Scroll down for articles, interviews, book reviews, and ponderings about Mindfulness which I hope will be interesting, useful and informative…...

Presentation at the Oxford Mindfulness Foundation 2025 Conference

Adaption and Development of an MBCT  program for use in a Hospice Day Centre, a work in progress

Background

There appears to be little research into the use of MBCT in Hospices or with those living alongside a life limiting condition(1,2). Living with a life limiting condition brings significant difficulties and challenges. This work-in-progress study explores if a Mindfulness Program, based on MBCT branch FPFW, may be supportive to this population in a Hospice day centre setting. There is some evidence that MBIs can be beneficial to this population in mood regulation (3) symptom control, and spiritual quality of life (3). Additionally, basic evidence suggests a loving kindness practice is supportive for those in palliative care (4). This project aims to explore if Mindfulness can be of benefit to those with a life limiting condition in a Hospice day centre. If so, Mindfulness could be a useful tool for managing quality of life when time left is limited.

Methods

Initially the FPFW Curriculum in  8 x 60 min format was taught to a self selecting group of Hospice service users. Verbal feedback from participants was gathered. Ill health and medical appointments made attending all sessions challenging. Therefore, the decision was made to adapt and develop a program with the ‘warp’(5) of an MBCT based MBI that can be attended in any order and does not rely on prior learning from previous sessions. A rolling program of 6 x 60 min  sessions based on the ‘Foundations of Mindfulness’: Body, Breath, Feelings, Thoughts plus Befriending and Appreciation was developed. Results were qualitative and informal: verbal feedback from participants was gathered at the end of each session. This informed the content and structure the next time the session was taught. This cycle has been repeated 12 times to date. Finally a short qualitative feedback questionnaire was used prior to formally writing up a teaching manual for other MBCT teachers to use.

Results

Gathering data has been challenging as the researcher and hospice do not want to overload participants with rating scales. In addition some participants only attended a few sessions before their life ended. Initial findings are that an MBCT based program is well received and valued, as a helpful and supportive tool for managing quality of life. Participants reported Mindfulness helped manage “stress” and “worrying”, increased sense of agency “I’ve got through things before, I can do it again” and facilitated self compassion "I can do it" and “I’m trying". The resulting program that has been developed is holographic, has 6 sessions that do not require prior knowledge, can be attended non-sequentially, and emphasises self-compassion, agency and appreciation in the here and now. This is now being taught and qualitative feedback gathered via a short questionnaire prior to writing up as a teaching manual for others interested in working in the Hospice setting.

Conclusions

Although quantitative data is lacking, and data gathering at high risk of bias, it appears that a modified FPFW curriculum strongly informed by the underpinning principles of MBCT is supportive in improving quality of life for self selecting participants with a life limiting condition. Observational conclusions from teaching adapted MBCT to this population are:

-Even simple mindfulness techniques appear to help people respond to adversity with a sense agency and wisdom (6).

-Responding with wisdom rather than reacting engenders a sense of agency even in when living with existential uncertainty.

-Appreciation can be supportive in creating upward spirals of positive emotion (7) even in the face of great adversity.

-Practicing befriending the self increases self compassion which nurtures resilience (8).

- It appears that the combination of responding with wisdom increases agency,  while actively practicing appreciation and self befriending combine to help nurture resilience in this population there by increasing quality of life.

References

(1)Latorraca et al. Mindfulness for palliative care patients. Systematic review  Int J Clin Pract. 2017;71:e13034. https://doi.org/10.1111/ijcp.13034

(2)Stadnyk et al. Mindfulness on Symptom Control and Quality

of Life in Patients in Palliative Care: A Systematic Review.American Journal of Hospice

& Palliative Medicine,2024;41(6) 706–714

(3)Gianotti et al. Mindfulness-based stress reduction in early palliative care for advanced cancer patients: An Italian single-centre study. MINDEEP. Annals of Oncology 2019: 30:5. doi:10.1093/annonc/mdz273

(4) Lim et al. The effect of 5-­ min mindfulness of love on suffering and spiritual quality of life of palliative care patients: A randomized controlled study. European Journal of Cancer Care. 2021;30:e13456.

(5)Crane et al. What defines mindfulness-based programs? The warp and the weft. Psychol Med. 2017 Apr;47(6):990-999. doi: 10.1017/S0033291716003317. Epub 2016 Dec 29. PMID: 28031068.

(6) Farb, N.A.S. Meta-Cognition with a Heart: Mindfulness, Therapy, and the Cultivation of Wisdom. Psychological Inquiry, 2020 31(2), 164–167. https://doi.org/10.1080/1047840X.2020.1750913

(7)Fredrickson BL, Joiner TE., Jr Positive emotions trigger upward spirals toward emotional well-being. Psychological Science. 2002;13(2):172–175. doi: 10.1111/1467-9280.00431.

(8) Ellicock,H.B. Can MBCT enhance resilience and through what mechanisms might it do so？2022, Unpublished Masters of Studies in MBCT Dissertation. University of Oxford.