ of diagnostic labels for those who are almost likely to do good.

Author Contributions

RS, PG, and RT contributed to the conception and design of the study, initial public polling survey on social media and search term construction. RS and ZAM contributed to screening and information assay. RS, ZAM, RT, and PG contributed to the drafting of the manuscript. All authors approved the final version.

Funding

RS was supported by an Australian Government Research Training Program Scholarship. RT and ZAM are supported by a National Health and Medical Research Council Program grant (#1106452). PG was supported by a NHMRC Research Fellowship (#1080042). The funding sources have no office in written report design, data collection, data analysis, data interpretation, or writing of the report.

Disharmonize of Involvement

The authors declare that the research was conducted in the absence of whatever commercial or financial relationships that could exist construed equally a potential conflict of interest.

Publisher's Notation

All claims expressed in this article are solely those of the authors and do not necessarily correspond those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Whatever production that may be evaluated in this article, or claim that may be fabricated by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors thank Justin Clark, Senior Research Data Specialist at the Constitute for Bear witness-Based Healthcare, Bond Academy for assistance with amalgam the search strategy and Luise Kazda, Ph.D., Candidate, Sydney School of Public Health, the University of Sydney for help with article screening.

Supplementary Material

The Supplementary Material for this article can be constitute online at: https://world wide web.frontiersin.org/manufactures/10.3389/fpubh.2021.725877/full#supplementary-cloth

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Source: https://www.frontiersin.org/articles/10.3389/fpubh.2021.725877/full

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