Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers

Background: Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP. Aim: We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs. Design: A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3). Participants: Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States. Results: Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3. Conclusions: The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted. The study is registered at ClinicalTrials.gov with identifier NCT02367508 ( https://clinicaltrials.gov/ct2/show/NCT02367508 ).

show abstract

“…reported elsewhere. 48 Participants earned a $25 gift card for each of the 3 completed quantitative surveys and the qualitative interview.…”

Section: Methodsmentioning

confidence: 99%

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

Johns

Beck-Coon

Stutz

et al. 2019

Am J Hosp Palliat Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Overview of included studies by intervention, design, and family carer population sub-group Intervention Design Sub-group Mindfulness-based stress reduction (n=13) Bajaj et al, 2017Berk et al, 2019Birnie et al, 2010Brown et al, 2016Cash et al, 2016Epstein-Lubow et al, 2011Ho et al, 2016Hoppes et al, 2012Hou et al, 2014Marconi et al, 2016Paller et al, 2015van den Hurk et al, 2015Whitebird et al, 2013 Black et al, 2013Bormann et al, 2009Innes et al, 2012Jain et al, 2014Kubo et al, 2018Leach et al, 2015Pomykala et al, 2012Waelde et al, 2017Waelde et al, 2004 RCT Pre-post Dementia Compassion-focused therapy (n=1) Collins et al, 2018 Pre-post Dementia (dyadic) Study-specific interventions (n=4) Cottingham et al, 2018Danucalov et al, 2013Dowling et al, 2014Milbury et al, 2015 Qualitative RCT Pilot RCT Pilot pre-post Cancer (dyadic) Dementia Dementia Cancer (dyadic) Note. RCT: randomised controlled trial; Feas = feasibility; ASL = Amyotrophic lateral sclerosis…”

Section: Tablementioning

confidence: 99%

“…Interventions involving elements of mindfulness and/or compassion were described in four studies: two were randomised controlled trials (Danucalov et al, 2017, Danucalov et al, 2013, Dowling et al, 2014, one a pre-post intervention study (Milbury et al, 2015), and one a qualitative study (Cottingham et al, 2018). was significantly more effective than control in improving stress, and effects were seen for positive affect and burden at 1-month post-intervention.…”

Section: Study-specific Interventionsmentioning

confidence: 99%

“…Intervention programs included yoga and compassion(Danucalov et al, 2017, Danucalov et al, 2013, Tibetan yoga(Milbury et al, 2015), positive affect(Dowling et al, 2014), and mindfulness(Cottingham et al, 2018). Each study is discussed individually.In the randomised controlled trial by Danucalov and colleagues (2017, 2013), a yoga and compassion program was compared against a wait-list control group in a sample of family carers of people with dementia (n=53) on the following outcomes at week-8 postintervention: stress, anxiety, depression, quality of life, vitality, attention, self-compassion, and salivary cortisol levels.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Mindfulness- and compassion-based interventions for family carers of older adults: A scoping review

Murfield

Moyle

O’Donovan

2021

International Journal of Nursing Studies

View full text Add to dashboard Cite

Objectives: To provide an overview of the current use of mindfulness-and compassion-based interventions with family carers of older adults, to aid primary healthcare practitioners in their decision-making around referral to wider healthcare services. The study was guided by four research questions: what interventions are currently used; whom they are used with; why they are used; and their evidence-base in terms of acceptability and effectiveness. Design: A scoping study using the methodological frameworks of Arksey and O'Malley and Levac et al. Data sources: Searches of electronic databases (MEDLINE, CINHAL, PsycINFO), reference lists of relevant articles, and journal websites were conducted in June 2019. Search terms were developed via an iterative process, and included medical subject headings and keywords relating to mindfulness and compassion, interventions, and family carers. Review methods: Articles were included if: written in English; published in a peer-reviewed journal; employed quantitative, qualitative, or mixed-method research designs; and described a mindfulness-and/or compassion-based intervention for adults identified as a family carer of an older adult. Data from included studies were charted (using a purposively-designed template), and descriptively analysed in relation to the study's research questions. Results: From 2,005 unique records, 32 primary studies were included. Seven types of mindfulness-or compassion-based interventions were broadly described within studies, including: mindfulness-based stress reduction (n=13), mindfulness-based cognitive therapy (n=3), meditation interventions (n=9), acceptance and commitment therapy (n=1), dialectical behaviour therapy (n=1), compassion-focused therapy (n=1), and study-specific interventions involving a combination of mindfulness and/or compassion (n=4). Studies sampled a total of n=991 participants and targeted six family carer subgroups: dementia (n=23), cancer (n=5), amyotrophic lateral sclerosis (n=1), chronic conditions (n=1), cirrhosis (n=1), and Parkinson's disease (n=1). A variety of health outcomes were assessed across interventions, with the most common being depression (n=26), anxiety (n=15), burden (n=15), quality of life (n=14), and stress (n=11). The evidence-base for each intervention was insufficient and too heterogeneous to make clear statements regarding effectiveness. However, based on these findings, interventions show some potential utility in supporting family carers in their role and, given a collective rate of attrition (18%), may do so in a way that is acceptable to carers. Conclusions: This scoping study highlighted the nascent use of mindfulness-and compassionbased interventions with family carers of older adults, and provided important substantive detail about what each intervention entails. Based on current evidence, a number of implications for research and practice are presented.

show abstract

“…In a study to explore the effects of a mindfulness intervention to cultivate patient and caregiver capacity to respond to the challenges of cancer with greater ease, the Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention was used. MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to advanced care planning [44]. However, another RCT that evaluated MBSR versus UC in lung cancer patients failed to show a positive impact on caregivers although the significant benefit of intervention was noted in patients [45].…”

Section: Reviewmentioning

confidence: 99%

Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques

Mehta

Sharma

Potters

et al. 2019

Cureus

View full text Add to dashboard Cite

Mindfulness is being used increasingly in various aspects of cancer management. Benefits of mindfulness practices are being observed to manage the adverse effects of treatment, symptoms from cancer progression, and the cost-effectiveness compared to conventional contemporary management strategies. In this review article, we present clinical trial data showing the benefits of mindfulness in various aspects of cancer management as well as techniques that have been commonly used in this practice.

show abstract

Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers

Cited by 19 publications

References 69 publications

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

Mindfulness- and compassion-based interventions for family carers of older adults: A scoping review

Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques

Contact Info

Product

Resources

About