Ann Cottingham

Mindfulness Training Helped Patients & Caregivers Cope with End of Life Care Issues Interview with:

Ann Cottingham

Ann H Cottingham

Ann H Cottingham MA MAR
Indiana University School of Medicine
Indianapolis,IN. What is the background for this study? What are the main findings?

Response: Advance care planning provides patients with cancer an opportunity to reflect on future care and treatment options with their physician and family and identify and document their preferences in preparation for a time when they may be unable to speak for themselves. Advance care planning increases both quality of life and satisfaction with care, however the majority of patients with cancer have not participated in these important conversations. Common emotional responses to cancer, such as feelings of anxiety, fear, and sadness, pose one barrier to planning as they can keep patients from thinking about or discussing sensitive topics related to their illness.

We conducted a pilot study to explore whether training in mindfulness, the psychological process of bringing one’s attention to experiences occurring in the present, could enhance the ability of patients and families to consider and discuss emotionally challenging topics — such as end-of-life preparations — and support timely advance care planning. Twelve patient-family caregiver pairs participated in a pilot study of Mindfully Optimizing Delivery of End-of-Life (MODEL) Care, which combined mindfulness meditation, mindful communication practices, and information about advance care planning. MODEL Care focused on developing emotional and communication capacities to enable patients and their family caregivers to respond to the experience of living with advanced cancer and to talk about the disease and future care preferences with greater ease.

The study found that MODEL Care successfully supported patients and their family caregivers in thinking about and then talking about the care they would want to receive if they become unable to speak for themselves, enhancing their ability to respond to emotional challenges, and decreasing barriers to end-of-life planning.

MODEL Care improved patient and caregiver ability to cope, lowered emotional reactivity, and enhanced ability to respond to issues that incited emotion. It also strengthened the patient-caregiver relationship and enhanced communication with each other. MODEL Care also improved both patient and family caregiver communication with the physicians caring for the patient.   Patients noted that the practices enabled them to cope more effectively with the symptoms of their disease, including pain. Caregivers reported changes in their loved one’s ability to cope with their disease following the mindfulness sessions. What should readers take away from your report?

Response: Advance care planning conversations are often delayed until there is a medical emergency and patients are too ill to make complex decisions. Family members then struggle to know what their loved one would want. Quality of life of both patients and caregivers is enhanced when both parties have the ability and willingness to have these conversations while the patient feels well enough to express their preferences for the types of treatment they would or would not want.

Existing advance care planning programs do not directly address emotional barriers to having these conversations and making advance care decisions. Developing mindfulness skills can assist patients and families in discussing illness and planning for the future with greater ease. What recommendations do you have for future research as a result of this work?

Response: Future research could build on the findings of this pilot study to explore the relationship among mindfulness practice, ability to communicate mindfully about advanced disease care preferences, ease with which patients and caregivers engage in these sensitive conversations, and concordance between expressed care preferences and treatments received. Is there anything else you would like to add? 

Response: The MODEL Care mindfulness intervention improved the ability of the patients and caregivers enrolled in this study to respond to the emotional challenges of living with cancer, including communicating about their disease and prognosis with their caregiver and discussing the future, including preferences for future care and treatment, reducing patient and caregiver psychological barriers to ACP.


Palliat Support Care. 2018 Jun 8:1-10. doi: 10.1017/S1478951518000354. [Epub ahead of print]

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

Cottingham AH1, Beck-Coon K1, Bernat JK2, Helft PR1, Schmidt K1, Shields CG3, Torke AM1, Johns SA1.


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Last Updated on July 19, 2018 by Marie Benz MD FAAD