Cancer patients and their family members continue to report communication deficits with their healthcare staff regarding diagnosis, disease progression, education about treatment and procedures, referral services, and psychosocial care. Given their increased exposure to patients and families, along with the intimacy of the care they provide, oncology nurses are often vulnerable to patient/family discussions about these topics. While national agendas and standard of care guidelines highlight the importance of communication during cancer care, nurses report being uncomfortable disclosing bad news, a lack of knowledge about cancer survivorship, difficulty discussing spiritual and sexual concerns, and experience missed opportunities to refer cancer patients to hospice. The proposed cancer education program will provide nurse communication training for oncology nurses by offering a two day workshop on cancer care and communication. This innovative educational initiative will be the first nurse-focused training program as prior work in this area over the last decade has focused exclusively on the role of the physician. Through this proposal we hope to establish a network of nurses trained in communication who can train other nurses and initiate institutional change.
Specific Aims : The project aims to adapt an established communication training curriculum for cancer care. Secondly, the project aims to deliver the curriculum to competitively selected oncology nurse teams from NCI-designated cancer centers and community cancer centers. Finally, the project aims to evaluate the impact of the curriculum and disseminate findings to develop a network of nurses with expertise in patient-centered communication. Cancer Education Program Plan: The cancer education program plan will be based on the COMFORT communication curriculum. COMFORT is an acronym that stands for the seven basic principles of nurse communication and teaches nurses the skills they need to accomplish the six core functions of patient- centered communication as defined by the National Cancer Institute. Expert faculty in the area of clinical nurse and oncology education have confirmed their involvement, along with support from the Oncology Nursing Society. It is proposed that a two-day course be held annually for four years to 100 nurses, providing training to a total of 400 oncology nurses nationwide. Evaluation of the proposed cancer education program plan will include an assessment of curriculum content, individual goal achievement and institutional performance improvement. Upon completion of the course, participants will identify goals for institutional change and 6 and 12 month follow up will assess goal attainment, barriers, and successes. This proposal supports the NCI strategic aim of improving the quality of life for cancer patients, survivors, and their families by translating NCI's patient-centered communication framework into practical tools that will enable oncology nurses to provide timely, efficient, and equitable care to cancer patients and their families.

Public Health Relevance

Although the Institute of Medicine, National Cancer Institute, and Oncology Nursing Society have identified communication as an important part of receiving quality cancer care, nurses working in cancer settings report numerous communication problems with family members, providing diagnosis information and education to patients, talking about end-of-life care, and working with other members of the healthcare team. An extensive nurse-focused communication skills workshop about patient-centered communication practices and information about models of excellence could lead to performance improvement for nurses, institutional processes that prioritize the patient, and increased attention to the psychosocial needs of both cancer patients and their informal caregivers. The goal of this cancer education program is to translate an already established communication curriculum based on NCI's patient-centered communication framework and examine its effectiveness in the delivery of cancer care.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Education Projects (R25)
Project #
Application #
Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Korczak, Jeannette F
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Beckman Research Institute/City of Hope
United States
Zip Code
Wittenberg, Elaine; Reb, Anne; Kanter, Elisa (2018) Communicating with Patients and Families Around Difficult Topics in Cancer Care Using the COMFORT Communication Curriculum. Semin Oncol Nurs 34:264-273
Wittenberg, Elaine; Xu, Jiayun; Goldsmith, Joy et al. (2018) Caregiver Communication About Cancer: Development of a mhealth resource to support family caregiver communication burden. Psychooncology :
Wittenberg, Elaine; Goldsmith, Joy V; Williams, Y'Esha et al. (2018) Caring for Family Caregivers: a Pilot Test of an Online COMFORT™ SM Communication Training Module for Undergraduate Nursing Students. J Cancer Educ :
Wittenberg, Elaine; Ferrell, Betty; Kanter, Elisa et al. (2018) Health Literacy: Exploring Nursing Challenges to Providing Support and Understanding Clin J Oncol Nurs 22:53-61
Wittenberg, Elaine; Ferrell, Betty; Goldsmith, Joy et al. (2018) COMFORT™SM communication for oncology nurses: Program overview and preliminary evaluation of a nationwide train-the-trainer course. Patient Educ Couns 101:467-474
Wittenberg, Elaine; Goldsmith, Joy; Ferrell, Betty et al. (2017) Promoting improved family caregiver health literacy: evaluation of caregiver communication resources. Psychooncology 26:935-942
Wittenberg, Elaine; Buller, Haley; Ferrell, Betty et al. (2017) Understanding Family Caregiver Communication to Provide Family-Centered Cancer Care. Semin Oncol Nurs 33:507-516