Mindfulness to Enhance Quality of Life and Support Advance Care Planning

Quality of Life Clinical Trial

— MEANING  

Official title:

Mindfulness to Enhance Quality of Life and Support Advance Care Planning (MEANING): A Randomized Controlled Pilot Trial for Adults With Metastatic Cancer and Their Family Caregivers

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03257007
• Other study ID #: 1702223546
• Status: Completed
• Phase: N/A
• Start date: May 9, 2017
• Est. completion date: December 11, 2017

Study information

• Verified date: August 2020
• Source: Indiana University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The MEANING trial is a randomized controlled mixed methods pilot designed to compare a novel mindfulness meditation-based intervention (MEANING) to usual care for adults with advanced-stage solid malignancies and their family caregivers.

Description:

Mindfulness meditation practices have reduced emotional distress, avoidant coping, and improved spiritual well-being in adult cancer patients. These beneficial effects may occur through present-moment acceptance of unpleasant thoughts, feelings, and circumstances and adaptive coping through self-awareness, self-regulation, and self-transcendence. Most mindfulness trials in cancer have focused on early-stage survivors; however, preliminary evidence suggests that mindfulness may help reduce distress in patients with advanced cancer and their family caregivers (FCGs).

Sixty patients with an advanced-stage solid malignancy and their FCGs (60 dyads) will be randomized in equal numbers to receive either the 6-week mindfulness intervention or usual care. Both groups will receive standard cancer care throughout the study period. Dyads randomized to the mindfulness arm will learn mindfulness meditation practices (e.g., body scan, sitting meditation) and mindful communication practices to enhance quality of life, support advance care planning engagement, and improve a variety of secondary outcomes.

The study will use a mixed methods 2-arm randomized design to examine the effects of the mindfulness intervention compared to usual care and seek to explain trial results using insights gleaned from post-intervention qualitative interviews.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 108
• Est. completion date: December 11, 2017
• Est. primary completion date: December 11, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria—Patients

• Patient is at least 18 years of age.

• Patient is at least 3 weeks post-diagnosis of an incurable (locally advanced or metastatic) solid malignancy.

• Patient's attending medical oncologist would not be surprised if the patient died in the next 12 months.

• Patient has not completed a POST form.

• Patient scores = 7 on the Mini-Mental Adjustment to Cancer cognitive avoidance subscale.

• Patient is willing and able to consent and travel to the class location for 6 weekly 2-hour sessions.

• Patient has a family member or close friend eligible and interested in participating in the study.

• Patient has adequate English fluency for completion of data collection

Inclusion Criteria—Family Care Givers (FCG)

• FCG is at least 18 years of age.

• FCG has been invited to participate in the trial with a patient who meets eligibility criteria above.

• FCG is willing and able to consent and travel to the class location for 6 weekly 2-hour sessions.

• FCG has adequate English fluency for completion of data collection

Exclusion Criteria—Patients

• Patient reports a score of > 2 on the Activities and Function item from the Patient Generated Subjective Global Assessment91 (PG-SGA; the patient-reported version of the Eastern Cooperative Oncology Group score).

• Patient makes 3 or more errors on a validated 6-item cognitive screener or exhibits significant psychiatric or cognitive impairment (e.g., dementia/delirium, retardation, active psychosis) that in the judgment of the investigators would preclude providing informed consent and study participation.

• Currently receiving hospice care (patients who enroll in hospice during the trial will have the option of continuing trial participation).

Exclusion Criteria—FCGs

• FCG exhibits significant psychiatric or cognitive impairment (e.g., dementia/delirium, retardation, active psychosis) that in the judgment of the investigators would preclude providing informed consent and study participation.

Related Conditions & MeSH terms

• Advance Care Planning
• Family Caregiver
• Meditation
• Metastatic Cancer
• Mindfulness
• Neoplasm Metastasis
• Palliative Care
• Quality of Life
• Supportive Care

Intervention

Behavioral:
• Mindfulness
The Mindfulness intervention sessions are designed to cultivate present-moment awareness in everyday life to facilitate adaptive and non-reactive relating to thoughts, feelings, and bodily sensations. Participants will be provided with 10-20 minute audio recordings of each of 5 mindfulness practices covered in class, recorded in the facilitator's voice. Participants will be encouraged to practice mindfulness at home 10-20 minutes per day, 6 days per week. Participants will be provided with weekly diaries on which to record type and amount of home practice of mindfulness skills.

Locations

Country	Name	City	State
United States	Indiana University	Indianapolis	Indiana

Sponsors (1)

Lead Sponsor	Collaborator
Indiana University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change from baseline in quality of life (QoL) for Patients	QoL for patients will be assessed with the McGill Quality of Life Inventory.	Baseline, 6 weeks, and 10 weeks
Primary	Change from baseline in quality of life (QoL) for Family Caregivers	QoL for family caregivers will be assessed with the Caregiver Quality of Life - Cancer scale (CQoLC).	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in advance care planning (ACP) stage of change	ACP stage of change will be assessed by a measure modified from Fried et. al assessing stage of change for 3 advance care planning behaviors (completing a living will, medical power of attorney form, or POLST form; patient only measure).	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in advance care planning (ACP) engagement	ACP engagement (self-efficacy, readiness) will be measured using 2 subscales of the Advance Care Planning Engagement Survey (patient only measure).	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in caregiver burden	Caregiver burden will be measured using the Zarit Burden Interview (family caregiver measure only)	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in avoidant coping	Avoidant coping will be assessed using the Mini-MAC Cognitive Avoidance subscale	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in avoidant coping	Avoidant coping will be assessed using the Brief COPE Self-Distraction, Denial, and Behavioral Disengagement subscales	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in depressive symptoms	Depressive symptoms will be assessed using the PHQ-8	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in anxiety	Anxiety will be assessed using the GAD-7	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in spiritual well-being	Spiritual well-being will be measured using the FACIT-SP.	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in sleep disturbance	Sleep disturbance will be assessed using the PROMIS Sleep Disturbance.	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in family communication	Family communication will be assessed using the Social Constraint Scale	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in interpersonal closeness	Interpersonal closeness will be assessed using the Perceived Interpersonal Closeness Scale.	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in acceptance of illness	Acceptance of illness will be assessed using the PEACE Scale.	Baseline, 6 weeks, and 10 weeks
Secondary	Change from baseline in mindfulness	Mindfulness will be assessed using the FFMQ-SF Non-reactivity to Internal Experience and Acting with Awareness subscales.	Baseline, 6 weeks, and 10 weeks
Secondary	Distress Thermometer	Distress will be assessed using the Distress Thermometer.	Baseline, 6 weeks, and 10 weeks
Secondary	Intervention satisfaction and helpfulness	Satisfaction and helpfulness with the Mindfulness intervention will be assessed using single-item investigator-created 7- and 10-point Likert scales, respectively (Mindfulness group only).	6 weeks