| 30 belief on the necessity of a diagnostic trajectory. Symptoms were interpreted as problematic when changes in the PwMC’ behavior were unmanageable, abnormal, or could not be explained by alternative explanations (38, 39, 43, 45, 46). Moreover, the necessity of a diagnostic trajectory was acknowledged by PwMC and SO when the symptoms were validated by others (38, 45, 46). ‘Then some a-an old friend of his noticed he was doing that. So err I thought it was about time that we went to see the doctor, our GP.’ (46) Theme 3: Support or wishes of the social network Support of the social network (i.e. close family and friends other than the SO) could be vital in taking the step to start a diagnostic trajectory. The wishes of close family and friends can influence expected outcomes or can weaken beliefs on the necessity of a diagnostic trajectory. PwMCs who were afraid to take the step to start a diagnostic trajectory alone, but were supported by their family and friends (regardless of their perception of symptoms) decided to pursue diagnostic testing (38), whereas a limited social network of the PwMC is often perceived as a barrier for starting diagnostic testing (40, 43, 45). ‘I was getting a little bit worried because I knew I was repeating things, but I wasn’t brave enough to take the first step myself so when my daughters asked if I would go to the doctor I said I would.’ (38). On top of that, PwMCs pursued a diagnostic trajectory just for the sake of accommodating family wishes (38, 41). On the contrary, the PwMCs’ decision to start a diagnostic trajectory was delayed when caregiving children refused to deal with the symptoms (43). Moreover, one PwMC decided to not pursue a diagnostic trajectory because a relative perceived help seeking as unhelpful (38). Theme 4: Interaction with HCPs HCPs’ reactions to symptoms and communication style could heighten and weaken PwMCs’ and SOs’ beliefs on the necessity of a diagnostic trajectory. PwMCs and SOs described interactions with HCPs whereby the HCP normalized or was dismissive of their symptoms, which in most cases delayed starting a diagnostic trajectory (38, 40, 43, 45, 46).
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