2 | 29 (medical) treatment as soon as possible or to at least have “a foot in the door” for future therapy as a result of a diagnosis (39, 41-43, 46). ‘Well I’d like to think there’s a medication that would help her. It helps everything else. It certainly is not going to help her a year or two down the road, it’s not going to, it’s too late. I’m hopeful that maybe there will be yet. (husband)’ (43). In addition, SOs were more inclined to start a diagnostic trajectory when they expected that a diagnosis would ease caregiver burden, would enable access to support and specialist care (39, 42), or provide information on the prognosis of the disease (43). In addition, SOs expected that a diagnosis would stimulate the PwMC to start living healthier or aid advance care planning (38, 42) Contrarily, some SOs expected a diagnostic trajectory would do more harm than good. This expectation came from respecting the PwMCs’ wish to not get tested or protecting the PwMC from the distress of diagnostic testing (39, 40, 46). Furthermore, they expected that a diagnosis would prevent the PwMC from living happy while still healthy which made them less inclined to pursue diagnostic testing (39), as did the expectation that a diagnosis would not contribute to future planning or to slowing down dementia (39, 42). In one study, a SO explained the PwMC’s reluctance towards diagnostic testing through the expectation that a diagnosis would result in placement in an institution (45). Theme 2: Normalization or validation of symptoms Normalizing symptoms by PwMCs and SOs weakens beliefs on the necessity of a diagnostic trajectory and the drive to do something because symptoms are not interpreted as problematic. SOs indicated that they did not believe a diagnostic trajectory was necessary if they interpreted memory complaints as part of normal aging, thought they were due to another illness, did not associate them with a disease, or perceived a low level of deterioration (39, 40, 45, 46). Conflicting interpretations of symptoms between the PwMC and the SO delayed starting a diagnostic trajectory (40, 42, 45, 46). The belief that diagnostic testing was not necessary could be strengthened when others normalized the symptoms too (40, 42). Contrary, when symptoms are interpreted as problematic by either the PwMC, SO or others such as friends and family members, worries about them increase, which contributes to the feeling of needing to do something about the symptoms and a heightened
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