A qualitative investigation of mindfulness practice to support advance care planning (ACP).

15 Background: Despite ongoing attempts to increase ACP in the U.S, a national longitudinal study of patients with cancer found no significant change in participation in end-of-life (EOL) discussions or living will completion between 2000-2012. A key barrier to ACP includes emotional discomfort talking about EOL care preferences. Mindfulness practices facilitate emotional regulation through present-centered awareness and non-reactive coping. In this pilot, an intervention combining mindfulness training, mindful communication skill development, and information about ACP was hypothesized to increase ACP in patients with cancer.

METHODS: The Mindfully Optimizing Delivery of End-of-Life Care (MODEL Care) intervention provided 12 hours of training to 13 patients with advanced-stage cancer and their family CGs (n = 13 dyads). Training included breath awareness, sitting meditation, mindful movement (yoga), mindful communication, and ACP information. Patients reported on participation in ACP behaviors at baseline and 4 weeks post intervention. Patients and CGs participated in semi-structured qualitative interviews after MODEL Care that were recorded, transcribed, and coded for key themes.

RESULTS: Compared to baseline, patients made notable improvement in ACP behaviors, including having goals of care conversations with their oncologist (p = .03) and family CG (p = .06). Qualitatively, patients and CGs reported an improved ability to "pause" and effectively manage tender emotions, coupled with improved communication and connection between patient and caregiver: "It kind of reminded us both that we need to make a conscious effort to ensure communication occurs on important things"; "We've been more in sync than we ever have been." Moreover, MODEL Care reportedly facilitated thinking about the future to "do what we need to do" and "get things prepared."

CONCLUSIONS: The MODEL care intervention improved patient and CG ability in areas foundational to ACP engagement: reduced emotional reactivity, communicating about difficult issues, and understanding relevance of ACP. Findings support the potential use of mindfulness training to support ACP for adults with cancer and their family CGs.

CLINICAL TRIAL INFORMATION: NCT02367508.