Background: In a previous study, patients with small cell lung cancer showed "false optimism" about their recovery. Because patients' ideas about prognosis affect the choices they make regarding their treatment and end of life care, we explored the reasons why patients showed this optimism.
Methods: An ethnographic study was conducted involving 35 patients with small cell lung cancer in a lung diseases ward and outpatient clinic in a university hospital in the Netherlands. Patients were observed during their entire illness trajectory from diagnosis until death.
Findings: At the point of diagnosis, the patient felt ill but not to such a degree that a diagnosis of an incurable cancer was expected. The patient was convinced of really having a cancer when he could see "with his own eyes" a tumour on the radiographic images. During and just after chemotherapy treatment, the patient felt very ill, much more than at the time of diagnosis. It felt as if treatment had made things worse. The patient was convinced that he had been successful in his fight against the tumour when he could see "with his own eyes" a much smaller tumour on the radiographic images.
Interpretation: When there was a discrepancy between what patients felt and what the doctor said, radiographic images were used to convince the patient that the doctor was right. An effect of this practice is that patients "learn" to not trust their own bodily sensations and to consider clinical evidence as a more reliable source of information about their condition.