Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers

Ann H. Cottingham, Kathleen Beck-Coon, Jennifer K. Bernat, Paul Helft, Karen Schmidt, Cleveland G. Shields, Alexia Torke, Shelley Johns

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement. Method: The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods. Result: Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease. Significance of results: The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalPalliative and Supportive Care
DOIs
StateAccepted/In press - Jun 8 2018

Fingerprint

Advance Care Planning
Mindfulness
Caregivers
Terminal Care
Neoplasms
Communication
Psychology
Anxiety
Quality of Life
Interviews

Keywords

  • advance care planning
  • Cancer
  • caregivers
  • coping
  • mindfulness

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Addressing personal barriers to advance care planning : Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers. / Cottingham, Ann H.; Beck-Coon, Kathleen; Bernat, Jennifer K.; Helft, Paul; Schmidt, Karen; Shields, Cleveland G.; Torke, Alexia; Johns, Shelley.

In: Palliative and Supportive Care, 08.06.2018, p. 1-10.

Research output: Contribution to journalArticle

@article{e79fb0f1f06e475c9a411d4785b6d66a,
title = "Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers",
abstract = "Objective: Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement. Method: The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods. Result: Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease. Significance of results: The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.",
keywords = "advance care planning, Cancer, caregivers, coping, mindfulness",
author = "Cottingham, {Ann H.} and Kathleen Beck-Coon and Bernat, {Jennifer K.} and Paul Helft and Karen Schmidt and Shields, {Cleveland G.} and Alexia Torke and Shelley Johns",
year = "2018",
month = "6",
day = "8",
doi = "10.1017/S1478951518000354",
language = "English (US)",
pages = "1--10",
journal = "Palliative and Supportive Care",
issn = "1478-9515",
publisher = "Cambridge University Press",

}

TY - JOUR

T1 - Addressing personal barriers to advance care planning

T2 - Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers

AU - Cottingham, Ann H.

AU - Beck-Coon, Kathleen

AU - Bernat, Jennifer K.

AU - Helft, Paul

AU - Schmidt, Karen

AU - Shields, Cleveland G.

AU - Torke, Alexia

AU - Johns, Shelley

PY - 2018/6/8

Y1 - 2018/6/8

N2 - Objective: Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement. Method: The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods. Result: Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease. Significance of results: The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.

AB - Objective: Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients’ and families’ emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement. Method: The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods. Result: Four salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease. Significance of results: The MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.

KW - advance care planning

KW - Cancer

KW - caregivers

KW - coping

KW - mindfulness

UR - http://www.scopus.com/inward/record.url?scp=85048114064&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048114064&partnerID=8YFLogxK

U2 - 10.1017/S1478951518000354

DO - 10.1017/S1478951518000354

M3 - Article

C2 - 29880064

AN - SCOPUS:85048114064

SP - 1

EP - 10

JO - Palliative and Supportive Care

JF - Palliative and Supportive Care

SN - 1478-9515

ER -