Background and aim: Effective communication is widely recognized as central to high-quality healthcare, yet studies of communication and communication interventions use highly heterogeneous outcomes that are difficult to compare. This study developed an international core outcome set (COS) for effective communication in healthcare, following the COMET Handbook and the COS-STAD standards; reporting follows COS-STAR.
Scope: The COS concerns communication between healthcare professionals and patients and, where involved, caregivers, across health conditions and healthcare settings. It includes verbal, non-verbal and written communication, in person, by telephone or by video. Communication between healthcare professionals (interprofessional or team communication) is not covered. The COS is intended for evaluating healthcare communication in research, including communication training and interventions to improve communication. Interventions to support shared decision-making are not excluded but are not the specific focus.
Methods: Candidate outcomes were generated through a targeted literature review and focus groups and rated in two online Delphi rounds (Round 1: 96 participants; Round 2: 45 participants) by three stakeholder groups: patients, patient representatives and caregivers; healthcare professionals and students in the health professions; and communication experts, teachers and researchers. An online consensus meeting (9 voting participants, 10 September 2026) agreed on the final COS of 18 outcomes with definitions. A cross-cutting equity principle, with particular attention to marginalized groups, was incorporated throughout the process.
Related core outcome sets: A search of the COMET database identified one related COS: the ongoing development of an international COS to evaluate the impact of shared decision-making in healthcare (COS-SDM; COMET study 3586; protocol published in BMJ Open 2026). No COS addressing healthcare communication as a whole was identified. Shared decision-making is one function of communication. Our COS addresses communication more broadly, including the relationship (e.g., feeling heard and understood, mutual trust), emotional aspects (e.g., manageability of emotional distress) and the care process (e.g., shared care plan, patient safety). Three of its 18 outcomes relate to decision-making: quality medical decisions, feeling informed and supported in decision-making, and autonomy. The two sets are intended to be complementary: studies of shared decision-making interventions should use COS-SDM, whereas studies evaluating communication more generally can use the present COS. Once COS-SDM is available, overlapping outcomes should be mapped and, where possible, measured with the same instruments, so that studies using either set remain comparable.
Status: The study was completed in September 2026 as part of a doctoral dissertation at the University of Bern; results will be submitted to Patient Education and Counseling. Registration in the COMET database is retrospective.
Principal investigator / Supervisor:
Prof. Dr. med. Steffen Eychmüller, University Center for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
Contributors:
Livia Fenzl (study lead, doctoral candidate), University Center for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
Sibylle Felber (communication scientist and trainer), University Center for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
Ricarda Murbach (medical student; focus groups as part of master's thesis), Faculty of Medicine, University of Bern, Switzerland
Disease Category: Other
Disease Name: Generic (all health conditions)
Age Range: 18 - 120
Sex: Either
Nature of Intervention: Any
- Clinical experts
- Consumers (caregivers)
- Consumers (patients)
- Patient/ support group representatives
- Researchers
- Other
- COS (Other)
- Consensus meeting
- Delphi process
- Focus group(s)
- Literature review
Candidate outcomes were identified through a targeted literature review and four focus groups (48 outcomes). These were rated in two online Delphi rounds (Round 1: n = 96; Round 2: n = 45; consensus: =80% rating 7–9 and =15% rating 1–3). An online consensus meeting (9 voting participants, September 2026) confirmed outcomes with consensus and voted on 13 further outcomes, resulting in a final COS of 18 outcomes.