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

Johns, Shelley A.; Beck-Coon, Kathleen; Stutz, Patrick V.; Talib, Tasneem L.; Chinh, Kelly; Cottingham, Ann H.; Schmidt, Karen; Shields, Cleveland; Stout, Madison E.; Stump, Timothy E.; Monahan, Patrick O.; Torke, Alexia M.; Helft, Paul R.

doi:10.1177/1049909119862254

Cited by 42Palliative Care and End-of-Life IssuesMindfulness and Compassion InterventionsPalliative and Oncologic Care

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

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Johns, Shelley A., Beck-Coon, Kathleen, Stutz, Patrick V., Talib, Tasneem L., Chinh, Kelly, Cottingham, Ann H., Schmidt, Karen, Shields, Cleveland +5 more·2020·American Journal of Hospice and Palliative Medicine®

DOI 10.1177/1049909119862254PMC PMC8112585

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Abstract

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 ).

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In that previous pilot, 59% of eligible patients and 100% of eligible caregivers enrolled, retention at 1-month follow-up was 85% for patients and 92% for caregivers, patient advance care planning engagement nearly doubled, and both patients and caregivers showed large, significant improvement in quality of life.
“Specifically, 59% of eligible patients and 100% of eligible caregivers enrolled and retention rates were high at 1-month follow-up (85% for patients and 92% for caregivers). From baseline to 1-month follow-up, patient engagement in advance care planning nearly doubled, and both patients and caregivers showed large, significant improvement in quality of life.”
From 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. (2024) · cites this paper as [32]
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In a previous single-arm pilot with cancer patient-caregiver dyads, the mindfulness-based intervention was feasible, acceptable, and showed preliminary efficacy.
“Our own single-arm pilot with cancer patient-caregiver dyads was the first to test the impact of a mindfulness-based intervention on advance care planning in any population [32]. Results supported the feasibility, acceptability, and preliminary efficacy of this group-based intervention [32].”
From 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. (2024) · cites this paper as [32]

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[21]Michael N, O’Callaghan C, Clayton J, Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice. Supportive Care in Cancer. 2013; 21(8): 2195– 2205. 23494583
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Effects of mindfulness meditation on quality of life in adults with advanced cancer and family caregivers: A randomized pilot.
Johns, S. A., Beck‐Coon, K., Brown, L. F., Stutz, P. V., Daggy, J., Tang, Q., Pell, J. A., Newton, E. V., & Helft, P. R. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2018.36.15_suppl.10096
Self-citation
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.
Mosher, C. E., Beck-Coon, K. A., Wu, W., Lewson, A. B., Stutz, P. V., Brown, L. F., Tang, Q., Helft, P. R., Levoy, K., Hickman, S. E., et al. (2024) · BMC Palliative Care · doi:10.1186/s12904-024-01564-7 · Cited by 23 · see citing works
Self-citation
Mindfulness training to support advance care planning: Qualitative findings from a randomized pilot.
Johns, S. A., Cottingham, A. H., Gowan, T. M., Talib, T. L., Stutz, P. V., Faidley, M. T., & Maiko, S. M. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2018.36.34_suppl.4
Self-citation
Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers
Cottingham, A. H., Beck-Coon, K., Bernat, J. K., Helft, P. R., Schmidt, K., Shields, C. G., Torke, A. M., & Johns, S. A. (2019) · Palliative and Supportive Care · doi:10.1017/s1478951518000354 · Cited by 24 · see citing works
Self-citation
A qualitative investigation of mindfulness practice to support advance care planning (ACP).
Johns, S. A., Cottingham, A. H., Beck‐Coon, K., & Helft, P. R. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2016.34.26_suppl.15
Self-citation

Authors: Johns, S. A., Beck-Coon, K., Stutz, P. V., Talib, T. L., Chinh, K., Cottingham, A. H., Schmidt, K., Shields, C., Stout, M. E., Stump, T. E., Monahan, P. O., Torke, A. M., & Helft, P. R.
Affiliations: Regenstrief Institute (US)
Indiana University School of Medicine, Indianapolis, IN, USA
Indiana University School of Medicine (US)
Indiana University – Purdue University Indianapolis (US)
Purdue University West Lafayette (US)
Indiana University Health (US)
Corresponding author: Johns, Shelley A.
ORCID: Johns, Shelley A.
Stutz, Patrick V.
Talib, Tasneem L.
Chinh, Kelly
Cottingham, Ann H.
Schmidt, Karen
Shields, Cleveland
Stout, Madison E.
Stump, Timothy E.
Monahan, Patrick O.
Torke, Alexia M.
Venue: American Journal of Hospice and Palliative Medicine®
Publisher: SAGE Publications
Published: 2019-08-04
Volume: 37
Issue: 2
Pages: 88-99
ISSN: 1049-9091 (ISSN-L)
1938-2715
DOI: 10.1177/1049909119862254
PMC: PMC8112585
OpenAlex: W2966302561
Cited by: 42
References: 72
Citations by year: 2026: 7 · 2025: 8 · 2024: 9 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 4
FWCI: 2.97
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: American Journal of Hospice and Palliative Medicine® (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
IUScholarWorks (Indiana University) (submittedVersion)
Funders: National Cancer Institute (K05CA175048)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords: mindfulness-based interventions, advance care planning, metastatic cancer, family caregivers, quality of life, end-of-life discussions, emotional distress, avoidance coping, family communication, sleep disorders, feasibility and acceptability, group intervention
MeSH terms: Adult, Aged, Female, Humans, Male, Middle Aged, Neoplasms, Pilot Projects, Quality of Life, Social Support, Terminal Care, Caregivers, Advance Care Planning, Mindfulness

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

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