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Objective: Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians’ (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis. Design: A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data. Setting and subjects: A primary care study, with narratives from 159 PCPs in 23 European countries. Main outcome measures: PCPs’ narratives on the question ‘If you saw this patient with cancer presenting in the same way today, what would you do differently? Results: The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and ‘I wouldn’t do anything differently’. Conclusion (Implications): To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients’ clinical conditions.

AIM AND OBJECTIVES: To explore how chronic illness transforms the self when living with and managing chronic illness and what this means for their self and identity. We also discuss how people with chronic conditions could be supported by healthcare professionals to manage illness in daily life. BACKGROUND: Self-management recommendations from health care are commonly based on a biomedical understanding of the disease. People's experiences of how a condition affects them and adequate support are crucial for their outcomes in daily self-management. DESIGN: A narrative review. METHODS: A systematic search was undertaken during January 2021 across the databases MEDLINE, CINAHL, PsycINFO, Soc INDEX and Philosopher's Index. A quality appraisal of articles was performed. Our analysis was inspired by qualitative content analysis. The PRISMA Checklist 2020/EQUATOR guidelines was used to report the study. RESULTS: Twenty-eight peer-reviewed qualitative empirical articles focusing on self in a variety of chronic illnesses with relevance to nursing published from January 2010 to December 2020 were included. The main theme, Developing from an uncertain existence to meaning and wholeness, was built up by the five themes: Walking on an unstable ground; Being stalemated; Being involved with others for better or worse; Searching for meaning; and lastly, Modifying self and integrating a new way of living. CONCLUSIONS: The results illuminate experiences that seldom are prioritized but need to be addressed by health professionals. Such experiences are oriented more towards the existential self rather than medical issues, why it is important to go beyond the medical lens. RELEVANCE TO CLINICAL PRACTICE: This is important knowledge for nurses aiming to support people with chronic illnesses. Nurses supporting people in self-management need to be aware that by teaching and encouraging people to revise their daily habits, they also work on the boundaries of their self-concept. PATIENT OR P

Aim: This study aimed to explore the experiences of being a clinical research nurse (CRN), in Sweden. Design: A qualitative study analysing individual interview data. Methods: Interviews with 10 participants were conducted in April 2017 and repeated with five participants in May 2022. A semi-structured interview guide was used to cover topics such as experiences of working in a new role and professional challenges related to the role. The transcribed interviews were analysed inductively using qualitative content analysis. Results: The main theme revealed that the CRNs experienced their work role as being like a hub in a wheel, using an ethical compass, but without real power. The six themes identified showed that CRNs worked independently and relied on clinical experiences as nurses but needed more education. They not only had a sense of duty but also too large responsibilities. Furthermore, they viewed their work as valuable and important. However, they needed an accentuated ethical compass and were also affected by power relations that negatively impacted work. Conclusion: Working as a CRN means being in a central position and working independently, which requires diverse skills and competencies. CRNs, however, face and manage complex ethical and practical challenges without real power. They experience huge responsibilities but need education and acknowledgement, indicating a need for improvement. This is an important message to stakeholders and managers about the necessity of taking adequate action to support CRNs who are crucial resources in clinical research. Patient or Public Contribution: No patient or public contribution.

Background: While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. Aim: To explore European PCPs’ experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. Design & setting: A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Method: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. Results: A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients’ descriptions did not suggest cancer; distracting factors reduced PCPs’ cancer suspicions; patients’ hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. Conclusion: The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The ‘Swiss cheese’ model of accident causation showed how the themes related to each other.

Objective: To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden. Design: A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016. Setting: Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2). Subjects: Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden. Main outcome measures: Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department. Results: The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18–99) to 29 days (IQI 9–74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department. Conclusion: Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon. Implication: In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.

Objective: Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians’ (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis. Design: A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data. Setting and subjects: A primary care study, with narratives from 159 PCPs in 23 European countries. Main outcome measures: PCPs’ narratives on the question ‘If you saw this patient with cancer presenting in the same way today, what would you do differently? Results: The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and ‘I wouldn’t do anything differently’. Conclusion (Implications): To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients’ clinical conditions.

OBJECTIVES: This study examined whether sociodemographic factors, including distance to hospital, were associated with differences in the diagnostic interval and the treatment interval for colorectal cancer in northern Sweden. METHODS: Data were retrieved from the Swedish cancer register on patients (n = 446) diagnosed in three northern regions during 2017-2018, then linked to data from Statistics Sweden and medical records. Also, Google maps was used to map the distance between patients' place of residence and nearest hospital. The different time intervals were analysed using Mann-Whitney U-test and Cox regression. RESULTS: Differences in time to diagnosis were found between groups for income and distance to hospital, favouring those with higher income and shorter distance. The unadjusted regression analysis showed higher income to be associated with more rapid diagnosis (HR 1.004, CI 1.001-1.007). This association remained in the fully adjusted model for income (HR 1.004, CI 1.000-1.008), but not for distance. No differences between sociodemographic groups were found in the treatment interval. CONCLUSION: Higher income and shorter distance to hospital were in the unadjusted models associated with shorter time to diagnosis for patients with CRC in northern Sweden. The association remained for income when adjusting for other variables even though the difference was small.

Introduction: Community health nurses contribute significantly to better health, well-being and independence of older adults. The aim of the study is to compare preventive services for older adults in community health care between Sweden and Slovenia. Methods: Literature review and document analysis were used to conduct a qualitative comparative analysis. Literature was retrieved from the MEDLINE, CINAHL and COBIB databases. An analysis of documents such as sectoral legal bases, guidelines and expert recommendations in Slovenia and Sweden was also conducted. The analysis included sources related to preventive services for older adults living at home published between January 2000 and December 2020 in Slovene, English or Swedish. Results: Twenty units of literature were included in the review. Four comparative factors were identified: system and legal basis, organisation and scope, providers, and content. In Slovenia, all older adults are entitled to the same range of preventive services. Compared to Sweden, the organisation of community health care in Slovenia is more centralised, all older adults are entitled to the same scope of preventive health visits, while the level of education and scope of competences of healthcare providers are lower. In both countries, the content of preventive home visits to older adults is similar. Discussion and conclusion: In Slovenia, community health nurses with additional knowledge could prescribe medical devices and medications form a limited list, as well as coordinate care. This would allow them to act more independently in patients' home environment. Further development of more personalised preventive services for older adults depends on research, resource provision and consideration of the organisational culture., Uvod: Preventivne obravnave v patronažnem varstvu pomembno prispevajo k samostojnosti, boljšemu zdravju in dobremu počutju starejših odraslih. Namen raziskave je primerjati preventivne obravnave starejših odraslih v patronažnem varstvu med Švedsko in Slovenijo. Metode: Na osnovi pregleda literature in analize dokumentov je bila narejena kvalitativna primerjalna analiza. Vključena je bila literatura iz podatkovnih bazah MEDLINE, CINAHL in COBIB. Narejena je bila tudi analiza dokumentov, kot so področne pravne podlage, smernice ter strokovna priporočila v Sloveniji in na Švedskem. Vključeni so bili viri objavljeni med januarjem 2000 in decembrom 2020, so se nanašali na preventivne obravnave starejših odraslih, ki živijo doma in so bili napisani v slovenščini, angleščini ali švedščini. Rezultati: V analizo smo vključili 20 enot literature. Opredeljeni so bili štirje faktorji primerjave: sistem in pravne podlage, organiziranost in obseg, izvajalci ter vsebina. V Sloveniji so vsi starejši odrasli upravičeni do enakega obsega preventivnih obravnav. V primerjavi s Švedsko je v Sloveniji bolj centralizirana organizacija patronažnega varstva, vsi starejši odrasli imajo enak obseg preventivnih obiskov, izobrazba in obseg kompetenc izvajalcev pa je v Sloveniji nižja. Vsebina preventivnih patronažnih obiskov starejših odraslih je v obeh državah podobna. Diskusija in zaključek: V Sloveniji bi lahko medicinske sestre v patronažnem varstvu z dodatnimi znanji pridobile tudi kompetence na področju predpisovanja z omejene liste zdravil in medicinskih pripomočkov ter koordinacije oskrbe. Tako bi lahko bolj samostojno delovale v domačem okolju pacientov. Za nadaljnji razvoj bolj personaliziranih preventivnih obravnav za starejše odrasle je pomembno raziskovanje, zagotavljanje virov in skrb za organizacijsko kulturo.

Background: Studies have reported on the important role of the clinical research nurse in clinical studies. Yet, there is no international consensus about the role's competencies and tasks. Furthermore, the literature offers a little description of the career pathway from a ward-based registered nurse to a clinical research nurse. More knowledge about this specific role could benefit the nursing profession as well as increase the quality of clinical research. Aim: The aim of the study was to explore Swedish registered nurses' experiences transitioning into the clinical research nurse role. Design: The study had a qualitative design. Data were collected via semi-structured interviews. Inductive qualitative content analysis was employed. Methods: Ten participants (i.e., clinical research nurses) were interviewed in the spring of 2017. A semi-structured interview guide was used to address the transition into the clinical research nurse role, experience working in a new role, experience of ethical dilemmas and experience of organizational and professional issues related to the role. The interviews were analysed inductively using qualitative content analysis. Results: The registered nurses described experiencing reality shock when they became clinical research nurses; that is, it was a challenging and transforming experience. The main theme, a challenging transition, was developed from the four subthemes highlighting that it defied their previous nursing role. They experienced an unclear professional identity, extended professional mandate, increased professional status and growing ethical consciousness in their new role. Conclusion: The results highlight that registered nurses who became clinical research nurses had needs that were both distinct from and overlapped with those of their former professional role as registered nurses. To avoid reality shocks, the development of clear competence pathways for nurses to become clinical research nurses, including introduction

Aim: To explore the role of CRNs in Sweden and differences in competences and tasks, using the Clinical Trial Nursing Questionnaire - Swedish version (CTNQ-SWE). Design: A cross-sectional survey. Methods: Participants were identified through strategic sampling. Data were analysed by descriptive and comparative statistics. Results: The respondents were experienced nurses who felt proficient in their role, they felt more acceptance by the principal investigators than by nursing colleagues. A majority of CRNs are involved in all procedures specified in the CTNQ-SWE. The most often performed tasks, also rated as the most important by the CRNs, concerned informed consent and management of investigational products. The education was often informal: with a lack of job descriptions and professional development plans. Need of formal specialist education was expressed. Conclusions: Knowledge about the role description can be used by clinical research enterprise internationally and healthcare organizations aiming to support CRNs in their role.

Purpose: We describe levels of cancer worry in the general population as measured with the Cancer Worry Scale (CWS) and investigate the association with colonoscopy screening intentions in three colorectal cancer risk scenarios. Methods: The data were sourced through a population-based survey. Respondents (n = 943) completed an eight-item CWS and questions on colonoscopy screening interest at three hypothetical risk levels. Results: Respondents without a personal cancer history (n = 853) scored 9.46 on the six-item CWS (mean, SD 2.72). Mean scores were significantly higher in women (9.91, SD 2.89) as compared to men (9.06, SD 2.49, p < 0.001). Linear regression showed higher cancer worry in women and those with children when controlling for education, age group, and country of birth. High cancer worry (six-item CWS mean >12) was identified in 25% of women and in 17% of men. Among those, 71% would attend a colonoscopy screening compared to 52% of those with low cancer worry (p < 0.001, 5% CRC-risk). Conclusions: The distribution of cancer worry in a general population sample showed higher mean scores in women, and levels overlapped with earlier findings in cancer-affected samples. Respondents with high cancer worry were more inclined to undergo a colonoscopy screening, and intention increased with higher levels of hypothetical risk.

Introduction: Community health nurses contribute significantly to better health, well-being and independence of older adults. The aim of the study is to compare preventive services for older adults in community health care between Sweden and Slovenia.Methods: Literature review and document analysis were used to conduct a qualitative comparative analysis. Literature was retrieved from the MEDLINE, CINAHL and COBIB databases. An analysis of documents such as sectoral legal bases, guidelines and expert recommendations in Slovenia and Sweden was also conducted. The analysis included sources related to preventive services for older adults living at home published between January 2000 and December 2020 in Slovene, English or Swedish.Results: Twenty units of literature were included in the review. Four comparative factors were identified: system and legal basis, organisation and scope, providers, and content. In Slovenia, all older adults are entitled to the same range of preventive services. Compared to Sweden, the organisation of community health care in Slovenia is more centralised, all older adults are entitled to the same scope of preventive health visits, while the level of education and scope of competences of healthcare providers are lower. In both countries, the content of preventive home visits to older adults is similar.Discussion and conclusion: In Slovenia, community health nurses with additional knowledge could prescribe medical devices and medications form a limited list, as well as coordinate care. This would allow them to act more independently in patients' home environment. Further development of more personalised preventive services for older adults depends on research, resource provision and consideration of the organisational culture., Uvod: Preventivne obravnave v patronažnem varstvu pomembno prispevajo k samostojnosti, boljšemu zdravju in dobremu počutju starejših odraslih. Namen raziskave je primerjati preventivne obravnave starejših odraslih v patronažnem varstvu med Švedsko in Slovenijo. Metode: Na osnovi pregleda literature in analize dokumentov je bila narejena kvalitativna primerjalna analiza. Vključena je bila literatura iz podatkovnih bazah MEDLINE, CINAHL in COBIB. Narejena je bila tudi analiza dokumentov, kot so področne pravne podlage, smernice ter strokovna priporočila v Sloveniji in na Švedskem. Vključeni so bili viri objavljeni med januarjem 2000 in decembrom 2020, so se nanašali na preventivne obravnave starejših odraslih, ki živijo doma in so bili napisani v slovenščini, angleščini ali švedščini.Rezultati: V analizo smo vključili 20 enot literature. Opredeljeni so bili štirje faktorji primerjave: sistem in pravne podlage, organiziranost in obseg, izvajalci ter vsebina. V Sloveniji so vsi starejši odrasli upravičeni do enakega obsega preventivnih obravnav. V primerjavi s Švedsko je v Sloveniji bolj centralizirana organizacija patronažnega varstva, vsi starejši odrasli imajo enak obseg preventivnih obiskov, izobrazba in obseg kompetenc izvajalcev pa je v Sloveniji nižja. Vsebina preventivnih patronažnih obiskov starejših odraslih je v obeh državah podobna.Diskusija in zaključek: V Sloveniji bi lahko medicinske sestre v patronažnem varstvu z dodatnimi znanji pridobile tudi kompetence na področju predpisovanja z omejene liste zdravil in medicinskih pripomočkov ter koordinacije oskrbe. Tako bi lahko bolj samostojno delovale v domačem okolju pacientov. Za nadaljnji razvoj bolj personaliziranih preventivnih obravnav za starejše odrasle je pomembno raziskovanje, zagotavljanje virov in skrb za organizacijsko kulturo.u

AIM: To describe perceived needs of support among patients close to discharge from the hospital and at the end of primary curative radiotherapy for breast, colorectal or prostate cancer. BACKGROUND: Few studies have specifically explored patients' early support needs when ending primary curative treatment. DESIGN: Qualitative interview study design. METHODS: A purposive sample of 27 participants with breast, colorectal or prostate cancer aged 33-88 years. The interviews were analysed by qualitative content analysis. Reporting followed the COREQ guidelines. RESULTS: Personal support to reach a sense of control and Social support for personal growth were two main themes, highlighting that people required adapted support from health care since needs of support could change over time. This support from health care was also relying on that trust-based relationships were developed. Through mutuality with others and engagement in meaningful activities people became enabled and felt further supported. Personal support from health care seems specifically important for the patients' feelings of control and could be a facilitator for patients to identify further support for personal growth in how to manage, on the one hand, illness and insecurity, and on the other, their well-being and everyday life with cancer. CONCLUSION: To empower patients who are ending primary treatment and being close to discharge from hospital, healthcare professionals should recognise patients' shifting needs and adapt the support. Adapted support is significant for patients' sense of safety. Biomedical information is not sufficient to fully support patients. RELEVANCE TO CLINICAL PRACTICE: Offering easy access to supportive care when primary treatment is finished could diminish people's stress, insecurity and avoidable use of healthcare services. Even after discharge, nurses preferably should adapt and offer support tailored to patients' needs. Such support may improve patients' sense of control and

Aim: To explore the role of CRNs in Sweden and differences in competences and tasks, using the Clinical Trial Nursing Questionnaire - Swedish version (CTNQ-SWE). Design: A cross-sectional survey. Methods: Participants were identified through strategic sampling. Data were analysed by descriptive and comparative statistics. Results: The respondents were experienced nurses who felt proficient in their role, they felt more acceptance by the principal investigators than by nursing colleagues. A majority of CRNs are involved in all procedures specified in the CTNQ-SWE. The most often performed tasks, also rated as the most important by the CRNs, concerned informed consent and management of investigational products. The education was often informal: with a lack of job descriptions and professional development plans. Need of formal specialist education was expressed. Conclusions: Knowledge about the role description can be used by clinical research enterprise internationally and healthcare organizations aiming to support CRNs in their role.

Purpose: Sweden has tried to speed up the process of early cancer detection by standardization of care. This increased focus on early cancer detection provides people with a conflicting norm regarding the importance of recognizing possible cancer symptoms and the responsibility of not delaying seeking care. Based on existing norms about patients’ responsibility and care seeking, this study explores how patients experience encounters with primary care physicians when they seek care for symptoms potentially indicating cancer. Methods: Thirteen semi-structured interviews were conducted with patients receiving care for symptoms indicative of cancer in one county in northern Sweden. Data was analysed with thematic analysis. Results: The common notion of describing patients as customers in a healthcare context does not sufficiently capture all aspects of what counts as being a person seeking care. Instead, people interacting with primary care face a twofold role in where they are required to take the role not only of customer but also of seller. Consequently, people shift between these two roles in order to legitimize their care seeking. Conclusions: Standardization oversimplifies the complexity underlying patients’ experience of care seeking and interaction with healthcare. Hence, healthcare must acknowledge the individual person within a standardized system., Originally included in thesis in manuscript form.

During the COVID-19 pandemic, the Internet has been a major source of information for people to keep updated with news and guidelines. However, concerns have been raised about the ‘infodemic’, which includes the overabundance of online information and the spread of misleading information. Adequate eHealth literacy skills among world citizens have therefore been emphasized as vital during the pandemic. Persons with type 2 diabetes have been at increased risk of severe outcomes of COVID-19 disease. This study aimed to explore online COVID-19 information acquisition experiences among persons with type 2 diabetes and varying eHealth literacy. Fifty-eight participants filled out the eHealth Literacy Scale (eHEALS), along with a qualitative questionnaire with free-text questions. Additionally, 10 participants were interviewed. Thematic analysis was applied to identify patterns in participants’ experiences. Two domains were identified: perceived challenges with online information about COVID-19, and coping strategies to manage challenges. The perceived challenges were: being exposed to information overload, dealing with conflicting information, and being strongly emotionally affected. The related coping strategies were: protecting oneself, trusting authorities, taking command, and using common sense. These strategies often involved triangulation of the information obtained, including participants consulting their common sense, various sources, or family and friends. This paper highlights the crucial role of authorities in delivering online information, that according to health literacy principles, is easy to access, understand, and use. Furthermore, our results reinforce the importance of diabetes nurses, as well as healthcare professionals in general, in encouraging patients to share their Internet findings, promote information from reliable sources, and deliver tailored information that suits individual needs. Because our results underline the importance of social supp

This study explores perceptions and preferences on receiving genetic risk informationabout hereditary cancer risk in members of the Swedish public. We conducted qualitative contentanalysis of five focus group discussions with participants (n = 18) aged between 24 and 71 years,recruited from various social contexts. Two prominent phenomena surfaced around the interplaybetween the three stakeholders involved in risk disclosure: the individual, healthcare, and therelative at risk. First, there is a genuine will to share risk information that can benefit others, evenif this is difficult and causes discomfort. Second, when the duty to inform becomes overwhelming,compromises are made, such as limiting one’s own responsibility of disclosure or projecting the mainresponsibility onto another party. In conclusion, our results reveal a discrepancy between publicexpectations and the actual services offered by clinical genetics. These expectations paired with desirefor a more personalized process and shared decision-making highlight a missing link in today’s riskcommunication and suggest a need for developed clinical routines with stronger healthcare–patientcollaboration. Future research needs to investigate the views of genetic professionals on how toaddress these expectations to co-create a transparent risk disclosure process which can realize the fullpotential of personalized prevention.

Cancer incidence is increasing, and cancer is a leading cause of death in the Scandinavian countries, and at the same time more efficient but very expensive new treatment options are available. Based on the increasing demand, high expectations and limited resources, crises in public legitimacy of cancer care evolved in the three Scandinavian countries. Similar cancer care reforms were introduced in the period 2007-2015 to address the crisis. In this article we explore processes triggering these reforms in countries with similar and well-developed health care systems. The common objective was the need to reduce time from referral to start treatment, and the tool introduced to accomplish this was integrated care pathways for cancer diagnosis, that is Cancer Patient Pathways. This study investigates the process by drawing on interviews with key actors and public documents. We identified three main logics in play; the economic-administrative, the medical and the patient-related logic and explored how institutional entrepreneurs skillfully aligned these logics. The article contributes by describing the triggering processes on politically initiated similar reforms in the three countries studied and also contributes to a better understanding on the orchestrating of politically initiated health care reforms with the intention to change medical practice in hospitals.

Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay's model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described