The COMCARE Framework for Person‐Centred Communication—A Practical Caring Framework

ABSTRACT

Aim

This paper examines a theory and practice developed framework aimed at guiding person‐centred communication in registered nurse–patient encounters. The primary objective is to refine and present a data‐ and theory‐driven framework tailored to the demands of nursing practice and those receiving care. To achieve this, the COMCARE model is introduced, providing practical guidance for understanding and implementing strategies for nurses' communication and caring behaviours.

Design

This theoretical paper addresses theory and research on communication strategies during registered nurse–patient encounters based on the principles of caring and person‐centredness.

Results

The COMCARE model outlines communication strategies to guide registered nurses to ensure caring and supportive interactions, aligning with the principles of person‐centred care. COMCARE builds on the necessary communication skills for person‐centred registered nurses–patient encounters and clarifies key components of such communication, with related goals. The key components proposed are related to empathic listening and asking questions, responding and acknowledging, guiding and using clear communication, supportive communication, and appraising and confirming communication. Person‐centred communication requires a broad repertoire of skills to be applied and tailored to individuals in various situations and practices.

Conclusion

The COMCARE model provides an overview of the communication skills essential for person‐centred care, emphasising guidance for nursing practice to support patients' optimal well‐being and health. This framework highlights the importance of communication skills in shaping patient experiences and outcomes and underscores the need for their application and implementation in caring and nursing practice. Effective communication by registered nurses and other healthcare professionals is vital for delivering high‐quality care. The COMCARE framework offers practical guidance and serves as a foundation for future training and education for nursing students, as well as informing policy and research in this area. Further research is needed to test and validate the COMCARE model in clinical settings.

1. Introduction

In patient encounters, maintaining dignity and adopting a caring human science perspective are central [1], emphasising the importance of meeting the needs of the person receiving care. As highlighted by Wiklund Gustin [2], the application of caring science should guide healthcare professionals in delivering individualised care tailored to each patient. In this context, the interplay between healthcare professionals and the person being cared for is essential. Caring science and person‐centred care imply providing empathy, respecting patients' autonomy, needs and perspectives, which are essential for collaboration, shared decision‐making and tailoring care to individual patients [3]. Without good communication, healthcare is not person‐centred. The existing person‐centred care (PCC) frameworks in nursing, such as the works by McCormack and McCance [4], Kitson et al. [5], Ekman et al. [6], and Dewar and Nolan [7], do not focus specifically on communication skills. While these frameworks underline the registered nurse (RN)–patient relationship and the importance of communication, they do not delve deeper into the nature and meaning of the communication skills that facilitate such care in practice. Hence, there is a need to clarify the key components of person‐centred RN–patient communication.

2. Background

2.1. Caring Science and PCC

Nursing practices and caring science are based on the needs and perspectives of the patient. This approach implies that caring should be person‐centred, focusing on the whole person while providing respectful, needs‐based care that considers both the patient and their next of kin, not just the disease or the symptoms [2, 8].

The concept of PCC departs from the principles of patient‐centred care [9, 10] and looks beyond an individual's identity as a patient. Both person‐ and patient‐centred care involve empathy, respect, engagement and relational aspects such as communication and shared decision‐making, with a holistic and individualised focus [3]. This is emphasised, for example, by McCormack [11] in terms of ‘the importance of having a clear picture of what patients and others important to them really value about their life’ (p. 35). PCC is very similar to fundamental care or compassionate care. The latter refers to relational actions involving caring conversations where a mutual relationship is developed to facilitate person‐centredness in practices [7]. Similarly, fundamental care involves caring actions that respect and focus on a person's needs to ensure their physical and psychosocial well‐being [12].

2.2. Communication and Nursing Practice

To understand the nature and meaning of communication skills in RNs' clinical practices that foster PCC, the basic elements of communication are essential. Communication is fundamentally interactional; it occurs in all relationships, meaning that one cannot NOT communicate and that all actions and behaviours convey some sort of communication [13]. Everything that one does is a message; actions, words, and silences all contain messages. Consequently, communication involves content and relational aspects. Communication processes involve interaction and relationship‐building between two or more persons, where communication helps to structure relationships and act in various situations [14]. Linking this to caring implies that one needs to understand how communication can help to structure nursing care and which types of communication can lead to preferred actions and patient outcomes.

While communication between patients and physicians is a well‐grounded research area [15], this is not the case in nursing science [16]. The current state of knowledge in medicine shows that the communication used will have an impact on the therapeutic alliance with patients, improving patients' health outcomes, adherence to treatment and advice, and patient satisfaction [17, 18, 19]. Communication with patients is imperative for sharing experiences, for patient involvement, and for empowering patients to become active and capable of managing their own health [19]. Healthcare professionals' communication skills are central to understanding health needs and patient views. Consequently, there must also be a greater focus on the communication skills needed by RNs [16].

The current state of knowledge concludes that communication is pivotal in all patient encounters and is central for the delivery of PCC and for reinforcing the humanity of healthcare [17]. Healthcare professionals, such as physicians and RNs, are dedicated to optimising patients' health and well‐being. Physicians primarily focus on diagnosing and treating illnesses to restore health and functionality, aiming for a cure based on the patient's health status. In contrast, RNs prioritise the individual's overall health and well‐being, focusing on maintaining a meaningful life for the patient. Traditionally, the distinction between the approaches of physicians and RNs has been referred to as cure versus care, implying that RNs' communication is, in itself, a powerful therapeutic tool. In particular, RNs play a key role in promoting public health, with contributions that extend beyond disease prevention and behaviour change [20]. Their role as health promoters is multifaceted and grounded in interdisciplinary knowledge and practical health promotion experience, which they integrate into everyday nursing practices. This broader scope reinforces the importance of RN‐patient communication not only in therapeutic contexts but also as part of a proactive, health‐promoting approach.

RNs communicate with patients across diverse working environments, ranging from integrating communication into daily nursing activities while performing tasks to consultations, nursing visits and telephone interactions [16, 21]. The role of communication varies depending on the situation and the setting, which makes effective communication challenging. RNs may unintentionally convey messages even as they focus on nursing tasks. For example, simply entering a patient's room and remaining silent can still communicate a message.

There is often limited training in RNs' communication skills during nursing education. In Sweden, where this work was conducted, nursing students receive limited or no formal communication training. According to Bullington et al. [22], communication training has not been systematically developed or regulated within Swedish nursing education. However, efforts have been made to describe and develop communication training methods. For example, Bullington et al. [22] developed communication training based on phenomenological principles aimed at supporting reflective dialogue with patients. This approach includes components such as presence, active listening, attentiveness, and the search for meaning in patient communication. While the goals of this model for communication training and the COMCARE framework are aligned, that is, to support caring communication in patient encounters, this paper aims to further develop a theory‐driven communication framework and identify key components that provide practical guidance for RNs' communication in patient encounters.

In nursing theory, the importance of communication has been addressed mainly by theories with a focus on the RN–patient interaction, such as Peplau, Orlando and King [23]. However, these theories are not directed at communication per se. A more recent study described attributes of person‐centeredness in terms of recognising, inviting and involving the patient [24]. Utilising these aspects asked RNs to be attentive and responsive in their communication, including emphasising and acknowledging the person's views, emotions and needs. Other recent works, not specifically nursing research, elaborate on frameworks for the implementation of PCC, where communication is an important part of the patient‐healthcare professionals' level of care [25], or barriers and facilitators for person‐centred communication [26], not explicitly the communication skills needed for PCC.

In summary, the PCC frameworks and the state of the art in communication research provide valuable guidance. However, there remains a gap in caring science that clearly articulates communication skills tailored to RNs' roles and responsibilities as guidance for practices and policy. Moreover, Wiklund [2] emphasised that caring science needs frameworks that drive action and impact patient care, serving as a foundation for sustainable healthcare by drawing on the ethos of caring science, which involves acknowledging patients' values and perspectives. With this goal, we propose the data‐ and theory‐driven framework COMmunicating to ensure the CARing and supportive Encounters (COMCARE) framework.

3. Aim

This theoretical paper examines a theory and practice developed framework aimed at guiding person‐centred communication in RN–patient encounters. The primary objective is to refine and present a data‐ and theory‐driven framework tailored to the demands of nursing practice and those receiving care.

4. Design and Data Sources

To achieve this, the COMCARE model is introduced, providing practical guidance for understanding and implementing strategies for RNs' communication and caring behaviours. This work builds on theory and research, informed by our extensive expertise and experience in empirical observational studies on communication across diverse healthcare settings. The research team includes three professors from different universities and research institutes, two in nursing and one in healthcare communication, who have extensive backgrounds in communication research, including a substantial number of empirical studies on healthcare interactions. Together, we bring a broad competence that spans the full age spectrum, from young children to the oldest adult patients, ensuring that our work reflects the diverse realities of clinical communication across the lifespan. In addition, the team comprises experienced nursing researchers who also serve as educators in nursing programmes at several Swedish universities, contributing both practical and pedagogical perspectives to the development of the model. Our experience with observational research plays a crucial role in bridging the gap between theory and practice, offering valuable insights into the complexities of communication in clinical settings and contributing to improvements in patient care. This is supported by Catchpole et al. [27], who highlight that observations focus on capturing what actually happens rather than relying on perceptions or assumptions about it. Therefore, this work predominantly builds on empirical research on communication, as observed in clinical practice. There is a need for nursing practice frameworks that align with the complexities of healthcare delivery and nursing care, particularly in communication, to ensure that significant aspects are not overlooked or misunderstood.

5. Findings: A Framework for Person‐Centred Communication—The COMCARE Model

In all interactions with patients, RNs need skills to communicate effectively. Good communication can cultivate empathy and empower patients to take an active role in their care. Maintaining caring encounters requires communication skills that are sensitive and tailored to individual circumstances, with the goal of supporting the person's health and well‐being. COMCARE provides a framework for achieving this goal. COMCARE is built upon key components of communication skills and their goals, which are non‐linear. Different goals require different communication skills. The implementation of these methods relies on understanding and integrating content and relational aspects into RNs' communication and using communication behaviours and language with clinical judgement. The overall goal is to communicate to ensure and maintain a caring and supportive interaction with patients in all encounters, whether RNs and patients meet only once or twice or have more long‐lasting relationships with continuity. When communicating with openness and respectfulness, RNs can cultivate a trustful interaction in a few seconds. Person‐centred communication requires a wide repertoire of skills to apply and tailor to individuals in various situations and settings. A person‐centred culture is all about communication. For an overview of the framework and key components of communication skills, see Figure 1. The communication skills are described below, with each component further illustrated with examples of verbal phrases and non‐verbal behaviours in Table 1.

FIGURE 1.

The COMCARE model with key components of various communication skills and related goals.

TABLE 1.

Examples of verbal phrases and non‐verbal behaviours enhancing the patient's experience and promoting caring and helpful encounters.

Communication to ensure caring and helpful encounters
	Examples of verbal phrases	Examples of non‐verbal behaviours
Empathic listening and asking questions	Is everything fine? Can you tell me a bit more about how you're feeling? You look concerned. What matters to you? Is anything troubling you? Is there anything else? Something you're wondering about?	Use a warm tone of voice that signifies that you care. Positioning yourself toward the patient in a proper way and, for instance, leaning forward to show interest when appropriate. Keep an open posture, arms uncrossed, to signal openness. Be open and aware of the patient's responses to your non‐verbal behaviours. Adapt non‐verbal behaviours to the patient's responses if needed. For instance, you may need more distance depending on whether the patient looks comfortable. Maintain eye contact to show that you are interested and listening. Encourage patients to express their thoughts and ask questions. Adjust communication style to meet diverse needs and cultural differences.
Responding and acknowledging communication	You look concerned. What matters to you? I can see that you are worried. If I understand you correctly, you prefer to have the X‐ray as soon as possible, is that right? It sounds like you're feeling worried. Are you? I understand that this situation might be difficult for you.	Nodding or repeat back what the patient says to show understanding. Do not interrupt. Use touch, like gently patting a patient's hand or shoulder to offer reassurance, when appropriate. Acknowledge feelings. Summarising what the patient said to ensure understanding and show empathy. Resolve conflicts or upset feelings if possible in a constructive manner.
Guiding and using clear communication	Let me explain what's going to happen next. At this moment we need to wait for your test result. Do you have any questions regarding that? Do you have any questions about how to care for your wound? Everything looks good right now. Anything else you want to ask about? Would you prefer to sit up or lie down?	Adjust tone and volume to suit different situations and needs. Offer options to give patients a sense of control. Be polite and avoid stressful behaviours. Use a relaxed body position and tone of voice to build trust and make patients listen and feel respected. Use a calm and reassuring tone while explaining a procedure. Avoid medical jargon and explain in easy‐to‐understand terms.
Supportive communication	How can I make it more comfortable for you? If you need anything, just say. We are here to help you through this. I understand that this can be overwhelming. Let's take it one step at a time.	Create comfort by listening and using a relaxed posture. Be mindful of the patient's personal space. Use a tone of voice that reinforces the message, for instance by using a calm and pleasant tone to provide support for a patient who is upset. Smiling to be supportive and to create a welcoming environment. Use sympathetic facial expressions when discussing sensitive topics. Maintain gentle eye contact and offer a tissue if the patient is crying.
Appraising and confirming communication	You're doing a great job handling all this. I can see why you might feel that way.	Use a tone of voice that reinforces the message, and nod to show that you understand. Smile or use touch to convey care and warmth when appropriate. Maintain eye contact to show attentiveness and nod reassuringly. Distance your posture if the patient seems uncomfortable, to put them at ease and feel respected. Show patience by giving patients time to process information and allow moments of silence during conversations.

The interplay between content and relational aspects is essential. This means, for example, that when content is tailored to the individual and delivered in a manner that respects their autonomy and dignity (relational aspect), it enhances the effectiveness of communication. Similarly, a positive encounter built on trust and empathy facilitates the exchange of relevant information (content aspect) and ensures that patients feel actively involved and empowered. The use of skills can be guided by awareness of the interplay between content and relational aspects when communicating while avoiding unnecessary pitfalls in patient encounters. The way in which communication skills are used will impact interactions with patients. It is not only about what is said but also how it is communicated. Hence, RNs' communication is most effective when words, tones of voice and non‐verbal expressions are aligned. When communicating, awareness is needed of how to tailor the words used, what messages should be conveyed, and how information can acknowledge individuals and their understanding. This also involves considering factors such as the patient's background, health literacy level, cultural beliefs, and communication style to ensure that conversations are congruent and that their content is conveyed effectively.

Communication serves different functions and goals, and its consequences can be immediate, intermediate, or long‐term [28]. This means that some effects are relevant during the encounter, whereas others manifest shortly afterwards or much later. RN communication can have a combination of both immediate and long‐term consequences. For example, allowing patients to express their emotions (immediate outcome) can make them feel supported (intermediate outcome) and, in the long term, reduce unnecessary anxiety and increase their well‐being (long‐term outcome). Moreover, communication with patients covers verbal, non‐verbal, written, and visual forms. Whether communication is person‐centred depends on how these skills are utilised, highlighting the importance of attentiveness and flexibility in adapting communication strategies to each situation.

5.1. Empathic Listening and Asking Questions

The communication skills used are imperative in establishing a first contact with the patient and encouraging them to express their concerns and preferences. Empathic listening and asking questions are communication skills aimed at inviting conversations and information exchange. Empathy is defined as ‘an attribute involving an ability to understand each patient's inner experiences and perspectives, and the capability to communicate this understanding’ [29]. Therefore, empathic listening is crucial in understanding patient concerns, as it involves not only paying attention to the words spoken but also demonstrating attentiveness and active involvement.

In patient encounters, there is an ongoing exchange of information and messages. This exchange is a complex interplay involving both verbal and non‐verbal communication, as well as listening. Being an emphatic listener means listening not only with the ears but also with the eyes and the heart. Patient concerns and emotions can be expressed by subtle signs. For example, in a study with children, they were observed as mainly expressing their fear and distress non‐verbally during needle procedures [30]. In another study in which older adults received homecare, they were observed to express their concerns and emotions implicitly [31].

In caring, relationships and dialogue are central [8]. RNs should listen attentively, enabling patients to express their needs and concerns [24]. Active listening and validating patients' feelings can demonstrate empathy. In trustful interactions, patients are more likely to share their worries, fears and preferences. The type of questions asked also matters—open‐ended questions encourage fuller expression, allowing patients to share thoughts and concerns and giving RNs deeper insights into their experiences and priorities. For example, instead of asking “Are you in pain?”, an RN might ask “How are you feeling right now?”. This invites patients to elaborate on their symptoms and provides valuable information for care planning. Asking open‐ended questions is crucial for ensuring that the right information is obtained at the right time, especially in telephone nursing decision‐making. However, using few open‐ended questions may result in insufficient information, potentially leading to patient safety issues [32]. This concern applies not only to telephone nursing but also to all areas of caregiving.

Messages can be conveyed both through words and beyond them. The tone of voice is a vital aspect of caring communication and caring relationships [33]. For example, the tone of voice can signal positive or negative emotions [34] or can either reinforce the literal meaning of a word or convey incongruent meanings of verbal messages [35]. Even when not consciously intending to communicate, an RN will also convey messages when silent. With their non‐verbal communication, such as body position and eye gaze, RNs can indicate whether they are stressed or interested in the patient.

Communication and information exchanges serve different purposes in patient encounters. Small talk during RN–patient interactions can convey important information, as seen in ward rounds [36], provide social or emotional comfort, particularly in oncology nursing [37], or facilitate exploration. RNs need to gather comprehensive information about the patient's health status. Hence, exploration and information exchange are also about observing and examining. Observations can often be made discreetly during care, without the patient being aware of it. This includes noticing signs of discomfort, distress or anxiety, as well as assessing mobility and physical condition without saying anything. Observations during care and treatment can provide important insights into the patient's current state or be used to monitor progress.

5.2. Responding and Acknowledging

Responding and acknowledging are communication skills used for sharing views and collaboration. By engaging in affirming and responsive interactions, RNs not only ensure that patients feel heard and respected but also create trust and empathy. These skills play a pivotal role in delivering compassionate and person‐centred care.

By responding to patients' emotions and concerns, RNs can provide reassurance and support, fostering a more positive emotional tone. Conversations that address socioemotional aspects can enhance person‐centred encounters [34]. Recognising and acknowledging expressions of emotion—whether positive or negative—helps build trust, even when such emotions are difficult to navigate. Addressing the emotional aspects of care ensures more empathetic and comforting communication [37]. This is particularly evident in hospice care, where RNs were found to support patients with cancer effectively when dealing with distressing issues [38]. However, different emotional expressions present varying challenges. For instance, RNs tend to respond more effectively to patients' sadness than to anger or neutral emotions [39].

Verbal and non‐verbal responses to patients' expressions can ensure RNs' comprehension of patients' experiences. Non‐verbal signs such as maintaining eye contact, nodding and providing verbal affirmations can convey that patients are being heard. In care and treatment, a common pitfall is focusing solely on procedures while overlooking the person behind the patient, that is, the essence of PCC. A study on preoperative needle procedures in children [40] found that using a child‐centred intervention led to greater acknowledgement of children's views and distress, resulting in a more positive emotional state and reduced procedure time. The interaction improved when the RNs talked with the child, such as asking ‘How did you feel?’ instead of talking to the child and saying ‘It won't hurt’ [40]. Thus, responding and acknowledging communication can make a significant positive contribution to the overall emotional state in patient encounters. This is in line with the Glasgow Consensus Statement [17], emphasising the importance of making a human connection.

5.3. Guiding and Using Clear Communication

Clear communication is essential for guiding patients; explaining plans, options, and consequences; and encouraging their involvement by clarifying the purpose of health visits, procedures, and ward routines. Communication helps guide patients through their healthcare journey, promotes understanding and collaboration, and empowers them to take an active role in their care. Clear guidance can also help alleviate anxiety by ensuring that patients are informed and supported. Information should be tailored to each patient, considering their condition, specific situation, and overall context [41]. Communication and guidance foster a sense of security and help prevent misunderstandings or unrealistic expectations [42]. In addition, encouraging patients to ask questions is critical [17], as it allows healthcare professionals to tailor explanations to each patient's unique needs and situation further.

Guidance plays a crucial role in interactions and in respecting patient autonomy. By providing accurate, personalised information, RNs can motivate and support patients throughout their care. Clear communication can ensure that patients know what is expected from them or why a certain treatment is necessary for their recovery. However, when providing guidance and information, there is a risk that RNs may become dominant, making RN‐patient communication asymmetrical [43]. In such cases, important information may be missed, and trust can be diminished.

Guidance also involves managing endings. At the conclusion of interactions or treatment phases, it is important to signal clearly when something is ending and outline the next steps. RNs can achieve this by using clear and respectful language to close the conversation, summarising what has been discussed or done, and reassuring the patient about what to expect next. This approach helps ensure that the patient feels informed, supported and comfortable throughout the encounter.

5.4. Supportive Communication

Supportive communication aims to recognise and acknowledge patients' capabilities. Through their communication, RNs can influence patients' involvement in the interaction and better understand what matters to them. Supporting patient capabilities involves asking questions such as ‘What do you think of this treatment plan?’ and empowering patients to voice their preferences. Acknowledging patient preferences helps foster a partnership that promotes shared decision‐making [6]. Supportive communication requires demonstrating respect and building a trusting relationship, with attentiveness not only to patients but also to their families or significant others [16, 24]. Supportive communication is closely linked to acknowledging communication; when patients feel acknowledged, they are more likely to provide relevant information, ask questions and collaborate with the RN in developing care plans that align with their needs and goals.

The choice of words holds significant power and can greatly affect the outcomes of communication. There are potential pitfalls that can result in communication content and behaviours that are unnecessarily harmful [44]. The words chosen can influence patients' emotions and help them feel at ease. Negative phrasing, even when intended to convey a positive meaning, can cause anxiety. For example, a difference was found between saying ‘Your back is not looking bad’ and saying ‘Your back is looking good’, with negative phrasing leading to more anxiety [45]. Hence, supportive and respectful language is essential for demonstrating empathy. Supportive communication helps patients feel comfortable and respected. Such communication also needs to be inclusive, meaning that patients feel that they can contribute equally to the conversation during encounters. Additionally, it also requires that no one becomes dominant or favoured over others.

Acknowledging patients' capabilities is closely linked to health literacy. RNs' supportive communication can promote patients' understanding and encourage healthy habits [46]. By fostering supportive communication, RNs can optimise patients' health literacy and their ability to access, understand, and use relevant health information. This aligns with RNs' health‐promoting role [20], in which a proactive approach is essential to nursing practice. Guiding is central to supportive communication, as it helps to motivate and empower patients while respecting their individual values, preferences, and autonomy. Conversely, limited health literacy can result from poor communication and information exchange between the patient and the RN [47].

5.5. Appraising and Confirming

The role of RNs in evaluating and confirming communication during patient encounters is crucial for assessing patients' comprehension of medical information, treatment options and potential outcomes, as well as ensuring mutual agreement on health concerns.

Health information must be easy to comprehend and apply. Depending on the situation, the RN may need to briefly recap key issues, summarise important points or discuss future plans. A key approach to validating patients' experiences and ensuring understanding is active listening, combined with reflecting (verbally) on what was said during the conversation [48]. Summarising conversations and checking for understanding promotes clarity and alignment between the RN and the patient. To ensure effective communication, RNs can use the teach‐back method—asking patients to confirm their understanding of the information provided and their comfort with the care they receive. This process is critical for fostering effective communication not only with patients but also with their families, as it enhances patient involvement and addresses health literacy needs [49]. A barrier to person‐centred care arises when reassurances and confirmations are missed, and conversations focus more on the RN's perceptions than on patient management, limiting opportunities for patient involvement.

6. Discussion

Communication is a powerful tool in human interaction and within the healthcare context, and it is an essential component of patient care. Well‐being and health are the primary goals of caring [8], which is in line with the overall goal and long‐term outcomes of the COMECARE model. Different communication skills within each component have immediate and intermediate outcomes aimed at providing optimal care and support for patients. Linking specific skills to their goals helps integrate them into a person‐centred approach, which is helpful for RNs, teachers and students.

Research has shown that PCC leads to improvements at the individual level (i.e., improved health and well‐being, increased patient empowerment and self‐efficacy), as well as at the healthcare level (i.e., better interactions between the patient and healthcare professionals, reduced and shorter hospital stays, reduced hospital costs, improved working environment) [50]. Previous frameworks for the implementation of PCC highlight communication as an important aspect [4, 25]. However, how to communicate following a PCC paradigm is still rather unclear. The COMCARE model includes strategies that are applicable in a wide range of RN–patient interactions, through which the RN will be able to explore the patient's perspective and establish supportive encounters.

The COMCARE model is based on the principle that effective communication is essential for high‐quality care and that RNs' communication competence is central to the PCC [24, 26]. Previous literature that has described person‐centred communication were used as references when developing the COMCARE model because they consider important aspects when interacting with patients, such as seeing the person as a unique human and attempting to understand the patient's perspective. The COMCARE model is generic in nature, allowing for guidance and implementation by RNs across different contexts (i.e., in both acute and non‐acute situations, intramural and extramural). COMCARE provides a versatile framework for enhancing communication skills in diverse nursing environments, ultimately contributing to better patient care and outcomes.

RNs should utilise communication skills with flexibility and wisdom. Those who are better skilled at communication (i.e., those who understand when to use silence as a tool or use small talk to encourage conversation) are likely to find it easier to integrate the strategies from the model into practice. These communication skills serve different goals for both patients and RNs, enabling effective assessment, information exchange and direct care provision [21, 23]. Moreover, although the model does not focus specifically on RNs' health promotion practices, it offers guidance for developing communication skills that support the recognition of patient capabilities, empowerment, and the optimisation of health literacy. The communication strategies outlined in the model can strengthen RNs' ability to foster collaborative partnerships with patients as capable and active participants in their care. Ultimately, healthcare must prioritise patient‐related outcomes over healthcare professionals‐related outcomes [28].

The communication processes in RN–patient interactions involve multiple determinants. These determinants, which can be considered antecedents of the communication process and thus of the COMCARE model, are related to three key elements: the patient, the RN and the care context. As shown in Figure 2, patients and RNs can differ in their values, ethics and cultural backgrounds, all of which influence the communication process [26, 51]. Additionally, the patient's health status and previous healthcare experiences affect the way they express themselves, interact and engage with healthcare professionals [26].

FIGURE 2.

Determinants of the communication process.

RNs are also unique individuals with personality traits, competence and personal ethics that play a role when communicating. Notably, RNs' personal ethics and power dynamics are at play in RN–patient communication. RNs need to recognise the power they carry and that it is their responsibility to take the initial step toward sharing power [52, 53]. The different components of the COMCARE model imply symmetry in the RN–patient interaction, meaning that there is equal sharing of power. To achieve such symmetry, RNs need to try to understand the patient's frame‐of‐reference (i.e., be open to the patient's beliefs and values) and to avoid communication behaviours that disempower the patient, such as being persuasive or controlling [53].

The COMCARE model was designed for face‐to‐face interactions between RNs and patients. Thus, its relevance in telehealth consultations is unclear. Moreover, the model does not consider the use of an interpreter in the communication process. The presence of an interpreter has been described by RNs as a useful tool, but one that still places additional burden on the RN raises ethical dilemmas and does not allow for the same level of PCC [54, 55]. While the components of the COMCARE model might still be used in conversations with an interpreter, barriers or difficulties in achieving PCC communication should be evaluated considering previous research on the use of interpreters.

RN–patient communication and the potential implementation of the COMCARE model occur within a particular care context. Figure 2 shows such a context, which can be characterised as different care levels (e.g., primary or tertiary care), specialities (e.g., cardiology, endocrinology or oncology) or working conditions (e.g., staffing conditions or time for consultations). Previous literature has mentioned the impact of the care context on the implementation of PCC, as well as person‐centred communication [56]. Thus, it is reasonable to mention that contextual factors influence the implementation of the COMCARE model.

Implementing PCC in healthcare often presents challenges, as PCC is recognised as a complex intervention due to the interaction of multiple influencing factors, often requiring changes in healthcare professionals' behaviour and organisational structures [57]. Similarly, enhancing communication within healthcare can be linked to implementing PCC, as improved communication also involves multiple determinants (as mentioned previously). Moreover, the multifaceted strategies of communication can thus cause difficulties in defining effective communication and the attitudinal changes required for its successful implementation. It is therefore crucial to establish a theoretical framework or model to ensure the relevance and effectiveness of implementing complex interventions [58]. The COMCARE model thus addresses the need for a unified theoretical foundation for person‐centred communication.

The COMCARE model has not yet been empirically tested. To facilitate the evaluation of the model, it might be necessary to develop an evaluation tool (perhaps observation‐based). This tool should define and exemplify the model's constructs, such as communication skills, and include screening methods to assess these constructs and formulate interventions aligned with them. Given that person‐centred communication may require behavioural changes, the COM‐B model, which focuses on capability, opportunity and motivation, can serve as a basis [59]. The COMCARE model could involve developing training modules to enhance person‐centred communication skills, ensuring adequate time and resources, and fostering a culture that values and rewards such communication among healthcare professionals.

By following these steps and utilising the COM‐B framework, a comprehensive tool can be developed to test the theoretical model empirically, which is a pivotal step when developing healthcare interventions. This process allows the model to be refined based on feedback and evaluation findings, thereby enhancing its acceptability and effectiveness [58]. The COMCARE model thus needs to undergo rigorous testing to refine and optimise its impact on improving communication between RNs and patients. Testing is essential to ensure that it is evidence‐based, effective and valuable in addressing the targeted issue (i.e., making RN–patient communication person‐centred), leading to improved health outcomes and informed decision‐making [58]. Along with the evaluation of the model, a process evaluation could be valuable, helping to understand how the intervention is delivered, assess its fidelity and feasibility, identify mechanisms of change, and examine how contextual factors influence outcomes [57].

Communication with patients is central to understanding their health needs and perspectives. The COMCARE includes strategies to explore patients' views and preferences, respond to their experiences and life projects, and support individual capabilities. Although the model is designed for RN–patient communication, the Glasgow Consensus Statement underscores the importance of effective communication for all healthcare professionals in delivering PCC [17]. Thus, communication is essential for all healthcare professionals, regardless of their role. Importantly, regardless of the role undertaken, organisations and management play crucial roles in creating the right conditions for person‐centered communication. Without training and support from supervisors to foster open and transparent communication to enhance understanding and trust, negative consequences can arise, such as decreased morale, frustration, poor communication within the healthcare team, inefficiencies in care delivery, and, ultimately, negative outcomes for patients [60]. Therefore, it is essential for healthcare supervisors to provide the necessary support, guidance and resources to enable healthcare professionals to deliver optimal care and support.

7. Conclusion and Practical Implementation

In summary, the COMCARE model outlines communication skills that are essential for enhancing the necessary competencies to ensure high‐quality person‐centred care. COMCARE also provides a consistent framework for understanding and training communication skills that are crucial for addressing patient needs, engaging and empowering patients—skills that are fundamental for delivering optimal care and support. Nevertheless, effective communication in RN–patient interactions remains an underdeveloped area that requires more thorough empirical investigation.

Author Contributions

Sundler Annelie J: conceptualization (lead), writing – original draft (lead), and writing – review and editing (equal). Hedén Lena: writing – review and editing (equal). van Dulmen Sandra: conceptualization (supporting) and writing – review and editing (equal). Acuña Mora Mariela: visualisation (lead) and writing – review and editing (equal). Carlsson Lalloo Ewa: visualisation (lead) and writing – review and editing (equal). Holmström Inger K: conceptualization (supporting), writing – review and editing (equal).

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Annelie J S., Lena H., Sandra, Mariela A. M., Ewa C. L., and Inger K H., “The COMCARE Framework for Person‐Centred Communication—A Practical Caring Framework,” Scandinavian Journal of Caring Sciences 39, no. 3 (2025): e70074, 10.1111/scs.70074.

Data Availability Statement

The authors have nothing to report.