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Mishra KK, Leung IC, Chao MT, Thompson-Lastad A, Pollak C, Dhruva A, Hartogensis W, Lister M, Cheng SW, Atreya CE. Mindfulness-Based Group Medical Visits: Strategies to Improve Equitable Access and Inclusion for Diverse Patients in Cancer Treatment. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241263486. [PMID: 38895040 PMCID: PMC11185011 DOI: 10.1177/27536130241263486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/22/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
Background Mindfulness-based interventions (MBIs) are supported by clinical practice guidelines as effective non-pharmacologic interventions for common symptoms experienced by cancer patients, including anxiety, depression, and fatigue. However, the evidence predominately derives from White breast cancer survivors. Racial and ethnic minority patients have less access to integrative oncology care and worse cancer outcomes. To address these gaps, we designed and piloted a series of mindfulness-based group medical visits (MB-GMVs), embedded into comprehensive cancer care, for racially and ethnically diverse patients in cancer treatment. Methods As a quality improvement project, we launched a telehealth MB-GMV series for patients undergoing cancer treatment, delivered as four weekly 2-hour visits billable to insurance. Content was concordant with evidence-based guidelines and established MBIs and adapted to improve cultural relevance and fit (eg, access-centered, trauma-informed, with inclusive communication practices). Program structure was adapted to address barriers to participation, with ≥50% slots per series reserved for racial and ethnic minority patients. Intake surveys incorporated a demographic questionnaire and symptom assessments. Evaluations were sent following the visits. Results In our first ten cohorts (n = 78), 80% of referred patients enrolled. Participants were: 22% Asian, 14% Black, 17% Latino, 45% non-Latino White; 65% female; with a median age of 54 years (range 27-79); and 80% had metastatic cancer. Common baseline symptoms included lack of energy, difficulty sleeping, and worrying. Most patients (90%) attended ≥3 visits. On final evaluations, 87% patients rated the series as "excellent"; 81% "strongly agreed" that they liked the GMV format; and 92% would "definitely" recommend the series to others. Qualitative themes included empowerment and connectedness. Conclusion Telehealth GMVs are a feasible, acceptable, and financially sustainable model for increasing access to MBIs. Diverse patients in active cancer treatment were able to participate and reported high levels of satisfaction with this series that was tailored to center health equity and inclusion.
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Affiliation(s)
- Kavita K. Mishra
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Department of Radiation Oncology, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Ivan C. Leung
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Maria T. Chao
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Department of Medicine, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Ariana Thompson-Lastad
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Department of Family and Community Medicine, San Francisco, CA, USA
| | - Christine Pollak
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Anand Dhruva
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, San Francisco, CA, USA
| | - Wendy Hartogensis
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
| | - Michael Lister
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Stephanie W. Cheng
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, San Francisco, CA, USA
| | - Chloe E. Atreya
- University of California, San Francisco (UCSF), San Francisco, CA, USA
- UCSF Osher Center for Integrative Health, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- UCSF Department of Medicine, San Francisco, CA, USA
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Juarez-Reyes M, Purington N, Kling SMR. Mindfulness-Based Group Medical Visits in Primary Care for Stress and Anxiety: An Observational Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:721-728. [PMID: 35671517 DOI: 10.1089/jicm.2021.0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: The prevalence of anxiety disorders in primary care is 20%, with 41% of these patients reporting no current treatment. Patients with anxiety are also more likely to have comorbidities with other medical and/or psychiatric conditions, increasing medical costs. Integrating mindfulness-based interventions (MBIs) into a group medical visit (GMV) format has been successfully used to manage pain, but limited literature is available on the effectiveness of these visit formats for patients with stress and anxiety. Methods: Ninety-two adult patients with self-reported stress and/or anxiety were recruited from three university outpatient primary care clinics between 2016 and 2019. Participants attended at least 4 of 6 weekly GMVs focused on MBIs. Change in heart rate, blood pressure, Generalized Anxiety Disorder-7 (GAD-7) score, and 9 item Patient Health Questionnaire (PHQ-9) score from the first to last visit were evaluated using mixed effect linear regression models. Results: Both GAD-7 (estimated change: -5.1; 95% confidence interval [CI]: -6.4 to -3.7) and PHQ-9 (estimated change: -3.3; 95% CI: -4.3 to -2.2) scores significantly decreased from the first to last visit. These reductions were independent of age, sex, and number of visits attended. No significant changes in heart rate or blood pressure were found. Conclusions: Significant reductions in anxiety and depression in primary care patients were observed after a 6-week standardized mindfulness based GMV. Intergroup variability was not significant indicating that the intervention is reproducible over time and across providers. Future randomized controlled trials with appropriate controls will better evaluate which components of the intervention account for findings.
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Affiliation(s)
- Maria Juarez-Reyes
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Portola Valley, CA, USA
| | - Natasha Purington
- Department of Medicine, Qualitative Sciences Unit, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Samantha M R Kling
- Department of Medicine, Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford University, Palo Alto, CA, USA
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Wile KA, Roy S, Stuckey H, Zimmerman E, Bailey D, Parascando JA, Reedy-Cooper A. Qualitative Needs Assessment for the Development of Chronic Pain Group Medical Visits. J Patient Exp 2021; 8:23743735211063122. [PMID: 34869851 PMCID: PMC8640981 DOI: 10.1177/23743735211063122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Group medical visits (GMVs) for patients with chronic pain are becoming more accessible and have been shown to be successful in furthering patient education on multidisciplinary, nonopioid interventions. Unfortunately, evidence suggests that many group visit models lack sustainability due to recruitment issues and retention rates. Additionally, most of the studies surrounding GMVs are located in primarily urban health centers, potentially limiting their generalizability. This study aims to identify patient interest in and barriers to GMVs for chronic pain and to explore how chronic pain impacts daily lives for GMV content optimization in a nonurban population. Nineteen participants age 18 to 65 years participated in semistructured phone interviews to generate a thematic analysis. Participants received their care from family practitioners at a suburban multiclinic academic medical group and were being prescribed at least 50 morphine milligram equivalents (MME) at the time of recruitment. Analysis generated two themes: (1) Participants expressed specific interest in GMVs with few barriers identified, and (2) Pain has a negative impact on mental health and most aspects daily life, creating a foundation for discussion in GMVs. Findings support significant patient interest in group medical visits for chronic pain, but careful planning is necessary to address patient needs, expectations, and barriers in order to ensure GMV sustainability.
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Affiliation(s)
- Kevin A Wile
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Siddhartha Roy
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Heather Stuckey
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | - David Bailey
- Penn State College of Medicine, Hershey, PA, USA
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Alexis Reedy-Cooper
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
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