Speaking of survival: oncologists' approaches to risk behavior conversations with cancer survivors

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.