This study examined how physicians initiated and navigated conversations about smoking with patients with lung cancer. While there are numerous health benefits associated with smoking cessation in patients with advanced lung cancer, conversations about smoking cessation are infrequent and often lack tangible cessation support. We conducted a qualitative inductive content analysis on transcripts of conversations (n = 58) recorded during an initial appointment between a physician and a standardized patient (SP). SPs portrayed a 62-year-old male with lung cancer completing an initial visit with a new physician. Qualitative analysis focused on examining how physicians discussed smoking with a new patient. We found that a majority of physicians initiated conversations about smoking, often during the medical history charting process or during conversations about the lung cancer diagnosis. The content of conversations about smoking generally fits within six categories: assesses smoking status, builds smoking history profile, praises smoking cessation, connects smoking behaviors to diagnosis or treatment, provides empathy or understanding, and presents a negative bias about smoking. We found that while a majority of physicians asked patients about smoking, most physicians aimed for these conversations to be short, routine, and medically driven. Conversations about smoking were not tailored to meet the specific needs of patients with lung cancer, which might include additional provision of support for smoking cessation and recognition of smoking-related stigma.

这项研究调查了医生如何发起和引导与肺癌患者有关吸烟的对话。虽然晚期肺癌患者戒烟对健康有很多好处，但关于戒烟的讨论很少，而且往往缺乏切实的戒烟支持。我们对医生和标准化患者 (SP) 初次预约期间记录的对话记录 ( n = 58) 进行了定性归纳内容分析。 SP 描绘了一位患有肺癌的 62 岁男性完成了新医生的初次就诊。定性分析的重点是检查医生如何与新患者讨论吸烟问题。我们发现，大多数医生通常在病史绘制过程中或在有关肺癌诊断的对话中发起有关吸烟的对话。有关吸烟的对话内容通常分为六类：评估吸烟状况、建立吸烟史档案、赞扬戒烟、将吸烟行为与诊断或治疗联系起来、提供同理心或理解，以及提出对吸烟的负面偏见。我们发现，虽然大多数医生询问患者有关吸烟的问题，但大多数医生希望这些对话简短、常规且以医学为导向。关于吸烟的对话并不是为了满足肺癌患者的特定需求而定制的，其中可能包括为戒烟提供额外的支持以及对与吸烟相关的耻辱的认识。