Perceptions about using mindfulness therapy: a lung cancer focus group study

The impact of mindfulness-based interventions on the experiences of cancer patients: A qualitative meta-synthesis

OBJECTIVE

This study analyzed qualitative research to explore cancer patients' perspectives on MBIs, including benefits, challenges, and recommendations.

METHODS

This systematic review focused on synthesizing qualitative data and was registered with PROSPERO under the protocol registration number xxx. Searched 7 databases for qualitative studies on MBIs & cancer patients (17 studies, 365 patients). Analyzed data using themes & assessed confidence in findings.

RESULTS

Thematic analysis using NVivo software revealed four significant themes: (1) benefits and positive outcomes (e.g., symptom improvement, team support, positive experiences), (2) challenges and difficulties (e.g., practice challenges, negative experiences), (3) the journey of change and acceptance (e.g., shifts in perception, personal growth, and acceptance), and (4) adaptations and recommendations (e.g., program modification and flexibility).

CONCLUSION

Mindfulness-based interventions have the potential to offer cancer patients positive emotional experiences, increased team support, and opportunities for personal growth, self-discovery, and acceptance. This, in turn, can help them manage the psychological distress associated with cancer. Customizing programs to align with individual patients' needs and preferences can enhance engagement and effectiveness.

PRACTICE IMPLICATIONS

Integrating MBIs into Patient Education and Counseling, tailored to individual needs and with ongoing support, can enhance cancer care. Group interventions foster peer support and effectiveness. Training providers and ensuring accessibility are crucial. Research and customization to patients' journeys optimize outcomes and satisfaction. A patient-centered approach is essential for positive experiences and improved clinical outcomes.

Effectiveness of mindfulness-based interventions on anxiety, depression, and fatigue in people with lung cancer: A systematic review and meta-analysis

BACKGROUND

Lung cancer is one of the most common cancers and poses a physical and psychological threat to patients. Mindfulness-based interventions are emerging forms of psychotherapy that are effective in improving physical and psychological symptoms, but no review has summarized their effectiveness on anxiety, depression, and fatigue in people with lung cancer.

OBJECTIVES

To evaluate the effectiveness of mindfulness-based interventions in reducing anxiety, depression, and fatigue in people with lung cancer.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched the PubMed, Web of Science, Embase, China Biology Medicine disc, Wanfang Data, China National Knowledge Infrastructure, and China Science and Technology Journal databases from inception to 13 April 2022. Eligible studies included randomized controlled trials of people with lung cancer receiving mindfulness-based interventions reporting on the outcomes of anxiety, depression, and fatigue. Two researchers independently reviewed the abstracts and full texts, extracted the data and assessed the risk of bias independently by using the Cochrane 'Risk of bias assessment tool'. The meta-analysis was performed by using Review Manager 5.4, and the effect size was calculated by the standardized mean difference and its 95% confidence interval.

RESULTS

The systematic review included 25 studies (2420 participants), whereas the meta-analysis included 18 studies (1731 participants). Mindfulness-based interventions significantly decreased levels of anxiety [standardized mean difference = -1.15, 95% confidence interval (-1.36, -0.94), Z = 10.75, P < 0.001], depression [standardized mean difference = -1.04, 95% confidence interval (-1.60, -0.48), Z = 3.66, P < 0.001], and fatigue [standardized mean difference = -1.29, 95% confidence interval (-1.66, -0.91), Z = 6.79, P < 0.001]. The subgroup analysis indicated that programs lasting less than eight weeks in length with structured intervention components (e.g., mindfulness-based stress reduction and mindfulness-based cognitive therapy) and 45 min of daily home practice implemented in patients with advanced stage lung cancer showed better effects than programs lasting more than eight weeks in length with less structured components and more than 45 min of daily home practice implemented in patients with mixed stage lung cancer. The overall quality of the evidence was low due to the lack of allocation concealment and blinding and the high risk of bias in most studies (80%).

CONCLUSIONS

Mindfulness-based interventions might be effective in reducing anxiety, depression, and fatigue in people with lung cancer. However, we cannot draw definitive conclusions because the overall quality of the evidence was low. More rigorous studies are needed to confirm the effectiveness and examine which intervention components may be most effective for improved outcomes.

Mindfulness and Relaxation Techniques for Stroke Survivors with Aphasia: A Feasibility and Acceptability Study

Stroke survivors with aphasia (SsWA) tend to experience high levels of anxiety and stress, leading to an increased risk of recurrent strokes. Mindfulness and/or relaxation that does not require language outputs could reduce psychosocial stress; however, these approaches work best if they consist of a range of techniques and are modified to suit the needs of SsWA. Using a mixed-methods approach, we examined the feasibility and acceptability of a set of tailored mindfulness and relaxation techniques for SsWA. Nine SsWA were recruited (six men and three women, median age = 51 years). Four relaxation and mindfulness techniques which had been tailored for SsWA were filmed into a DVD/YouTube video and were given to participants together with a practice diary for home practice once daily for 5 weeks. The participants joined focus group discussions and completed a feasibility scale 5 weeks later. The participants perceived these techniques as easy, user-friendly and acceptable for SsWA in general. Although practised less often than instructed, many participants reported benefits of regular practice. The perceived relevance of these techniques to the participants’ own situations and the intention to continue varied. Future research could encourage the regular practice of self-help interventions by incorporating behavioural change techniques such as using prompts and cues.

Engaging Patients in Research That Involves Meditation: Religious Concerns and Nursing Implications

BACKGROUND

Studies evaluating the use of meditative practices for supporting symptom management among patients undergoing cancer treatment have increased substantially in recent years. Although meditative practices as adjuncts to promoting health have become mainstream, concerns that such strategies conflict with traditional religious tenets have co-occurred. In the context of a 12-week sequential multiple assignment randomized trial of home-based meditative practices and reflexology delivered to patients with cancer by or with family caregivers to manage symptoms, early attrition was identified in the meditative practices arm.

OBJECTIVE

Finding religious concerns were factors contributing to attrition; the purpose is to describe adjustments to the training protocol for study recruiters and interveners when enrolling participants and teaching patient-caregiver dyads meditative practices.

METHODS

The training protocol for recruiters and interveners was adapted to address religious concerns related to meditative practices.

RESULTS

Since initiation, recruiters and interveners have appreciated the adapted protocol, which has improved their capacity to respond to religious concerns. Participants have responded well to consideration of the practices as mindful movements coordinated with breath.

CONCLUSIONS

Given broader application of meditation in symptom management studies, researchers will need to be ready to address religious concerns. It is essential that protocols for introducing meditation are broadly presented to respond to concerns of patients and cancer caregivers regarding perceived conflicts with their specific religious beliefs.

IMPLICATIONS FOR PRACTICE

As the provision of integrative care options that include meditation training for patients grows, nurses require awareness of potential barriers and strategies to ameliorate religious concerns.

Reflexology and meditative practices for symptom management among people with cancer: Results from a sequential multiple assignment randomized trial

Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.

Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients' dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

CANcer BEhavioural nutrition and exercise feasibility trial (CanBenefit); phase I qualitative interview findings

BACKGROUND

Older people with lung cancer are often frail and unfit due to their cancer and co-morbidities and may tolerate cancer treatments poorly. Physical activity (PA) and a healthy diet offer quality of life benefit to people with cancer before, during, and post treatment. However, older adults are poorly represented in the clinical trials on which recommendations were made.

OBJECTIVE

To assess the acceptability, usefulness, and practicality of delivering a tailored wellbeing (PA and nutrition) intervention for older adults with lung cancer before, during, and after cancer treatments (chemotherapy and/or immunotherapy).

METHODS

Semi-structured interviews conducted with nine patients with lung cancer and three patients with mesothelioma, ≥70 years and ten informal carers, and nine Multidisciplinary Team (MDT) members. A topic guide covered the acceptability, usefulness, and practicality of a wellbeing intervention as well as specific feedback on individual components. Data were subjected to thematic analysis.

FINDINGS

Four themes were generated: current lack of wellbeing care in clinical work; preferred "can have" dietary and "can do" PA advice; peer support as facilitating factor; and barriers to compliance including patients' psychological and physical issues as well as current cancer pathway and staffing issues.

CONCLUSION

Older adults with lung cancer would welcome a proactive, clear and instructive, wellbeing intervention. Many barriers to compliance exist, particularly before and during cancer treatments due to the psycho-social impact of diagnosis, and the effects of cancer treatment. The intervention must be tailored to individual need and address physical limitations, psychological and social welfare in addition to PA and nutritional advice.

Barriers to Translation of Physical Activity into the Lung Cancer Model of Care. A Qualitative Study of Clinicians' Perspectives

RATIONALE

Evidence-based clinical practice guidelines recommend physical activity for people with lung cancer, however evidence has not translated into clinical practice and the majority of patients do not meet recommended activity levels.

OBJECTIVES

To identify factors (barriers and enablers) that influence clinicians' translation of the physical activity guidelines into practice.

METHODS

Qualitative study involving 17 participants (three respiratory physicians, two thoracic surgeons, two oncologists, two nurses, and eight physical therapists) who were recruited using purposive sampling from five hospitals in Melbourne, Victoria, Australia. Nine semistructured interviews and a focus group were conducted, transcribed verbatim, and independently cross-checked by a second researcher. Thematic analysis was used to analyze data.

MEASUREMENTS AND MAIN RESULTS

Five consistent themes emerged: (1) the clinicians perception of patient-related physical and psychological influences (including symptoms and comorbidities) that impact on patient's ability to perform regular physical activity; (2) the influence of the patient's past physical activity behavior and their perceived relevance and knowledge about physical activity; (3) the clinicians own knowledge and beliefs about physical activity; (4) workplace culture supporting or hindering physical activity; and (5) environmental and structural influences in the healthcare system (included clinicians time, staffing, protocols and services). Clinicians described potential strategies, including: (1) the opportunity for nurse practitioners to act as champions of regular physical activity and triage referrals for physical activity services; (2) opportunistically using the time when patients are in hospital after surgery to discuss physical activity; and (3) for all members of the multidisciplinary team to provide consistent messages to patients about the importance of physical activity.

CONCLUSIONS

Key barriers to implementation of the physical activity guidelines in lung cancer are diverse and include both clinician- and healthcare system-related factors. A combined approach to target a number of these factors should be used to inform research, improve clinical services, and develop policies aiming to increase physical activity and improve survivorship outcomes for patients with lung cancer.

Being Mindful as a Phenomenological Attitude

PURPOSE

The purpose of this article is to reflect on being mindful as a phenomenological attitude rather than on describing mindfulness as a therapeutic intervention. I will also explore the possibilities that being mindful might open up in relation to nursing research and holistic nursing.

DESIGN AND METHOD

I will describe and interpret mindfulness as a state of being by means of van Manen's phenomenological method, using the language of phenomenology rather than the language of reductionist science. Thus, this article can be considered a reflective narrative, describing both the process of orienting to the phenomenon, making preunderstandings-including own experiences of mindfulness-visible, and a thematic analysis of nine scientific articles describing the phenomenon.

FINDINGS

Being mindful as a phenomenological attitude can be described as a deliberate intentionality, where the person is present in the moment and open to what is going on, bridling personal values and accepting the unfamiliar, thus achieving a sense of being peacefully situated in the world, and able to apprehend one's being-in-the-world.

CONCLUSIONS

Being mindful as a phenomenological attitude can contribute not only to phenomenological nursing research but also support nurses' presence and awareness.

Understanding factors influencing physical activity and exercise in lung cancer: a systematic review

PURPOSE

Despite evidence and clinical practice guidelines supporting physical activity (PA) for people with lung cancer, this evidence has not translated into clinical practice. This review aims to identify, evaluate and synthesise studies examining the barriers and enablers for patients with lung cancer to participate in PA from the perspective of patients, carers and health care providers (HCPs).

METHODS

Systematic review of articles using electronic databases: MEDLINE (1950-2016), CINAHL (1982-2016), EMBASE (1980-2016), Scopus (2004-2016) and Cochrane (2016). Quantitative and qualitative studies, published in English in a peer-reviewed journal, which assessed the barriers or enablers to PA for patients with lung cancer were included. Registered-PROSPERO (CRD4201603341).

RESULTS

Twenty-six studies (n = 9 cross-sectional, n = 4 case series, n = 11 qualitative) including 1074 patients, 23 carers and 169 HCPs were included. Barriers and enablers to PA were identified (6 major themes, 18 sub-themes): Barriers included patient-level factors (physical capability, symptoms, comorbidities, previous sedentary lifestyle, psychological influences, perceived relevance), HCP factors (time/knowledge to deliver information) and environmental factors (access to services, resources, timing relative to treatment). Enablers included anticipated benefits, opportunity for behaviour change and influences from HCPs and carers.

CONCLUSION

This systematic review has identified the volume of literature demonstrating that barriers and enablers to PA in lung cancer are multidimensional and span diverse factors. These include patient-level factors, such as symptoms, comorbidities, sedentary lifestyle, mood and fear, and environmental factors. These factors should be considered to identify and develop suitable interventions and clinical services in attempt to increase PA in patients with lung cancer.

Mindfulness in people with a respiratory diagnosis: A systematic review

OBJECTIVES

To describe how mindfulness is delivered and to examine the effect of mindfulness on health-related quality of life (HRQOL), mindful awareness and stress in adults with a respiratory diagnosis.

METHOD

Five electronic databases were searched. Data were extracted and assessed for quality by two reviewers.

RESULTS

Data were extracted from four studies. Interventions were based on Mindfulness-Based Stress Reduction and delivered by trained instructors. Recordings of mindfulness were provided for home-based practice. One study targeted the intervention exclusively to anxious individuals with a respiratory diagnosis. Adherence to mindfulness was poor. No effects were seen on disease-specific HRQOL (standardized mean difference (SMD)=-0.21 95% CI: -0.36 to 0.48, p=0.78), mindful awareness (SMD=0.09 95% CI: -0.34 to 0.52, p=0.68) or stress levels (SMD =-0.11 95% CI: -0.46 to 0.23, p=0.51).

CONCLUSION

Mindfulness interventions, delivered to individuals with a respiratory diagnosis, varied widely in terms of delivery and the outcomes assessed making it difficult to draw any conclusions regarding its effectiveness.

Mining featured micro ribonucleic acids associated with lung cancer based on bioinformatics

Background

Few genetic markers useful for the screening of lung cancer risk exist. Although related research has shown that certain expression profiles of micro ribonucleic acids (miRNAs) are different in lung cancer versus the normal lung, such as miR-29a and miR-29s, the precise molecular mechanism of lung cancer remains obscure. In order to get a better understanding of the pathogenetic mechanism of lung cancer, we analyzed the differentially expressed genes (DEGs) and identified featured miRNAs in lung cancer tissues.

Methods

We used the gene expression profile GSE10072, including 49 gene chips of non-tumor tissues and 58 gene chips of lung tumor specimens. The DEGs between these two groups were identified by Limma package in R language. The TarBase database was used to construct the networks of miRNA regulating DEGs related to lung cancer. After ordering miRNAs regulating DEGs, we further screened featured miRNAs combined with the miR2Disease database.

Results

A total of 5572 DEGs were obtained between lung cancer and control specimens. After constructing a miRNA regulatory network, a total of 398 regulations between 57 miRNAs and 321 target genes existed. By intergrating the miR2Disease database and using a sorting algorithm, a total of six featured miRNAs related to lung cancer were identified, including miR-520h, miR-133a, miR-34, miR-103, miR-370, and miR-148. They might be involved in lung cancer progression by regulating ABCG2, PKM2, VAMP2, GPD1, MAP3K8, and DNMT3B, respectively.

Conclusion

The top 10 significant miRNAs, such as miR-520h, miR-133a, miR-34, and miR-103 may be potential therapeutic targets for lung cancer.

Patient views on smoking, lung cancer, and stigma: a focus group perspective

PURPOSE

Patients with lung cancer, the leading cause of cancer death, are shown to have high levels of psychological distress and poorer quality of life as compared to patients with other cancer types. The purpose of this paper is to describe patient focus group discussions about the lung cancer experience in relation to perceived stigmatization, smoking behaviors, and illness causes; and to discuss implications of these findings relative to the role of the nurse as a patient advocate.

METHODS AND SAMPLE

Eleven adult lung cancer patients participated in audio taped focus group sessions. Discussion questions probed patient perceptions of lung cancer challenges and adaptation issues.

RESULTS

Six primary themes from the qualitative analysis included: 1) societal attitudes; 2) institutional practices and experiences; 3) negative thoughts and emotions such as guilt, self-blame and self-deprecation, regret, and anger; 4) actual stigmatization experiences; 5) smoking cessation: personal choices versus addiction; and 6) causal attributions.

CONCLUSIONS

Patients with lung cancer uniquely experience an added burden from developing an illness that the public recognizes is directly associated with smoking behaviors. Stigmatization and smoking related concerns are of high importance. Oncology nurses must be at the forefront in ensuring that patients with lung cancer do not experience additional burden from perceptions that they somehow deserve and need to defend why they have the illness that they are facing.