# Mindfulness with Palliative Cancer Patients, What Should Be Taken into Account? A Qualitative Analysis

Katell Menard, Maya Corman, Michaël Dambrun

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## To cite this version:

Katell Menard, Maya Corman, Michaël Dambrun. Mindfulness with Palliative Cancer Patients, What Should Be Taken into Account? A Qualitative Analysis. EAPC Congress, Jun 2023, ROTTERDAM, Netherlands. Palliative Medicine, 37 (1S), pp.181, 2023, 10.1177/02692163231172891. http://dx.doi.org/10.1177/02692163231172891

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# Mindfulness with Palliative cancer patients, what should be taken into account ? A qualitative analysis

Ménard K. ¹, Corman M. ², Dambrun M. ²

1. Cancer Center Centre Jean Perrin, Clermont Ferrand, France

2. Université Clermont Auvergne, Laboratoire de Psychologie Sociale et Cognitive (LAPSCO UMRS CNRS), France

INTRODUCTION

## How can the needs expressed by palliative patients be taken into account in mindfulness practice?

### Concept of Total Pain by Cicely Saunders (1967):

* Multidimensional nature of pain: physical, social, psychological and spiritual pain.

* Each aspect of pain being interdependent of others ¹

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Mindfulness Based Interventions' (MBI) scientific assessment is exponential : improving quality of life of cancer patients and alleviating certain symptoms, but mostly in the curative phase or after treatments. A few qualitative analysis about the benefits and the specificity in Palliative care ²,³

METHODO

Design of an interview guide based on ground expertise and literature

14 semi-structured interviews
2 research centers

interpretative phenomenological analysis

### Patients' characteristics :

9 Women

M age = 68
(SD= 7.19)

* Gynecologic Cancer (N=3)

* Bronchic Adenocarcinom (N=2)

Mean Karnofsky Score = 50%

* Urologic Cancer (N=4)

Disease stage
III or IV

* Gastro intestinal Cancer

## Sample interview questions for each dimension of pain

* Could you describe how is your physical pain? What impact this pain has in your inner life? (Physical sphere)

* How isolated have you felt in the last few days? Can you describe this experience and tell me what would you like to do or have done to alleviate this feeling of isolation? (Social sphere)

* Can you describe your emotional state over the last few days? What negative/positive emotions are you feeling the most these days? What are you doing to alleviate them? (Psychological sphere)

* Can you tell me what means spirituality ? how is spirituality important in your daily life? How helps you the most to face the difficult days? days?

## What are the causes of Suffering ? ⁴

### AVERSION TO UNPLEASANT EXPERIENCE

**The pain** rejected, avoided (64%)
"I would tell no, I'm not in pain but I'm sure I was in pain" "Pain is the worst because we cannot accept it. Anyway I don't accept it anymore!"

**The uncertainty** (71%) "if I must continue like this until the end ..."

**The dependance** (57%) "it's inaction that I don't bear." "during the meals, I feel obligated. I am not free."

**The disease** (42%) "Situation is horribly sad and I don't find any justification. It's horrible to finish like this."

**The suffering** (21%) "I accept that I am at the end, not far from death but no suffering. I have suffered too much in my life"

### ATTACHMENT TO PLEASANT EXPERIENCE (64%)

"I miss the walks, the friendship, the singing"

"one thing that bothers me is that I don't enjoy the passage (of friends) as well as I did before" "I'm parasitized by the fact that it's over, that these memories there will never be again."

Or DIFFICULTY TO REMEMBER PLEASANT EXPERIENCE

"I try to remember the good times with my children but well I can not capture the good times"

### DISSOCIATION/SEPARATION between me and the environment (71%)

"we are a little cut off from the world." "visit of my relatives imposes on me to forget myself as I am to stay as they know me."

## Spontaneous Emergence of another way to respond to Suffering ⁴

**Spontaneously Mind body practices** (71%): breathing, walking, massage, meditation, visualization ...
"put the pain in perspective"
"the meditation makes that we don't apprehend the pain, this does not avoid the pain but it allows not to remain on it

### INTERDEPENDANCE (86%)

In Human relationship :
« We are here to help each other's, otherwise is it useful ? »
« We are living only by others.” I am very rarely alone. It is as if I were given oxygen. They take me well-being, love. »

In relation with the nature, the environment :
« We are part of nature » "I have the feeling that we are coming from the nature, that makes us alive."

### The capacity to experience and to recognize the IMPERMANENCE (64%)

« We, we will disappear, but the world will last. »

"it's life and death... it grows, it dies... it's actually life"

Experience of impermanence of pain (57%)

### ACCEPTANCE (57%)

"I accept the diagnose, the treatment, the dependance from everything that the disease creates" "what I accept the most is that I'm at the end"
"not continuing, I accept it."

### EQUANIMITY Capacity to feel positive and negative emotions (43%)

« it makes me sad and happy at the same time » "it soothes me as it can panic me" "I put things in perspective." "I don't wonder, I take the moment as it is."

Encouraged by
Mindfulness
Practices

RESULTS

CONCLUSION

## Description of the experience of palliative patients in terms of the mindfulness practice

### developing meditation programs suitable and identifying areas for research on the benefice of the practice

### helping mindfulness teachers to anchor the practice in the daily lives of these patients or to be alert to their frailty

### Patient's expression, a pedagogic tool to improve care relation

## Références :

1. Mehta A., & Chan, L. S. (2008). Understanding of the concept of "total pain": a prerequisite for pain control. *Journal of Hospice & Palliative Nursing*, 10(1), 26-32.

2. Piet et al (2012) The effect of Mindfulness Based Therapy on Symptoms of anxiety and depression in adult cancer patients and survivors : a systematic review and meta analysis, J Consult Clin Psychol., 2012

3. S. Poletti et al (2019) Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study, Complementary Therapies in Medicine, 47 (2019) 10221

4. How does mindfulness transform suffering? I: the nature and origins of dukkha, John D. Teasdale & Michael Chaskalson (Kulananda) Pages 89-102 | Published online: 14 Jun 201