Being mindful of mindfulness interventions in cancer: A systematic review of intervention reporting and study methodology.

OBJECTIVES: While mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have demonstrated efficacy in clinical populations, the potential therapeutic benefit of mindfulness in the context of cancer is less clear. The aim of this review was to critically appraise mindfulness intervention reporting and study methodology. METHODS: Studies using randomized control trial design and/or a control arm were included. PubMed, Medline, PsycINFO, CINAHL, and Embase databases between January 1999 and April 2017 were searched. Studies were assessed on (1) reported theoretical framework, (2) intervention description, and (3) justification of modifications to standardized MBSR/MBCT. The overall quality of study design and research methodology were also assessed. RESULTS: Of 30 studies identified, none adhered to MBSR. Modified versions of MBSR were reported in 19 studies. Five studies reported variants of MBCT, 1 used a combination of MBSR/MBCT, and 5 inadequately documented the intervention/ theoretical framework. Overall, component and timeline modifications were poorly documented and justified. Mean intervention contact time was less than standardized MBSR/MBCT protocols. Target outcomes were poorly justified, and 12 studies failed to identify a primary aim, reporting multiple outcomes. Only 9 of 15 studies recruiting clinical populations included clinical cutoffs, and an active therapeutic control was included in 4 studies. CONCLUSIONS: Mindfulness is increasingly considered a standard therapy in psycho-oncology. While many studies proclaim benefits, considerable variability, modification to standardized protocols, and claims of benefit often reflect decreases in sub-clinical supportive care symptomology rather than therapeutic relief of clinically significant psychological disorders.

Bereaved cancer carers' experience of and preference for palliative care.

INTRODUCTION: The importance of addressing carers' needs is becoming increasingly recognised. Cancer patients' carers are identified as a vulnerable population with many unmet informational, emotional and practical needs, particularly during the palliative and end-of-life phases of care. During these phase of illness, patients and carers face the imminence of death and require additional support such as that provided by palliative care services. There is little research on carers' views regarding optimal timing of palliative care referral and the utility of palliative care services. This study aimed to explore bereaved carers' experience and understanding of palliative care and their views on optimal timing of first contact. METHODS: Thirty bereaved carers of patients with metastatic cancer who had previously participated in a randomised controlled trial of early referral versus standard access to palliative care services were interviewed via phone. The interviews were semi-structured, audio-taped and transcribed. Sampling ceased when information became redundant. Interpretive Phenomenological Analysis methodology was used for data analysis. RESULTS: Five major themes were identified: meaning of palliative care, timing of palliative care, valued aspects of palliative care, preparation for the patient's death and the role of palliative care in preparing for and after the patient's death. The results show that bereaved carers of cancer patients define the meaning of palliative care in terms of its function and associate it by and large with end of life. Carers were grateful for the support received from palliative care, but acknowledged its limits. Carers most appreciated the practical help and the respect that the palliative care team showed. They generally recommended that palliative care be introduced when patients need help at home or when symptoms become difficult to control rather than as soon as patients are told that the cancer is incurable. CONCLUSIONS: This study has provided information on the meaning of palliative care to carers who have had the experience of caring for a patient who died. Carers were uncertain about the role of palliative care and associated it with end-of-life care. Education could help de-stigmatise palliative care and reduce misgivings regarding its introduction.

Identifying and training effective clinical teachers--new directions in clinical teacher training.

Decisions about recruitment of clinical teachers and about the content of clinical teacher training programs are complex. This article aims to identify core components that reflect the characteristics of effective clinical teachers and effective clinical teaching in the ambulatory setting. These are grouped into four thematic categories--personal attributes, educational theory and principles, core clinical teaching skills, and mentored instructional activities.