Nurse Comfort With Palliative and End-of-Life Communication

A Rural and Urban Comparison

Mary J. Isaacson, PhD, RN, CHPN; Mary E. Minton, PhD, RN, CNS, CHPN; Patricia DaRosa, DDS, MSc; Shana Harming, BS

Journal of Hospice and Palliative Nursing. 2019;21(1):38-45.

Conclusion

Our study addresses a gap in knowledge by describing rural and urban nurses' self-report of comfort in palliative and EOL communication. More experienced nurses reported greater comfort in palliative and EOL communication, which thus may be helpful in mentoring less seasoned nurses in cultivating this skill set. The C-COPE itemization and ranking data suggest communication topics for building awareness from which practicing nurses and clinical nurse educators may seek continuing education specific to palliative and EOL care communication.

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Acknowledgments
The authors thank the leadership team and the nurse participants of their clinical practice partner Avera Health. Additional appreciation is extended to the authors' content experts who provided essential process input in their development of the C-COPE instrument.

Table 1. Participant's Characteristics by Rural and Urban Areas
Variable	Total N = 252^a n (%)	Rural n = 54 n (%)	Urban n = 198 n (%)	P
Gender, female	235 (94.4)	51 (96.2)	184 (93.9)	.740^b
Missing data	3 (1.2)	1	2
Race
White	245 (98.8)	52 (98.1)	193 (99.0)	^c
American Indian	1 (0.4)	1 (1.9)	0
Asian or Pacific Islander	1 (0.4)	0	1 (0.5)
Other	1 (0.4)	0	1 (0.5)
Missing data	4 (1.6)	1	3
Level of education
Associate degree	52 (20.7)	16 (29.6)	36 (18.3)	0.00^d
Bachelor's degree	167 (66.5)	28 (51.9)	139 (70.6)
Master's degree	15 (6.0)	3 (5.6)	12 (6.1)
Other (eg, LPN)	17 (6.8)	7 (13.0)	10 (5.1)
Missing data	1 (0.4)	0	1
Work setting
Outpatient hospital	34 (13.7)	11 (20.4)	23 (11.8)	^c
Inpatient hospital	188 (75.5)	29 (53.7)	159 (81.5)
Home health	5 (2.0)	3 (5.6)	2 (1.0)
Hospice	14 (5.6)	7 (13.0)	7 (3.6)
Palliative care	3 (1.2)	3 (5.6)	0
Other (e-care, float pool)	5 (2.0)	1 (1.9)	4 (2.0)
Missing data	3 (1.2)	0	3
Religion
Protestant	108 (43.4)	28 (51.9)	80 (41.0)	.444^b
Catholic	72 (28.9)	14 (25.9)	58 (29.7)
Christian, other	62 (24.9)	10 (18.5)	52 (26.7)
Other	7 (2.8)	2 (3.7)	5 (2.6)
Missing data	3 (1.2)	0	3
Age, median (IQR), y	35 (27-49)	42 (30-54)	32 (27-45.5)	.008^e
Missing data	32 (12.7)
Tenure as RN, median (IQR), y	8 (3.5–22)	18 (6-31)	6 (3-17)	.009^e
Missing data	37 (14.7)	5	32
Length in current facility, median (IQR), y	5 (3-12)	5 (3-16)	5 (3-11)	.903^e
Missing data	57 (22.6)	5	52

Abbreviations: IQR, interquartile range; LPN, licensed practical nurse; RN, registered nurse.
^a Demographic variable sum may not equal the total sample because of participant nonreport.
^b Pearson χ² test.
^cχ² Test not performed because of 25% expected count of less than 5.
^d Fisher exact test.
^e Mann-Whitney U test.

Table 2. Differences in C-COPE Scores: Rural and Urban RNs
	n	Median	Interquartile Range	P ^a
Overall	252	46.0	38–57
Rural RN	54	42.0	34–53	.03
Urban RN	198	47.0	39–58	.03

Abbreviations: C-COPE, Comfort with Communication in Palliative and End-of-Life Care; RN, registered nurse.
^a Mann-Whitney U test.

Table 3. Itemized C-COPE: Rural and Urban RNs
C-COPE Items		Rural n = 54 %	Urban n = 198 %
Patient communication (difficult or very difficult)
Talking with patients once they have received ''difficult news''	32.1	22.2	34.8
Talking with patients about spiritual and/or religious concerns	11.9	9.3	12.6
Talking with patients about spiritual and/or religious concerns that are different than my own beliefs	21.8	18.5	22.7
Remaining silent and listening to the expression of feelings from patients	1.6	0	2.0
Talking to patients about end-of-life decisions	23.0	13.0	25.8^a
Talking with patients from cultures other than my own	22.6	16.7	24.2
Talking with patients about physical symptoms	2.0	0	2.5
Talking with patients about psychosocial symptoms	6.0	5.6	6.1
Talking with patients about suffering	19.4	13.0	21.2
Talking with patients without using medical jargon	3.6	3.7	3.5
Family communication (difficult or very difficult)
Talking with families once they have received ''difficult news''	31.7	24.1	33.8
Talking with families about spiritual and/or religious concerns	13.1	11.1	13.6
Talking with families about spiritual and/or religious concerns that are different than my beliefs	20.6	16.7	21.7
Discussing decisions to be made when a family member is the patient's proxy	18.7	20.4	18.2
Remaining silent and listening to the expression of feelings from families	2.0	3.7	1.5
Talking to families about end-of-life decisions	24.6	11.1	28.3^a
Talking with families from cultures other than my own	22.6	20.4	23.2
Talking with families about the patient's physical symptoms	2.8	0	3.5
Talking with families about the patient's psychosocial symptoms	6.7	3.7	7.6
Talking with families about suffering	19.4	18.5	19.7
Talking with families without using medical jargon	5.2	3.7	5.6
Team communication (difficult or very difficult)
Talking with physician(s) about palliative care issues	9.5	9.3	9.6
Talking with nurse colleagues about palliative care issues	2.4	0	3.0
Talking with physician(s) about end-of-life issues	9.9	7.4	10.6
Talking with nurse colleagues about end-of-life issues	2.8	1.9	3.0
Talking with chaplain(s) about palliative care and/or end-of-life issues	3.6	1.9	4.0