Wash your hands. Cover your mouth when you cough. Do not spread germs. We have all heard these hygiene mantras growing up, but we must admit that compliance has not always been perfect. With the coronavirus disease 2019 (COVID‐19) pandemic raising mounting alarm, fear has persuaded unprecedented adherence to hygiene principles globally, as we try to stop the spread of this novel virus.

What motivates a change in behaviour? What motivates someone to stop a bad habit and adopt a good one? Can clinicians aid in this motivation?

Chung et al. [1] performed a cross‐sectional study evaluating health behaviours including physical activity, diet, body mass index, alcohol consumption, and smoking status, as well as health‐related quality of life (HRQoL) in patients with bladder cancer at different treatment stages. In their study sample, most of the patients with bladder cancer were overweight or obese, did not adhere to healthy diet recommendations, were unwilling to change their eating habits, and did not meet guidelines for weekly physical activity. However, patients who had adopted healthy behaviours reported a better HRQoL and more healthy behaviours correlated with a better HRQoL. No difference was found when comparing the health behaviours of patients with non‐muscle vs muscle‐invasive bladder cancer (MIBC) or comparing patients at different stages of treatment. This implies that patients’ health behaviour does not change despite bladder cancer diagnosis and treatment; however, pre‐diagnosis data were unavailable for comparison. Interestingly, the large majority of the patients with bladder cancer were non‐smokers (81%), despite most (71%) reporting a prior history of smoking. What led to a change in smoking status when it appears that no other health behaviour changed with diagnosis and treatment of bladder cancer?

Gallus et al. [2] surveyed 3075 ex‐smokers in Italy to answer the question: why do smokers quit? The most frequently reported reason for smoking cessation (43.2%) was a current health problem. Smoking has been linked to the development of numerous medical conditions and is a well‐established risk factor for bladder cancer. Thus, a new diagnosis of bladder cancer undoubtedly serves as a strong motivator for smoking cessation. The benefits of a healthy diet and regular physical activity on one’s health are less defined. Furthermore, the definitions of a ‘healthy’ diet and ‘regular’ physical activity are variable, making counselling about these behaviours confusing and difficult. Dolor et al. [3] found that physicians feel inadequately trained to provide diet counselling to patients as compared to smoking cessation counselling. Additionally, physicians agreed that counselling regarding weight loss, diet, and physical activity requires too much time compared to smoking cessation counselling. These discrepancies may help explain why physicians were more likely to discuss smoking cessation with patients compared to weight loss, diet, and physical activity in a study by Nawaz et al. [4].

At our own institution, we have found that HRQoL significantly declines in patients with bladder cancer after diagnosis relative to controls, with more pronounced decrements seen in patients with MIBC [5]. Patients with bladder cancer are a vulnerable population who face many medical and personal challenges. As clinicians, we should equip these patients with the proper tools to succeed during bladder cancer treatment, including counselling regarding healthy behaviours. Inviting the help of specialists, such as nutritionists and physical therapists, to discuss the importance of diet and exercise early during treatment may be advantageous for patients and more likely to motivate patients to adopt these healthy behaviours. Furthermore, given the paucity of data linking the health behaviours of patients with bladder cancer to HRQoL, studies such as this one [1] could provide much‐needed evidence to persuade patients regarding the positive impact that healthy behaviour can have on their HRQoL. If we can successfully motivate patients with bladder cancer to adopt healthy behaviours, then their HRQoL will likely improve.

洗手。咳嗽时遮住嘴。不要传播细菌。我们都听说过这些卫生准则正在成长，但是我们必须承认，遵守法规并不总是完美的。随着2019年冠状病毒病（COVID‐19）大流行引起越来越严重的警觉，随着我们试图阻止这种新型病毒的传播，恐惧已经说服了全球前所未有地遵守卫生原则。

是什么促使行为发生变化？是什么促使某人停止不良习惯并养成良好习惯？临床医生可以帮助这种动机吗？

Chung等。[ 1进行了一项横断面研究，评估不同治疗阶段膀胱癌患者的健康行为，包括身体活动，饮食，体重指数，饮酒和吸烟状况以及健康相关的生活质量（HRQoL）。在他们的研究样本中，大多数膀胱癌患者超重或肥胖，不遵循健康的饮食建议，不愿意改变饮食习惯，不符合每周体育锻炼的准则。然而，采用健康行为的患者报告了更好的HRQoL，而更健康的行为与更好的HRQoL相关。比较非肌肉型与肌肉浸润性膀胱癌（MIBC）患者的健康行为或比较不同治疗阶段的患者时，没有发现差异。这意味着尽管进行了膀胱癌的诊断和治疗，患者的健康行为也不会改变。但是，无法提供预诊断数据进行比较。有趣的是，尽管大多数（71％）报告有吸烟史，但绝大部分膀胱癌患者均为非吸烟者（81％）。当膀胱癌的诊断和治疗没有其他健康行为改变时，是什么导致吸烟状况发生变化的呢？

加卢斯等。[ 2 ]在意大利对3075名前吸烟者进行了调查，回答了一个问题：为什么吸烟者会戒烟？报告最经常戒烟的原因（43.2％）是当前的健康问题。吸烟与多种医学状况的发展有关，是公认的膀胱癌危险因素。因此，对膀胱癌的新诊断无疑是戒烟的有力诱因。健康饮食和定期进行体育锻炼对人体健康的好处尚不明确。此外，“健康”饮食和“正常”体育锻炼的定义是可变的，这使对这些行为的咨询变得混乱和困难。Dolor等。[ 3]发现与戒烟咨询相比，医生对患者的饮食咨询没有足够的培训。另外，医生同意与减肥，戒烟和体育锻炼有关的咨询与戒烟咨询相比需要太多时间。这些差异可能有助于解释为什么与体重减轻，饮食和身体活动相比，医生比患者更愿意与患者讨论戒烟问题。[ 4 ]。

在我们自己的机构中，我们发现与对照相比，膀胱癌患者诊断后的HRQoL显着下降，而MIBC患者的HRQoL下降更为明显[ 5]。膀胱癌患者是一个脆弱的人群，面临许多医疗和个人挑战。作为临床医生，我们应该为这些患者配备在膀胱癌治疗期间成功的适当工具，包括有关健康行为的咨询。邀请营养学家和理疗师等专家的帮助，在治疗过程中及早讨论饮食和运动的重要性可能对患者有利，并且更有可能激发患者采取这些健康的行为。此外，鉴于缺乏将膀胱癌患者的健康行为与HRQoL相关联的数据，此类研究[ 1]可以说服患者说服健康行为对其HRQoL产生积极影响。如果我们能够成功地激发膀胱癌患者采取健康的行为，那么他们的HRQoL可能会改善。