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

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.