Abstract
Difficult conversations in hematology/oncology often involve prognosis, goals of care, and treatment decisions, contributing to moral distress and burnout. Prior studies show nurses view their role as integral yet secondary to physicians, citing limited confidence, inadequate training, and time constraints. Understanding behavioral drivers can inform strategies to support nurses in these challenging interactions.
This qualitative study explored hematology/oncology/blood and marrow transplant (BMT) nurses’ experiences with difficult conversations, identifying barriers and facilitators through the Capability, Opportunity, Motivation–Behavior (COM-B) model and Theoretical Domains Framework (TDF).
Purposive sampling recruited hematology/oncology/BMT nurses at a large academic medical center. Semi-structured interviews were transcribed; thematic analysis used an inductive-deductive approach guided by COM-B and TDF.
Sixteen nurses participated (13 inpatients, three outpatients). Capability barriers included fatigue, competing demands, and limited confidence or training; facilitators included mentorship, reframing, and self-directed learning (e.g., ELNEC). Nurses noted tension between their supportive role and the provider-driven structure of conversations. Opportunity barriers involved a lack of privacy in shared rooms, unplanned timing, and inconsistent access to interdisciplinary resources, particularly at night, but nurses created opportunities by partnering with providers, gauging patient readiness, and using clinical changes (e.g., fever) to initiate dialogue. Motivation factors were less explicit but intertwined with other domains: moral distress, emotional fatigue, and bias could reduce engagement, while advocacy, professional identity, and emotional regulation sustained it. Across domains, nurses emphasized that relational trust with patients, inclusion in team discussions, and clinical environments that allow time, privacy, and interdisciplinary support strengthen engagement in meaningful conversations.
Findings highlight the need for both individual and organizational strategies to help nurses engage more confidently in difficult conversations. Communication training, mentorship, and interdisciplinary collaboration can build confidence, while institutional support (e.g., adequate nurse-patient ratios, private spaces, accessible interdisciplinary resources) creates opportunities and helps nurses navigate difficult conversations with patients and families.
Notes
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References:
1. Antonopoulou, V., Schenk, P. M., McKinlay, A. R., Chadwick, P., Meyer, C., Gibson, B., Sniehotta, F. F., Lorencatto, F., Vlaev, I., & Chater, A. M. (2024). Healthcare professionals' responses to complaints: A qualitative Interview study with patients, carers and healthcare professionals using the Theoretical Domains Framework and COM-B Model. Health Expectations, 27(6). https://doi.org/10.1111/hex.70118
2. Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R., Duncan, E. M., Colquhoun, H., & Grimshaw, J. M. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science, 12(1), 77.
3. Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42.
4. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357.
5. West, R., & Michie, S. (2020). A brief introduction to the COM-B Model of behaviour and the PRIME Theory of motivation. Qeios Ltd. https://dx.doi.org/10.32388/ww04e6
Sigma Membership
Alpha Alpha Lambda at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Communication Barriers, Difficult Conversations, Oncology Nursing, Hematology
Recommended Citation
Octaviano, Joy; Oh, Anna; Blum, Penelope; and Lopez, Regine, "Difficult Conversations in Hematology/Oncology Nursing: A COM-B Study of Barriers and Facilitators" (2026). International Nursing Research Congress (INRC). 164.
https://www.sigmarepository.org/inrc/2026/presentations_2026/164
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Self-submission
Date of Issue
2026-08-13
Difficult Conversations in Hematology/Oncology Nursing: A COM-B Study of Barriers and Facilitators
Toronto, Ontario, Canada
Difficult conversations in hematology/oncology often involve prognosis, goals of care, and treatment decisions, contributing to moral distress and burnout. Prior studies show nurses view their role as integral yet secondary to physicians, citing limited confidence, inadequate training, and time constraints. Understanding behavioral drivers can inform strategies to support nurses in these challenging interactions.
This qualitative study explored hematology/oncology/blood and marrow transplant (BMT) nurses’ experiences with difficult conversations, identifying barriers and facilitators through the Capability, Opportunity, Motivation–Behavior (COM-B) model and Theoretical Domains Framework (TDF).
Purposive sampling recruited hematology/oncology/BMT nurses at a large academic medical center. Semi-structured interviews were transcribed; thematic analysis used an inductive-deductive approach guided by COM-B and TDF.
Sixteen nurses participated (13 inpatients, three outpatients). Capability barriers included fatigue, competing demands, and limited confidence or training; facilitators included mentorship, reframing, and self-directed learning (e.g., ELNEC). Nurses noted tension between their supportive role and the provider-driven structure of conversations. Opportunity barriers involved a lack of privacy in shared rooms, unplanned timing, and inconsistent access to interdisciplinary resources, particularly at night, but nurses created opportunities by partnering with providers, gauging patient readiness, and using clinical changes (e.g., fever) to initiate dialogue. Motivation factors were less explicit but intertwined with other domains: moral distress, emotional fatigue, and bias could reduce engagement, while advocacy, professional identity, and emotional regulation sustained it. Across domains, nurses emphasized that relational trust with patients, inclusion in team discussions, and clinical environments that allow time, privacy, and interdisciplinary support strengthen engagement in meaningful conversations.
Findings highlight the need for both individual and organizational strategies to help nurses engage more confidently in difficult conversations. Communication training, mentorship, and interdisciplinary collaboration can build confidence, while institutional support (e.g., adequate nurse-patient ratios, private spaces, accessible interdisciplinary resources) creates opportunities and helps nurses navigate difficult conversations with patients and families.
Description
This qualitative study explored hematology/oncology/BMT nurses' experiences with difficult conversations, identifying barriers and facilitators using the COM-B model. Interviews identified capability, opportunity, and motivation barriers (fatigue, limited training, privacy, emotional strain) and facilitators (mentorship, interdisciplinary collaboration, patient engagement strategies). Findings can inform training and institutional support to strengthen nurses’ confidence and communication.