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  • Measure Summary
  • NQMC:000232
  • Jan 2003

Comfort: score on General Comfort Questionnaire.

Kolcaba K. Comfort theory and practice: a vision for holistic health care. New York (NY): Springer Publishing; 2003. 264 p.

This is the current release of this measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Clinical Quality Measure: Patient Experience


This measure assesses quality in terms of comfort using the General Comfort Questionnaire. The questionnaire, given to either patients or family members, measures the extent to which the responder is experiencing comfort at that point in time.


  • Patients and families want and often need to be comforted in stressful health care situations.
  • It is important to assess aspects of care that patients and families care about.
  • Comfort is congruent with precepts of complementary therapies and holistic interventions, such as massage, music and art therapy, or spiritual interventions.
  • The outcome of comfort is of multidisciplinary concern and provides a common and positive goal for health care teams to meet.
  • The outcome of patient and family comfort is entailed in standards of care for many settings, including hospice, palliative care, and long-term care (LTC). It is important to determine if these standards of care are met, from the patients' and families' perspective.
  • Enhanced comfort signifies improvement above a previous baseline in which comfort needs were predominate. If associated with specific interventions (comfort measures) provided by health care personnel, the improved state indicates that interventions were effective.
  • When comfort is increased, patients and families are better able to engage in health seeking behaviors.
  • As a positive outcome of care, patient and/or family comfort speaks to benefits of care, not merely a decrease or absence of negative outcomes such as nosocomial infections, diminished mobility or function, prolonged length of stay (LOS), or mortality. As such, measures of patient and/or family comfort are positive indicators of quality of care, not just absence of quality.

Evidence for Rationale

Kolcaba K. Inclusion of general comfort questionnaire in AHRQ database of quality measures [memo]. National Quality Measures Clearinghouse (NQMC) submission. 2002 Oct 1. 4 p.

Primary Health Components

Comfort; assessment

Denominator Description

The highest possible score (288 points) on the General Comfort Questionnaire administered to alert, competent individuals

Numerator Description

The raw score of the patient or family member on the General Comfort Questionnaire

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure


Extent of Measure Testing

Evidence for face validity exists because patient representatives from each population of interest agreed that the items were relevant to their comfort experiences in each setting, and panels of experts also spoke to the representativeness of the questionnaires.

Concurrent validity is more difficult to assess, because the author is the only person who has developed questionnaires to measure patient and family comfort. Low positive correlations exist between comfort questionnaires and visual analog scales for total comfort and for Relief, Ease, and Transcendence. The visual analog scale for Total Comfort is not sensitive to changes in patient comfort over time.

Adequate construct validity exists because the instruments show statistically significant sensitivity in expected directions. For example, respondents in the community have higher comfort that those in hospital settings and comfort is a strong predictor of success of interventions for urinary incontinence.

Evidence for Extent of Measure Testing

Dowd T, Kolcaba K, Steiner R. Using cognitive strategies to enhance bladder control and comfort. Holist Nurs Pract. 2000 Jan;14(2):91-103. PubMed External Web Site Policy

Kolcaba K, Fox C. The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncol Nurs Forum. 1999 Jan-Feb;26(1):67-72. PubMed External Web Site Policy

Kolcaba K, Steiner R. Empirical evidence for the nature of holistic comfort. J Holist Nurs. 2000 Mar;18(1):46-62. PubMed External Web Site Policy

Kolcaba K. Holistic comfort: operationalizing the construct as a nurse-sensitive outcome. Adv Nurse Sci. 1992;15(1):1-10.

State of Use

Current routine use

Current Use

Quality of care research

Measurement Setting

Assisted Living Facilities


Hospital Inpatient

Hospital Outpatient

Skilled Nursing Facilities/Nursing Homes

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size


Target Population Age

Age greater than 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Making Care Safer
Person- and Family-centered Care

IOM Care Need

End of Life Care

Getting Better

Living with Illness

IOM Domain




Case Finding Period


Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic


Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

The highest possible score (288 points) on the General Comfort Questionnaire administered to alert, competent individuals




Numerator Inclusions/Exclusions

The raw score of the patient or family member on the General Comfort Questionnaire


Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Individually Reported Health State

Instruments Used and/or Associated with the Measure

General Comfort Questionnaire

Measure Specifies Disaggregation

Does not apply to this measure



Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors


Standard of Comparison


Original Title

General Comfort Questionnaire.


Kolcaba, Katharine, PhD - Independent Author(s)


Kolcaba, Katharine, PhD - Independent Author(s)

Funding Source(s)

Katharine Kolcaba, PhD, developed the General Comfort Questionnaire with funding from the Frances Payne Bolton School of Nursing, Case Western Reserve University.

Composition of the Group that Developed the Measure

Katharine Kolcaba, PhD, was the primary author with help from her colleagues and professors during her PhD program.

Financial Disclosures/Other Potential Conflicts of Interest

Katharine Kolcaba, PhD, has her own consulting company to assist researchers and institutions in applying her principles for measurement of comfort in different populations of patients in health care settings. Information about her services are available at The Comfort Line Web site External Web Site Policy.


This measure was not adapted from another source.

Date of Most Current Version in NQMC

2003 Jan

Measure Maintenance


Date of Next Anticipated Revision


Measure Status

This is the current release of this measure.

The measure developer reaffirmed the currency of this measure in March 2016.


Kolcaba K. Comfort theory and practice: a vision for holistic health care. New York (NY): Springer Publishing; 2003. 264 p.

Measure Availability

Source not available electronically.

For more information, contact Springer Publishing Co. at 536 Broadway, New York, NY 10012.

NQMC Status

This NQMC summary was completed by ECRI on March 14, 2003. The information was verified by the measure developer on April 9, 2003.

This NQMC summary was retrofitted into the new template on June 6, 2011.

The information was reaffirmed by the measure developer on March 14, 2016.

Copyright Statement

This NQMC summary is based on the original measure and is adapted with permission from Springer Publishing Company.

Requests should be made to: Springer Publishing Co., 536 Broadway, New York, NY 10012.

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