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The C-COPE instrument is based on literature review, content from the COMFORT model, and iterative input from four content experts. The COMFORT communication model is grounded in patient-centered care and narrative medicine, where patients, families, and the healthcare team value each other’s story and collaboratively identify wishes and goals of care. COMFORT communication skills include bearing witness, understanding health literacy, actively listening, understanding family communication patterns, talking through the tension, embracing patient and family goals of care, and learning to collaborate with members of the team. The C-COPE operationalizes the key components of the COMFORT model: Communication, Orientation and opportunity, Mindful presence, Family, Openings, Relating, and Team. The 28-item instrument includes two ranked items and 26 items rated on a 5-point Likert-type scale (1 = not difficult, 2 = slightly difficult, 3 = uncertain, 4 = difficult, 5 = very difficult) to assess healthcare professional comfort with palliative and end-of-life communication. The range of possible C-COPE total scores is 26-130 points, with higher scores indicating less comfort with palliative and end-of-life communication. Rated items were categorized according to patient communication, family communication, and team communication. Preliminary psychometric analysis based on this pilot test of the C-COPE instrument supports test-retest reliability with ICC > 0.77, internal reliability for total score with Cronbach’s alpha = 0.91, and four factors with Cronbach’s alpha ranging from 0.81- 0.90.


South Dakota State University


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Revised version : 01/13/2022

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