Mindfulness May Aid Cancer Patients in End-of-Life Planning

TOPLINE:
A group structured mindfulness intervention improves existential well-being and advance care planning self-efficacy in patients with advanced cancer. Patients also may show moderate improvements in psychological outcomes, and their caregivers show improved quality of life following mindfulness training.
METHODOLOGY:
Advance care planning to prepare for future medical decision-making has been associated with better quality of life for both adults with advanced cancer and their caregivers, but it is not used by most US patients. Mindfulness, or compassionate acceptance of present-moment experiences, may reduce emotional barriers to such end-of-life discussions.
Researchers conducted a pilot randomized controlled trial with 55 patient-caregiver dyads recruited from several rural and urban oncology clinics in Indiana, randomizing them to either 6 weekly group sessions of a structured mindfulness intervention (n = 33 pairs) or usual care (n = 22 pairs).
Participants included patients with locally advanced or metastatic solid malignancies and with a life expectancy < 12 months, according to attending oncologists, along with their consenting family caregivers; all ≥ 18 years of age and fluent in English.
Primary outcomes included patient quality of life and well-being, while secondary outcomes encompassed patient advance care planning engagement (self-efficacy and readiness) and other psychological and symptom outcomes.
Multilevel models were used to assess intervention efficacy for patients and caregivers, with outcomes evaluated via surveys at baseline, post-intervention, and 1-month post-intervention from April to December 2017.
TAKEAWAY:
Patients in the mindfulness intervention experienced significant increases in existential well-being and self-efficacy for advance care planning across follow-ups, while usual care patients showed no improvement.
Other group differences in outcomes were not statistically significant, but patients in the mindfulness intervention groups showed a trend toward moderate increases in psychological well-being across follow-ups, while their caregivers showed moderate improvements in quality of life at 1-month follow-up.
Both intervention and control groups reported small to moderate increases in readiness to engage in advance care planning, although not statistically significant.
In other trends, caregivers in the mindfulness groups showed moderate improvement in burden levels at 1-month follow-up compared with usual care controls.
IN PRACTICE:
“Our preliminary results suggest that training in mindfulness skills and advance care planning may improve quality-of-life, advance care planning, and psychological outcomes in patients and caregivers coping with advanced cancer,” wrote the authors.
SOURCE:
The study was led by Catherine E. Mosher, Department of Psychology, Indiana University Indianapolis. It was published online on September 28, 2024, in BMC Palliative Care.
LIMITATIONS:
According to the authors, the study sample was primarily White and receiving care from oncology clinics in Indiana, limiting generalizability. The small sample size restricted statistical power for detecting significant small to moderate effects, though this aligned with the primary goal of obtaining preliminary estimates of intervention effects prior to conducting a fully powered trial.
DISCLOSURES:
This research received financial support from Indiana University Health, the Walther Cancer Foundation, and the National Cancer Institute.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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