Kerstiens Savanna, Scherr Courtney Lynam, Jacobs Maia, Carroll Allison J, Jayeoba Monisola, Daly Elyse Renee, Phillips Siobhan M, Hitsman Brian, Garcia Sofia F, Spring Bonnie
School of Communication, Northwestern University, Evanston, IL, USA.
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
J Cancer Surviv. 2025 Apr 15. doi: 10.1007/s11764-025-01798-1.
This study explored oncologists' reported conversations with adult cancer survivors about three modifiable risk behaviors: poor diet, smoking, and insufficient physical activity. These behaviors can increase disease recurrence and early mortality. By asking oncologists to report their approach to these discussions, we can begin to identify areas for improvement.
We conducted semi-structured interviews with 17 oncology clinicians from various subspecialties. We identified themes using inductive thematic analysis.
Four major themes were identified. Participants reported only sometimes explicitly discussing risk behaviors and avoiding sensitive topics like weight. They described tailoring their conversations around what they believe a patient can handle to maintain a positive relationship or avoid hurting patients' self-image. Participants explained that they rely on specialists or programs for specific risk management strategies and indicated that patients most often initiate conversations about lifestyle risks. Participants avoided or indirectly discussed lifestyle risks.
The oncologists' reported risk communication with survivors suggested a delicate balance between patient-centered communication and benevolent bias-where oncologists tailor conversations based on their perceptions of what a patient can handle. Indirect discussions may lead survivors to undervalue the importance of addressing these risks. To enhance communication effectiveness and avoid unmanaged risk behaviors, oncologists need support to be more fully engaged in specific risk management conversations with cancer survivors.
Oncologists' benevolent bias may lead to inadequate risk management by the clinician and result in survivors underestimating the importance of specific risk factors, potentially leading to poorer health outcomes.
本研究探讨了肿瘤学家报告的与成年癌症幸存者就三种可改变的风险行为进行的对话，这三种行为分别是不良饮食、吸烟和体育活动不足。这些行为会增加疾病复发和早期死亡的风险。通过询问肿瘤学家报告他们进行这些讨论的方式，我们可以开始确定需要改进的方面。
我们对17名来自不同亚专业的肿瘤学临床医生进行了半结构化访谈。我们采用归纳主题分析法确定主题。
确定了四个主要主题。参与者报告说只是有时会明确讨论风险行为，并避免涉及体重等敏感话题。他们描述根据自己认为患者能够承受的内容来调整对话，以维持积极的关系或避免伤害患者的自我形象。参与者解释说他们依靠专家或项目来获取特定的风险管理策略，并指出患者最常发起关于生活方式风险的对话。参与者避免或间接讨论生活方式风险。
肿瘤学家报告的与幸存者的风险沟通表明，在以患者为中心的沟通和善意偏见之间存在微妙的平衡，即肿瘤学家根据他们对患者能够承受的内容的认知来调整对话。间接讨论可能会导致幸存者低估应对这些风险的重要性。为了提高沟通效果并避免未得到管理的风险行为，肿瘤学家需要得到支持，以便更全面地参与与癌症幸存者的特定风险管理对话。
肿瘤学家的善意偏见可能导致临床医生的风险管理不足，并使幸存者低估特定风险因素的重要性，从而可能导致更差的健康结果。
