Keeping unresolved concern reviewable before pancreatic cancer diagnosis: diagnostic advocacy labour in primary care

Earlier diagnosis of pancreatic cancer is difficult because early changes are often common, intermittent, or explainable in other ways. Here, earlier diagnosis means recognition, investigation, or referral before later, more specific features make cancer clinically easier to suspect. Existing work explains symptom appraisal, help-seeking, safety-netting, and reassurance after negative tests; less is known about how unresolved concern re-enters review after earlier explanations or reassuring results have made serious disease less available. This qualitative analysis examined how patients and relatives described concern being weakened, becoming salient again, and being carried through primary care before pancreatic cancer diagnosis. The corpus comprised 24 transcript files: 23 interviews and one focus group transcript. Using candidacy as an interpretive lens, we examined how concern became eligible for review and how that eligibility had to be rebuilt. Patients and relatives sometimes became the memory and follow-up system for unresolved concern: they returned, retold the story, chased promised steps, or asked others to help so bodily changes could be noticed and reviewed. We call this diagnostic advocacy labour. Concern lost force when symptoms remained scattered, fitted everyday explanations, entered plausible alternative clinical accounts, or appeared settled by reassuring results. Concern became salient again when symptoms failed to settle, visible deterioration made seriousness harder to dismiss, or separate contacts were assembled into a trajectory. Re-entry did not guarantee diagnostic movement: access, whole-sequence review, follow-through, and ownership had to be secured. The analysis shifts diagnostic safety from symptom recognition alone to systems that keep unresolved concern reviewable over time.