We are in the process of developing a new course called ‘Living Well to Die Well’ and as part of this process I have been looking at the evidence base for mindfulness meditation in relation to the process of dying. This is in relation to the person who is dying, the bereaved and also those who work with people who are dying.
I also looked for meta-analyses and systematic reviews on mindfulness and death or dying in order to get a sense of the field. However, I struggled to find much research.
Latorraca et al (2017) is a systematic review of mindfulness for palliative care, looking at four randomised control trials in which a mindfulness intervention is compared with an alternative approach in the field of palliative care. Only two of the four studies showed a statistically significant result. The first was an eight week mindfulness course which was found to improve physical aspects of quality of life. The second was a single five minute mindfulness session which was found to reduce stress. The authors commented that although mindfulness is currently being used in clinical practice in the field of palliative care the evidence base is in its infancy.
Jaffray et al (2015) is a systematic literature review looking at the effects of mindfulness based interventions (MBIs) for informal palliative care givers. The results showed that MBIs were beneficial, particularly in terms of reducing depression and caregiver burden and increasing quality of life. The majority of studies included in this review related to those who were caring for dementia sufferers.
Chadwick et al (2008) is a qualitative study of the experience of five participants diagnosed with terminal cancer who attended a six week mindfulness course. Participants identified several ways in which they benefitted, including an increased sense of well-being as well as easing negative emotional states associated with a terminal illness. Key themes that emerged were the social context of the group and the hospice environment as well as the benefits of developing meta-awareness. The researchers noted that each of the four elements of palliative care recommended by NICE for use within the NHS in England (emotional, physical, spiritual and social) was mentioned by at least one participant.
Beng et al (2015) is a pilot RCT study evaluating the efficacy of a five minute mindful breathing practice for distress reduction in palliative care patients and their families. Participants were either guided through the breath awareness practice by a palliative care physician or were ‘listened to’ by the same physician, who asked open questions about their experience. Those who did the mindfulness practice experienced reduced distress, with the reduction of distress being greater during the session than after the session. Therefore, the researchers recommended encouraging people to continue with the practice, for example using audio recordings.
Kogler et al (2013) investigated the relationship between mindfulness, mental distress and psychological well-being in recently bereaved informal caregivers. Mindfulness was found to be a significant predictor of improvement in psychological distress, meaning in life and quality of life three months after the intervention.
Then I looked into what the research said about what it would take to die well. Zamen et al (2021) is a systematic review of systematic reviews on the conditions for a good death. This review found that common themes were:
- Dying at a preferred place;
- Relief from pain and psychological distress;
- Emotional support from loved ones;
- Autonomous treatment decision making;
- Avoidance of futile life-prolonging interventions and of being a burden to others;
- Right to assisted suicide or euthanasia;
- Effective communication with professionals; and
- Performance of rituals.
While mindfulness is not a panacea it can help with pain, psychological distress and communication. Also, one aim of our Living Well to Die Well course is to build a community who will be able to support each other in making end of life decisions and to provide emotional and spiritual support with mindfulness and compassion.
These initial results sound promising. From my experience as a practitioner and teacher of mindfulness I have experienced how mindfulness practice can support people to develop in the four areas of emotional, physical, social and spiritual wellbeing, which are recommended elements of palliative care. Hopefully, more research will be forthcoming.
Heather Regan-Addis teaches on the Masters Degree courses that the Mindfulness Association partners on with the University of Aberdeen (Studies in Mindfulness) and with the University of West of Scotland (Teaching Mindfulness and Compassion).
Beng et al (2015) https://journals.sagepub.com/doi/abs/10.1177/1049909115569048
Chadwick et al (2008) https://onlinelibrary.wiley.com/doi/abs/10.1002/shi.341
Jaffray et al (2015) https://journals.sagepub.com/doi/abs/10.1177/0269216315600331
Latorraca et al (2017) https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.13034