Butterflies in the Stomach: a qualitative study of patients’ experiences during the diagnostic pathway for lung cancer

Background In Norway, standardized fast-track diagnostic pathways for lung cancer aim to reduce time to diagnosis and treatment. Pathways are designed to improve clinical efficiency, little is known about how patients experience the diagnostic phase. Objective To explore patients’ experiences of the diagnostic pathway for suspected lung cancer. Methods This qualitative study had an exploratory descriptive design. Semi-structured individual interviews with 17 patients referred to a fast-track diagnostic pathway for lung cancer at a Norwegian university hospital. Participants were at different stages of the diagnostic process. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis as described by Braun and Clarke. Results Four themes were generated. Honesty, trust and direct information highlighted the importance of clear, timely, and transparent communication for patients’ sense of safety and trust. To be in a diagnostic pathway is a family project illustrated how the diagnostic process affected not only patients but also their families, with patients balancing their own need for support against a desire to protect relatives from distress. To wait and see or do something active described diverse coping strategies, ranging from maintaining routines and staying active to experiencing life as “on hold,” marked by anxiety, sleep disturbances, and emotional strain. Everything happens so fast and not knowing what you get into captured the dual experience of appreciating rapid and efficient care while simultaneously feeling overwhelmed and unprepared for the pace and implications of the pathway. Conclusion Patients experience the diagnostic phase for suspected lung cancer as emotionally demanding, shaped by communication quality, family involvement, individual coping strategies, and the speed of the fast-track system. Although the pathway ensures timely diagnostics, it is associated with psychological burden. Findings indicate a need for psychosocial support during the diagnostic phase and provide a foundation for developing prehabilitation interventions in a Norwegian context.