![]() After an initial analysis of the data collected in this first stage, in a second stage (1995-7) a group of 18 patients was observed from initial diagnosis to their death. The size of the sample was based on AT's experience that it was not possible to keep intensive contact with more than about 15 patients and their families. ![]() In a first stage (1992-4) the researcher (AT) observed a group of 17 patients from initial diagnosis to their death. Funerals were attended and a small number of bereaved spouses interviewed. On many occasions patients were visited at home, particularly in the terminal phase of their illness when they had stopped attending the outpatient clinic. After obtaining consent from patients, AT attended their outpatient clinic consultations, had informal conversations with patients and relatives in the clinic waiting room, accompanied them to x ray and other hospital services, and also conducted more formal interviews with patients and staff. 8, 9 Data were collected through (full time) observation of patients in the lung diseases ward and clinic of a university hospital. We designed a qualitative observational (ethnographic) study to discover and explore factors in the communication between patients and staff (doctors and nurses) that contribute to false optimism. She also discovered that those concerned in the treatment of these patients in daily medical practice considered this false optimism to be a more important problem than euthanasia. In this way, by spending much time observing at the clinic and by focusing on the context of euthanasia, AT discovered the widespread occurrence, familiar to doctors and nurses, of false optimism about recovery. In the waiting room, terminal patients with a maximum life expectancy of a few months said that the doctor had told them that they were cured. During observations in the clinic it became apparent that patients there rarely dealt with their approaching death. ![]() To determine the moment when patients begin to talk about euthanasia and to investigate comprehensively the subsequent process we also had to make observations in the outpatient clinic. 7 Only the final phase of euthanasia could be observed, however, because the preparatory process had usually taken place in the outpatient clinic. The researcher (AT) initially carried out a study on the role of nurses in decisions concerning euthanasia on a ward for lung disease. We studied in actual practice what information was given and what information was received and the effects on decision making about treatment and end of life care. We examined which aspects of communication between doctors (and nurses) and patients contribute to the fact that patients do not know their poor prognosis. 4, 5 Initially we assumed that features of the communication between doctors (and nurses) and patients had caused this conflict between actual prognosis and what these patients seemed to believe. This topic is important because patients' ideas about their prognosis affect the choices they make regarding their treatment and end of life care. ![]() We explored the reasons why virtually all these patients showed this false optimism. It was not unusual for a patient to tell relatives and friends that the doctor had informed them that they were cured, when actually the cancer was not cured and the life expectancy of these patients was a maximum of two years. 2, 3 Our study started from the observation that, after their first course of chemotherapy virtually all patients with small cell lung cancer in a university hospital programme showed a “false optimism” about their recovery, in the sense that the patients' interpretations of their prognosis were considerably more optimistic than those of their doctors. Many patients, when they fear that their prognosis is rather poor, do not ask for precise information and do not hear it if it is provided by the doctor. 1 This does not imply that these patients want to hear the really bad news about their condition. Almost all patients with cancer want to know their diagnosis and most patients also want to be informed about the chance that they will be cured.
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