Palliative Care Communication in Oncology Nursing

Joy Goldsmith, PhD; Betty Ferrell, PhD, MA, FAAN, FPCN; , Elaine Wittenberg-Lyles, PhD; Sandra L. Ragan, PhD


Clin J Oncol Nurs. 2013;17(2):163-167. 

In This Article

Abstract and Introduction


Oncology nurses consistently exhibit distress when communicating about end-of-life topics with patients and families. Poor communication experiences and processes correlate with emotional distress, moral distress, and work-related stress. The National Consensus Project (NCP) for Quality Palliative Care developed clinical practice guidelines to establish quality standards for the practice of palliative care. NCP's guidelines are expressly intended as an interdisciplinary document and are representative of the inherent interdisciplinary nature of palliative care. Communication's value to palliative and oncology nursing is unique because those two specialties include a high frequency of challenging interactions for patients, families, and healthcare professionals. The COMFORT communication curriculum, a holistic model for narrative clinical communication in practice developed for use in early palliative care, is posed as a resource for oncology nurses with a series of practice case examples presented against the backdrop of NCP's eight domains of quality palliative care.


Palliative care prioritizes patient pain and symptom management, emphasizes communication with patients and their families, and establishes coordination of care. Given the prevalence of cancer and the high need to manage symptoms of this often advanced illness, researchers have proposed that palliative care should be integrated into standard oncology care (Periyakoil & Von Gunten, 2007; Smith et al., 2012). With emerging research showing the benefits and feasibility of combining palliative care and oncology (Smith et al., 2012), questions remain about how to successfully integrate both services. One step toward integrating palliative care and oncology is to provide clinicians with communication training to meet patient and family needs. The COMFORT communication curriculum has been presented for nurse communication training in early palliative care (Goldsmith & Wittenberg-Lyles, in press; Wittenberg-Lyles, Goldsmith, Ferrell, & Ragan, 2013; Wittenberg-Lyles, Goldsmith, & Ragan, 2010; Wittenberg-Lyles, Goldsmith, Richardson, Hallett, & Clark, 2013). COMFORT is an acronym for seven holistic principles of palliative care communication including narrative clinical practice (Communication), health and cultural literacy (Orientation and opportunity), presence in practice (Mindful presence), the role of family caregivers (Family), transitions in care (Openings), patient and family needs (Relating), and teamwork (Team). The COMFORT model also is now a component of the End-of-Life Nursing Education Consortium communication module and is available at For more details of the COMFORT model, see Wittenberg-Lyles, Goldsmith, and Ferrell (2013).

Clinical guidelines establishing quality standards for palliative care practice were developed through the National Consensus Project for Quality Palliative Care ([NCP], 2009). The NCP guidelines define each domain, but ultimately establish the necessary elements of quality palliative care (see Figure 1). The NCP guidelines direct the interdisciplinary team, but also hold special significance to nurses as the providers most often interacting with patients and families across all settings of care. To demonstrate the pertinence of COMFORT to quality palliative care, this article highlights corresponding NCP domains and fictive practice examples with specific communication tools. COMFORT and the NCP guidelines illustrate how essential palliative care communication is to every aspect of quality oncology care.

Figure 1.

Domains of Quality Palliative Care Note. From Clinical Practice Guidelines for Quality Palliative Care (2nd ed., p. 4) by the National Consensus Project for Quality Palliative Care, 2009, Pittsburgh, PA: Author. Copyright 2009 by the National Consensus Project for Quality Palliative Care. Reprinted with permission.