Addressing barriers to advance care planning by adults with advanced cancers

Researchers have found that mindfulness showed promise in improving quality of life and advance care planning outcomes in patients and their family caregivers coping with advanced cancer.

Both patients with poor cancer prognoses and family caregivers often use avoidant coping strategies, such as delaying advance care planning discussions.

Mindfulness emphasizes paying attention to the present moment with an attitude of openness, compassion and interested curiosity accomplished through meditation and other exercises to manage stress.

In a randomised controlled trial, mindfulness training tailored to the needs of cancer patients improved psychological well-being and self-confidence for advance care planning for patients. For caregivers, mindfulness training supported improvements in quality of life at follow-up.

The two-arm study blended mindfulness skills training with advance care planning education to address emotional barriers to advance care planning and contrasted it with usual care which included no coping training or tools.

To help patients clarify their values and goals regarding the kind of care that they want to receive, if and when their disease progresses, and to help caregivers if the patient becomes unable to make medical decisions, the intervention was delivered in six two-hour group sessions enabling patients and caregivers to interact and share experiences. These study participants also received resources to practice mindfulness at home.

Study senior author Shelley Johns of the Regenstrief Institute said: “Drawing upon many years of working in clinical practice with adults facing advanced cancer and their family caregivers, I had noticed considerable avoidant coping that was preventing patients from sharing their thoughts, feelings, and care preferences with their family caregivers.

“This avoidance seemed to be increasing stress for both patients and caregivers and interfering with quality of life. When we guided patients and family caregivers in mindfulness practices and offered skills they could use to have these tender conversations with greater ease, they became more receptive to making decisions.

“Mindfulness is about noticing what’s here so we can choose the wisest response and hopefully be less emotionally reactive.

“Mindfulness practices help individuals increase their mindfulness muscle, so to speak. Anything that we do in our life, from brushing our teeth to having a conversation with a loved one, can be done with mindful focus, with mindful attention.

“Medical care is understandably focused on the patient — and family caregivers often feel left out. In this study, caregivers and patients were both centre stage and I think that’s why the caregivers of these patients, as well as the patients themselves, were so interested in mindfulness.

“The caregivers were looking for tools, resources, skills and opportunities to learn something that could be of use to them in supporting their family member who had a diagnosis with a poor prognosis.”

Participants were 55 family caregivers and 55 adults with advanced solid malignancies including breast, prostate, lung and colorectal cancers, many of whose long-term treatments were no longer achieving desired results.

“Mindfulness can help adults be more fully focused on the present and can address the emotional barriers to advance care planning, bringing peace of mind knowing their medical decisions are known to both their caregiver and their medical team,” said corresponding author Catherine Mosher,  professor of psychology at the School of Science at IU Indianapolis.

“The take-home message from this study is that mindfulness practices can be a supportive resource for dealing with the realities of life that come with advanced stage cancer, whether you are the patient or the family caregiver,” added co-author Susan Hickman.

“Ongoing conversations about goals, values and preferences are essential to help prepare patients and their caregivers for end-of-life decision-making.”