By Stacey Kusterbeck
Patients with poor cancer prognoses and their family members often, understandably, feel overwhelmed. Many cope with avoidance, putting off difficult questions or decision-making. “Trying not to think about the possibility of disease progression or death can be helpful in the short-term. Yet it can cause problems when it interferes with timely advance care planning,” says Shelley Johns, PsyD, of the Regenstrief Institute, the Indiana University School of Medicine and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center.
This can result in individuals with advanced cancer failing to explore their values, goals, and preferences to prepare for future medical decision-making. Johns and colleagues conducted a study to see if mindfulness was a possible alternative to avoidant coping for people with cancer and their family caregivers.1 The researchers provided mindfulness training and advance care planning education to patients and caregivers, delivered in six two-hour sessions. There was high interest among patients and families, who were randomized to the intervention group or usual care. “Our team enrolled 55 patient-caregiver dyads in just 16 weeks of active recruitment. Many studies targeting this population struggle to meet their accrual goals, but that was not our experience,” says Johns. In fact, among the 115 patients who screened eligible for the study, nearly half (47.8%) enrolled. Among family caregivers, 100% of those approached agreed to participate.
Patients in the intervention group reported significantly increased well-being and self-efficacy for advance care planning, compared to the usual care group.
The take-home message for clinicians who want to support timely advance care planning is that mindfulness meditation and interpersonal mindfulness (being aware of oneself and others during interactions, while remaining nonreactive and nonjudgmental) may be an alternative to avoidant coping. “These practices may help reduce emotional barriers to advance care planning,” explains Johns.
This particular study tested a six-session mindfulness program delivered in a group setting. Ethicists who have completed mindfulness training could facilitate a similar program at their institutions. “Ethicists could also refer patients and families to a local or online Mindfulness-Based Stress Reduction program, on which the tested program was based,” suggests Johns.
Reference
1. Mosher CE, Beck-Coon KA, Wu W, et al. Mindfulness to enhance quality of life and support advance care planning: A pilot randomized controlled trial for adults with advanced cancer and their family caregivers. BMC Palliat Care. 2024;23(1):232.
Shelley Johns, PsyD, of the Regenstrief Institute, the Indiana University School of Medicine and the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and colleagues conducted a study to see if mindfulness was a possible alternative to avoidant coping for people with cancer and their family caregivers.
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