Treatment of Tobacco Use and Dependence

  • Patient-clinician communication has been applied in tobacco use and dependence interventions.
  • The positive influence of the clinician recommendation highlights the results of the National Cancer Institute's Health Information National Trend survey (HINTS), whereby patients revealed that despite newly available communication channels such as the Internet, physicians remain the most highly trusted source of health information.
  • The U.S Public Health Service's clinical practice guidelines for smoking cessation, Treating Tobacco Use and Dependence, outline a process known as the "5 As" of provider-to-patient communication: Ask, Advise, Assess, Assist and Arrange.
  • These directives dovetail with the functions of communication previously described and work directly or indirectly to achieve attempts in smoking cessation among patients.
  • Ask fulfills the functions of information exchange and fostering relationships; Advise fulfills the function of information exchange; Assess fulfills the functions of responding to emotions and managing uncertainty; Assist fulfills the functions of making decisions and enabling self-management and Arrange fulfills the function of enabling self- management.

Communication with Breast Cancer Survivors

Study Aims

  • The aim of this cross-sectional study was to investigate how a patient-centered style of communication, defined as the degree to which providers respond to patient comments and concerns, is associated with survivor uncertainty, survivor mood state, and survivor perception of patient-centered communication for breast cancer survivors experiencing varying fatigue levels.


  • Sixty (60) breast cancer survivors and 6 providers participated in a study that tested a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship.
  • Visits were audio-taped, then coded using the Measure of Patient-Centered Communication (Brown, Stewart, & Ryan, 2001).


  • Survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication.
  • Breast cancer survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.
  • When women experience uncertainty due to chronic symptoms, their desire for information may fluctuate as a way of managing this uncertainty and maintaining hope.
  • Communication results show that irrespective of fatigue level and actual amount of patient-centered communication, conversation about symptoms was most influential in predicting survivor mood state and survivor perception of patient-centered communication.
  • Despite much literature on the importance of soliciting and addressing patient input during consultations, this study found that routine follow-up breast cancer survivor consultations were only 52% patient-centered, suggesting that providers do not consistently attend to issues and concerns raised by survivors.