Communication Tools for End-of-Life Conversations in Palliative Nursing: A Narrative Review.

Background: Effective end-of-life communication is essential to patient-centered palliative care, yet nurses often report feeling unprepared for these challenging conversations. A variety of structured tools have emerged to support healthcare professionals in facilitating meaningful discussions with terminally ill patients. Objectives: This narrative review aims to identify and synthesize the main communication tools available to nurses to improve end-of-life conversations, with a focus on practical, evidence-based strategies that enhance patient-centered care planning. Methods: A comprehensive literature search was conducted in PubMed, CINAHL, Scopus, and UpToDate for studies published between 2012 and March 2025. Inclusion criteria encompassed English or Italian peer-reviewed articles focusing on adult patients receiving palliative care and evaluating communication tools designed for or involving nurses. Data were extracted and summarized based on study type, tool, and reported outcomes. Results: Nineteen studies met the inclusion criteria, including randomized controlled trials, systematic reviews, and qualitative studies. Communication tools were categorized into five main groups: card games, question prompt lists, acronym-based protocols, structured conversation guides, and digital tools. Across studies, these tools were associated with improved communication quality, greater patient participation, increased expression of care preferences, and enhanced emotional well-being. Conclusion: Nurse-led use of structured communication tools can facilitate timely, compassionate end-of-life conversations aligned with patients' values and needs. Their integration into palliative nursing practice requires targeted training and institutional support. Future research should explore their long-term effects on patient outcomes and care quality.