Patient–provider communication and perspectives on smoking cessation and relapse in the oncology setting

Abstract

Objective-To fill a gap in research by examining cancer patient-provider communication regarding tobacco use and patients' perspectives regarding their experiences with smoking cessation and relapse.Methods-In-depth interviews were conducted with 20 lung and head and neck cancer patients and 11 health care providers.Results-Qualitative analyses revealed that cancer patients express high levels of motivation to quit smoking; however patients do not ask providers for assistance with quitting and maintaining abstinence and relapsed patients are reluctant to disclose smoking behavior due to stigma and guilt. Health care providers vary in the advice and type of assistance they supply, and their awareness and sensitivity to relapsed patients' feelings. Whereas providers emphasized long-term risks of continued smoking in their interactions with patients and recommendations for intervention content, patients expressed a preference for a balance between risks and benefits.Conclusion-Findings underscore the need for increased awareness, emphasis, and communication about the immediate risks of continued smoking and the benefits of continued abstinence specifically for cancer patients.Practice Implications-Our findings demonstrate the potential to affect cancer outcomes by improved training in conducting smoking cessation and relapse prevention interventions. Additional training could be given to health care providers to increase adherence to clinical practice guidelines (5 A's), to learn ways to enhance patients' motivation to maintain abstinence, and to deliver smoking messages in a non-threatening manner.

Oncology Healthcare Providers‘ Pivotal role in Smoking Cessation and Relapse Prevention

“…This finding is in line with our previous formative work suggesting that providers do not feel qualified to provide smoking cessation assistance and prefer to refer patients to other resources [10]. Other frequently cited barriers by providers include feeling unable to help the patient to quit, patient resistance and time constraints [10,16]. Together, these data support the need for greater training for healthcare providers to increase knowledge of evidence-based smoking cessation interventions, and to enhance awareness that patients with cancer are motivated to quit smoking and that providers can make an impact with brief interventions (i.e., lasting <3 min).…”

“…For example, a survey completed by Warren and colleagues with lung cancer physicians found that only 33% felt adequately trained to provide cessation interventions [16]. This finding is in line with our previous formative work suggesting that providers do not feel qualified to provide smoking cessation assistance and prefer to refer patients to other resources [10]. Other frequently cited barriers by providers include feeling unable to help the patient to quit, patient resistance and time constraints [10,16].…”

“…Second, the oncology setting presents a unique opportunity to provide patients with tailored information regarding health risks and recommended behavior change related to their current cancer diagnosis and treatment and, specifically, to frame quitting Editorial Simmons, Haura & Brandon smoking as a way for patients to regain control over their health. Finally, because patients with cancer are highly motivated to quit smoking [10], they may be particularly receptive to cessation assistance at this time.…”

Smoking Patterns in Cancer Survivors

“…In a qualitative study of 20 lung and head and neck cancer patients and 11 health care providers, Simmons et al (2009) found that while many of the patients were interested in quitting, they did not ask for help, and providers were inconsistent in the type of smoking cessation information and help offered . In another study of cancer survivors (n = 1,825), only 81% of providers knew of their smoking status, and only 72.2% of current smokers (n = 310) were advised to quit smoking, missing that teachable moment (Coups, Dhingra, Heckman, & Manne, 2009).…”

Disparities Between Blacks and Whites in Tobacco and Lung Cancer Treatment

“…Unfortunately, despite these new guidelines, half of comprehensive cancer centers do not have tobacco treatment programs [90]. Lung cancer patients generally do not receive tobacco treatment from their oncology providers, nor is smoking routinely addressed in the primary care setting following diagnosis [52,[91][92][93]. Consequently, most lung cancer patients who smoke have not used established behavioral and pharmacological tobacco treatment [48], and a lack of patient-provider communication in the context of smoking and a lung cancer diagnosis might exacerbate this gap in treatment.…”