Pilot Testing of a Brief Couple-Based Mind-Body Intervention for Patients With Metastatic Non-Small Cell Lung Cancer and Their Partners

Is mindfulness practice "at risk" of increasing spirituality? Systematic review and critical analysis of a claimed effect

INTRODUCTION

Mindfulness meditation has gained prominence in somatic and psychiatric care in several countries including France. Studies have shown its effectiveness in various conditions, in particular the prevention of depressive relapses. However, there are criticisms and concerns about its potential links to Buddhism and spirituality, raising issues of secularism and sectarianism. This issue is particularly conflicting in France with regard its historical and political relationship with secularism.

OBJECTIVES

This study aims to assess quantitative data regarding the impact of mindfulness meditation on spirituality and religiosity using quantitative validated scales.

METHODS

A systematic review was conducted. PubMed was searched for relevant studies using keywords related to mindfulness and spirituality/religiosity scales. Four scales assessing spirituality were identified: FACIT-sp, INSPIRIT, DSES, and DUREL. Qualitative analysis determined if scale items pertained to spirituality or other topics considered by opponents to mindfulness as "at risk" for deviances or sectarian aberrations. Quantitative analysis assessed the effect size of changes in scale scores before and after mindfulness meditation interventions.

RESULTS

Eighteen studies were analyzed, with varying scales and program durations including 1272 participants. Qualitative analysis showed that most scales contained items related to spirituality as well as "at risk" elements like religion and mysticism. Quantitative analysis revealed that a few studies reported significant increases in spirituality scores following mindfulness meditation, but the clinical relevance of these changes was questioned. In general, control groups had smaller score changes.

INTERPRETATION

While some studies suggest a potential increase in spirituality due to mindfulness meditation, the clinical significance of these findings remains uncertain. Moreover, mindfulness meditation's ties to Buddhism are disputed, and its roots are intertwined with various psychotherapy traditions that incorporate spirituality. The role of secularism in psychotherapy is also debated in France, emphasizing the need for proper use and regulation policy rather than prohibition of mindfulness-based approaches. This study highlights the complexity of assessing the impact of mindfulness meditation on spirituality and religiosity. It suggests that a pragmatic approach focusing on risk and harm reduction may be more suitable than labeling the practice as "at risk". Further research is needed to clarify these issues in the specific cultural context of France.

Mindfulness-Based Interventions for Survivors of Lung Cancer and Their Partners: A Systematic Review

BACKGROUND

Survivors of lung cancer and their partners often have complex unresolved physical, psychosocial, and behavioral needs that can negatively affect the survivors' and partners' well-being. This systematic review aimed to (1) examine the content and delivery of mindfulness-based interventions (MBIs) and (2) summarize and synthesize the current evidence for effectiveness of MBIs targeting survivors of lung cancer and/or one selected partner (dyads).

METHOD

Six databases were searched for interventional studies published in English between 1980 and June 2020 using three terms (lung neoplasms, mindfulness, caregivers). For outcome measures, the interventions focused on behavioral change (meditation, yoga, stretching, breathing), symptom management (dyspnea, fatigue, sleep disruption, anxiety, depression, stress reduction), and knowledge. Two reviewers independently assessed article eligibility. One reviewer performed and another independently verified data extraction. The Cochrane risk-of-bias tool for randomized trials was used to critically appraise RCTs.

RESULTS

Searching yielded 307 records, of which 64 were assessed for eligibility. Six studies investigated the impact of an MBI on survivors and partners. Four studies were single-arm feasibility studies; two were RCTs. Two feasibility studies and one RCT recruited romantic couples whereas the others recruited asymmetrical dyads. The single-arm studies reported strong feasibility and acceptability. RCTs reported significant outcomes for reduced cancer-related distress and depression, and improved QOL, self-compassion, mindfulness skills, and rumination.

CONCLUSION

Dyadic intervention research is a growing field. Few interventions target individuals with lung cancer and their partners. No interventions target partners alone. Future research should evaluate rigorous methodologies that enhance the understanding of independent and interdependent health-related effects within dyads and across relationships and settings.

Technology-Based Interventions for Cancer Caregivers: Concept Analysis

Background

Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap.

Objective

This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice.

Methods

The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers.

Results

The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers.

Conclusions

This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively.

3-Doors Compassion Project: Examining the longitudinal effects of a nine-month Tibetan mind-body meditation program

Abundant research supports the benefits of participating in mindfulness meditation training programs including Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. However, these well researched programs include a narrow range of meditation practices and research to date has minimally examined how home practice associates with favorable outcomes. The present study evaluated the 3 Doors Compassion Project (3DCP), a structured 9-months meditation program that teaches Tibetan Mind-Body practices and examined how frequency and duration of home practice associated with favorable outcomes. Twenty-seven medical and mental healthcare professionals completed assessments prior to, during, and following participation in the 3DCP program and recorded daily meditation practices. Study aims were to test general effectiveness of the 3DCP program and to test the hypotheses that frequency and duration of meditation home-practice would associate with improvements on mindfulness, stress, and depression. General linear mixed modeling demonstrated significant improvements throughout the duration of the 3DCP program for mindfulness, depression (p < .001) and stress (p < .05), with each variable evidencing incremental monthly improvements. Frequency of meditation (i.e., days practiced per month), but not time (i.e., minutes per month) was significantly associated with improvements throughout the 3DCP program. Results provide support for the benefits of the 3DCP while offering clinically useful information that can inform current guidelines for meditation home practice. As predicted, the 3DCP was associated with significant improvements on all outcomes. Favorable outcomes were linked to frequency, but not total time of meditation practice, which suggests that consistent meditation may be more helpful than extended meditation.

A Prospective Pilot Study Evaluating Feasibility and Preliminary Effects of Breathe Easier: A Mindfulness-based Intervention for Survivors of Lung Cancer and Their Family Members (Dyads)

Objective: Symptom burden remains a distressing problem for survivors with non-small-cell lung cancer (stages I-IIIa). This pilot study evaluated feasibility and preliminary effects of a tailored mindfulness-based intervention, Breathe Easier, which encompasses meditation, 2 levels of mindful hatha yoga, breathing exercises, and participant interaction.

METHODS

Participants were recruited from 2 cancer programs in the US Southeast. A family member was required for participation. Sixty-two participants enrolled (20% recruitment) and 49 completed the intervention (79% retention). Participants chose level 1 yoga (basic) or level 2 (more advanced). Of the completers, survivors were 39% male and 65% Black. A community-based participatory research framework helped identify the specific needs and interests of potential participants and foreseeable barriers to implementation. A 2-month prospective, 1-group, pre-post design evaluated feasibility. Intervention dosage was measured using written protocols. Attendance and completion of daily home assignments measured adherence. Acceptability was assessed using a 10-item questionnaire, completed at three time points. Preliminary outcome data collected pre- and post-intervention tested the hypothesis that participants who received the 8-week intervention Breathe Easier would, post-intervention, demonstrate (a) less dyspnea, (b) less fatigue, (c) less stress, (d) improved sleep, (e) improved anxiety and depression, and (f) improved functional exercise capacity. Exit interviews were conducted, transcribed verbatim, and analyzed for content using descriptive statistics.

RESULTS

Quantitative and qualitative measures indicated strong feasibility. Over time, level 1 participants had statistically less dyspnea, fatigue and improved exercise capacity, as well as improved sleep, and stress scores. Level 2 participants experienced slightly increased dyspnea and fatigue but improved sleep, stress, and exercise capacity. All participants experienced anxiety and depression within normal limits pre- and post-intervention. Five major themes emerged out of exit interviews: Learning to Breathe Easier; Interacting with Others as a Personal Benefit; Stretching, Releasing Tension, and Feeling Energized; Enhancing Closeness with Committed Partners; Refocusing on Living; and Sustaining New Skills as a Decision.

CONCLUSIONS

The study offers insight into the feasibility of an 8-week in-person mindfulness-based intervention with a unique subset of understudied survivors of lung cancer and family members. Outcome data interpretation is limited by the 1-group design and sample size.

Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors

BACKGROUND

Emotional disclosure is the therapeutic expression of emotion. It holds potential as a means of providing psychological support. However, evidence of its efficacy in palliative settings is mixed. This may be due to variation in intervention characteristics.

AIM

To derive a greater understanding of the characteristics of potentially effective emotional disclosure-based interventions in palliative care by:(1) Developing a taxonomy of emotional disclosure-based interventions tested in people with advanced disease and(2) Mapping and linking objectives, outcomes, underlying mechanisms, and implementation factors.

DESIGN

A scoping review drawing on Intervention Component Analysis to combine evidence from studies' methods, results, and discussion sections.

DATA SOURCES

Six databases were searched to May 2020 including CINAHL, PsycINFO, and MEDLINE. Studies of emotional disclosure in adults with advanced disease were included. Study quality was appraised using an established tool.

RESULTS

Seven thousand seven hundred ninety-two unique records were screened, of which 25 primary studies were included. Intervention characteristics were grouped into classes within three domains: topic of disclosure, format, and dose. Evidence was not available to determine which, if any, of the characteristics is most effective. Thematic synthesis of evidence from methods and discussion sections identified factors to consider in tailoring an emotional disclosure-based intervention to this setting, including: population characteristics (e.g. time since diagnosis), providing a safe environment, and flexibility in format.

CONCLUSIONS

This review approach facilitated a clearer understanding of factors that may be key in developing emotional disclosure-based interventions for palliative populations. Intervention Component Analysis has potential for application elsewhere to help develop evidence-based interventions.

Understanding benefit finding among patients with colorectal cancer: a longitudinal study

PURPOSE

Perceiving positive life changes ("benefit finding") is thought to promote better adjustment after cancer, yet is poorly understood among colorectal cancer (CRC) patients. We characterized benefit finding and examined its relationship to demographic/medical factors, change over time, and association with distress.

METHODS

CRC outpatients (N = 133, 50% metastatic) completed self-report measures (demographic/medical factors, benefit finding, distress) at baseline and 6 months later. Wilcoxon rank-sum (Kruskal-Wallis) tests or Spearman correlations tested associations between benefit finding and demographic/medical factors. Linear regressions assessed (1) change in benefit finding over time and whether this differed by demographic/medical factors, and (2) association between benefit finding and distress and whether this changed over time.

RESULTS

Benefit finding was common among patients with CRC, with highest rated items reflecting gratitude, acceptance, and stronger family relationships. Women and racial minorities reported greater benefit finding than men (p < 0.001) and White patients (p = 0.015), respectively. Medical factors (e.g., metastatic disease) were not associated with benefit finding. Benefit finding significantly increased over time (p = 0.03). While greater benefit finding trended towards an association with lower distress, results were not statistically significant and the relationship did not change over time.

CONCLUSION

Benefit finding was characterized largely by perceived psychological and social benefits, as opposed to pragmatic benefits. Individual differences and social determinants may be more informative than medical characteristics when it comes to benefit finding; although, cultural factors and mediators should be examined further. Benefit finding seems to evolve over time perhaps as a coping process; however, its association with psychological distress appears tenuous.

Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers

OBJECTIVES

To examine relationships in mindfulness and illness acceptance and psychosocial functioning in patients with metastatic breast cancer and their family caregivers.

SAMPLE & SETTING

33 dyads from an academic cancer center in the United States.

METHODS & VARIABLES

Participants completed questionnaires on mindfulness, illness acceptance, relationship quality, anxiety, and depressive symptoms. Dyadic, cross-sectional data were analyzed using actor-partner interdependence models.

RESULTS

Greater nonjudging, acting with awareness, and illness acceptance among caregivers were associated with patients' and caregivers' perceptions of better relationship quality. Higher levels of these processes were associated with reduced anxiety and depressive symptoms in patients and caregivers.

IMPLICATIONS FOR NURSING

Aspects of mindfulness and illness acceptance in dyads confer benefits that are primarily intrapersonal in nature. Nurses may consider introducing mindfulness and acceptance-based interventions to patients and caregivers with adjustment difficulties.

A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial

BACKGROUND

Although mindfulness-based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot-tested a couple-based meditation (CBM) relative to a supportive-expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers.

PATIENTS AND METHODS

Seventy-five patient-caregiver dyads completed baseline self-report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60-minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later.

RESULTS

A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer-related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer-related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group.

CONCLUSION

It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490 IMPLICATIONS FOR PRACTICE: The current randomized controlled trial has established that a mindfulness approach to the management of patients' and spouses' psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive-expressive treatment for patients with metastatic non-small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness-based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.

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

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 ).

Longitudinal associations between gratitude and depression 1 year later among adult cystic fibrosis patients

Individuals with cystic fibrosis (CF) are confronted by a range of difficult physical and psychosocial sequelae. Gratitude has drawn growing attention as a psychosocial resource, but it has yet to be examined among adults with CF. The current investigation evaluated longitudinal associations between trait gratitude and subsequent outcomes from depression screening 12 months later, adjusting for disease severity (FEV₁% predicted) and other significant clinical or demographic covariates. Participants were 69 adult CF patients recruited from a regional adult treatment center. They completed a validated measure of gratitude (Gratitude Questionnaire-6) at baseline and a screening measure of depression (Hospital Anxiety and Depression Scale) at 12-month follow-up. In a logistic regression analysis controlling for disease severity, higher levels of baseline gratitude were associated with reduced likelihood of depression caseness at 12 months (OR .83, 95% CI .73-.91, p = .001). Gratitude remained predictive after adjusting for other psychosocial resource variables (i.e., perceived social support and positive reframing coping). Findings offer an initial indication of the potential salutary role of dispositional gratitude in an understudied clinical population.

Psychological interventions in palliative care

PURPOSE OF REVIEW

To provide an update on recent studies about psychological interventions in palliative (mainly cancer) care with a focus on physical, psychological, spiritual, and social aspects.

RECENT FINDINGS

Some promising psychological interventions for physical challenges, such as fatigue, pain, dyspnea, and insomnia do exist, but further research is needed. Regarding psychological aspects, current reviews showed small to large effects in the reduction of depression and anxiety symptoms through cognitive behavioral-based interventions, mindfulness-based interventions, and meaning-based interventions. Meaning-based or dignity-based approaches were also used for targeting spiritual aspects or existential distress. Social aspects that play a crucial role in palliative care are addressed by social support interventions, end-of-life discussions, and advanced careplanning. All of these psychological interventions must meet the specific requirements of palliative care, namely abbreviated session time and flexibility concerning locality of interventions, a minimized questionnaire burden and a high attrition rate caused by patients' poor physical conditions or deaths.

SUMMARY

There is substantial research on psychological interventions in palliative care that shows promising results, but sample sizes were often small. Due to its high relevance for this growing patient group, there is a strong need for ongoing/further research.