Psychometric analysis of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument

Examining the Relationship Between Rural and Urban Clinicians' Familiarity With Patients and Families and Their Comfort With Palliative and End-of-Life Care Communication

Background: Effective healthcare clinician communication is a key component of quality palliative and end-of-life (PEOL) care. However, communication may be hampered when clinicians are not comfortable initiating these conversations with patients and their families. Clinicians working in rural areas report several barriers to providing palliative care. This study examined the relationship between rural and urban clinicians' reported familiarity with their patients and families end-of-life, their reported comfort in initiating PEOL conversations, and their PEOL care knowledge. Method: This study used a cross-sectional design to examine the relationships between rural and urban clinicians' familiarity, their comfort in PEOL communication, and their PEOL care knowledge. Results: N = 548 rural and urban clinicians participated. Rural clinicians reported greater familiarity, more PEOL knowledge, and more comfort with PEOL communication. Multiple regression analyses of PEOL knowledge showed significant associations in knowledge with older clinicians (P < 0.01) and additional palliative care training (P < 0.01); comfort in PEOL communication had significant associations with more palliative care training (P < 0.01) and opportunities to provide palliative care (P < 0.01). Conclusion: The concept of familiarity is highly complex and poorly understood in relation to PEOL care in both rural and urban settings. Future research is needed to explore how additional training in PEOL care and clinician reported familiarity positively impact patient outcomes by increasing the number of advance directives completed and followed and improved documentation of advance care planning.

Palliative Care Communication Among Home Health Interprofessional Staff: A Randomized Controlled Trial of Feasibility, Acceptability, and Preliminary Effectiveness

Skilled home health care (HH) is the largest and fastest growing long-term care setting in the United States. Patients in HH are served by an interprofessional team, and may have little direct contact with physicians, when discussing their progress, prognosis, and goals of care. Such conversations are part of primary palliative care communication. Evidence on primary palliative care communication training in the non-physician HH interprofessional team is lacking. The objectives of this study were to assess the feasibility, acceptability, and preliminary effectiveness of using a palliative care communication model known as COMFORT© to provide palliative care communication training to HH staff. A randomized controlled trial was conducted at a regional health system in the southeastern U.S. to test online training modules (n = 10) (Group 1) and online training modules plus face-to-face training (n = 8) (Group 2). Measures included training completion rates, staff acceptability ratings, comfort with palliative and end-of-life communication (C-COPE) and moral distress (MMD-HP). Results showed that COMFORT© training was feasible (92%), highly acceptable (>4 on a 6-point scale), and positively correlated with improved C-COPE scores (P = .037). There was no significant difference in moral distress scores pre- and post-intervention or in effectiveness between the groups. However, acceptability of COMFORT© was positively correlated with history of leaving or considering leaving a job due to moral distress (χ 2 = 7.6, P = .02). Preliminary findings from this pilot study suggest that administration of COMFORT© training was feasible, and it was correlated with increased HH staff comfort with palliative care communication.

Navigating Disharmony: Nurse Experiences Providing End-of-Life Communication

The purpose of this study was to describe nurses' experiences of communicating with patients and families at end of life (EOL). The COMFORT Communication Model guided this descriptive qualitative study. Participants from 1 major health care system located in the Great Plains completed an online survey, which consisted of Likert-type (N = 252) and open-ended questions (n = 201). This article reports the qualitative findings of this survey. Thematic analysis of the participants' narrative responses revealed an overarching theme of disharmony when caring for patients and families at EOL. We identified 3 themes within the overarching theme of disharmony: navigating denial, words matter, and knowledge deficit. Nurses express discomfort and a knowledge deficit when providing communication specific to primary palliative and EOL care. Nursing education has an obligation to ensure that new graduates are trained in and develop comfort with the communication principles of primary palliative and EOL care. This holistic approach may improve the quality of communication surrounding the EOL experience for patients, families, and nurses.