Mindfulness training to support advance care planning: Qualitative findings from a randomized pilot.

Abstract

4 Background: Emotional discomfort talking about end of life (EOL) often inhibits advance care planning (ACP). Mindfulness meditation facilitates emotional regulation through present-centered awareness and non-reactive coping and may help adults with cancer and their family caregivers (CGs) approach ACP with greater ease. As part of a randomized pilot study of a mindfulness intervention, we conducted qualitative interviews with cancer patients and their CGs to explore participants’ perceptions of the effects of mindfulness on EOL discussions and ACP. Methods: Adults with advanced solid malignancies and an estimated prognosis of < 12 months were randomized with their CG (N = 55 dyads) to receive standard care alone or standard care plus a 6-session mindfulness intervention that included guided mindfulness meditation, mindful communication practices, and ACP information. A subset of mindfulness patients (n = 20) and CGs (n = 15) completed semi-structured qualitative interviews post-intervention that were recorded, transcribed, and coded using a deductive approach. Results: Researchers identified three primary themes. For patients and CGs, the mindfulness intervention: (1) enhanced awareness and discussion of ACP; (2) increased acceptance of poor prognosis; and (3) fostered supportive communication. Consistent with these themes, patients noted that the intervention enabled them to begin to accept that cure may not be possible, helped them “get over the hurdle” of talking about EOL, and provided an opportunity to reflect on their life priorities, including goals of care. CGs reported that the intervention fostered ACP conversations that had been previously avoided, enhanced understanding of patient preferences that often differed from their own, and increased ability to accept realities of the patient’s illness. Patients and CGs both reported improved understanding of the need to plan for EOL, greater openness to discussing sensitive issues, and an enhanced ability to listen more deeply and communicate with greater kindness. Conclusions: Findings support the use of mindfulness training to equip patients and CGs for timely EOL discussions and ACP. Clinical trial information: NCT03257007.