Objective The purpose of this study was to explore clinician experiences with cancer symptom and quality of life (SQL) management from diagnosis throughout therapy in the ambulatory setting, plus identify preferences for a future SQL decision support system. Methods Eligible clinicians worked in ambulatory cancer care with responsibility for direct patient care. Focus groups were conducted to discuss symptom management throughout the treatment experience and features desired in a future decision support system. Each group was audio‐recorded, transcribed, de‐identified, and entered into NVivo 9 for analysis. Open and axial coding was completed, grouping common concepts into nodes; large constructs among the nodes were identified and main messages were synthesized. Results A total of 118 clinicians were contacted by email resulting in a final sample of 51 attending 1 of 9 focus groups. Clinicians described a standard face‐to‐face approach to assessment of SQL, before and throughout therapy. Preparing patients for expected symptoms and approaches to management included paper‐based patient education materials and referrals. Communicating with patients between visits was covered in detail, notably use of telephone and email. Future system features desired by the clinicians included an electronic, Web‐based system with real‐time, trended data, reasonable alerts, and tailored information for patients. Conclusions Cancer care specialists reported strategies to assess and manage cancer SQL in ambulatory care including patient‐reported outcome measures, contact communication modes, face‐to‐face interviews, and paper‐based patient education materials. Future system features desired by clinicians included an electronic, Web‐based system with real‐time, trended data, reasonable alerts, and tailored information for patients.