Smilow Cancer Hospital at Yale-New Haven took on a program to assess the effectiveness of mindfulness-based stress relief (MBSR) in patients with cancer.
Bud Wassell, MS, CEAP, LPC
Bud Wassell, MS, CEAP, LPC
Patients with cancer increasingly are supplementing their standard medical treatment with complementary approaches like acupuncture and massage to help manage the many physical and emotional symptoms that accompany a cancer diagnosis.
Numerous studies have shown that mindfulness-based stress reduction (MBSR), founded by Jon Kabat-Zinn, can be very effective in managing stress and a variety of mind/body conditions.1,2 Studies of MBSR focusing on healthcare providers (HCPs) also have yielded positive results, with MBSR helping to increase focus, attention, and calmness and reduce stress, fatigue, anxiety, and depression.3,4
The research also points to a positive impact on the patient experience, including compassionate response to suffering, increased feelings of social connection, improvements in patient-centered communication, and more satisfied patients.5-7 The full MBSR program, however, involves a 2.5-hour class for 8 weeks with expectations of daily practice and a day of mindfulness— an overall commitment of 29-33 hours.
Given current busy schedules and time constraints, it is unlikely that many HCPs are able to commit to these time demands. Abbreviated versions of MBSR have proven to be effective in the workplace and with HCPs and can be delivered in much less time.8-10 Thus, we embarked on a project to assess the efficacy of a shorter MBSR program at the Smilow Cancer Hospital, part of Yale New Haven Health.
Funded by Closer to Free mini-grants to improve the patient experience, this project conducted 3 abbreviated mindfulness solutions classes for up to 60 Smilow Cancer Hospital employees (20/class), in late 2015 and early 2016. Classes were 1 hour per week for 8 weeks with expectations of 30-40 minutes of daily practice. Classes were scheduled at various times during the late afternoons and over the lunch hour. Participants received a manual, and online lessons were available to supplement the in-person experience and to make up any missed classes.
The Professional Quality of Life Scale (ProQOL), the Perceived Stress Scale (PSS), and the Maslach Burnout Inventory (MBI) were given to participants to measure the effect of the program on compassion fatigue, burnout and secondary stress, depersonalization, personal achieve- ment, and perceived stress. The PSS and the ProQOL assessments were given at the beginning and end of the classes. The MBI was added for classes 2 and 3.
Seventeen HCPs began the first abbreviated series of mindfulness solutions classes, and 12 completed the course (Class 1); 10 of 15 completed the second set of 8 classes (Class 2), and 12 of 14 the third course (Class 3). In each of the 3 classes, some students did not attend all 8 in-person sessions due to work and family obligations, but they followed along with the e-mail assignments.
The most dramatic and consistent results across all 3 classes were seen on the PSS, equivalent to a 24% to 48% decrease in perceived stress. The first class showed positive results on the ProQOL, the second group had a very high positive change in depersonalization, and the third class showed significant positive change in emotional exhaustion; depersonalization and emotional exhaustion are key measures of burnout (FIGURE).
PSS indicates Perceived Stress Scale. The Maslach Burnout Inventory (MBI) has 3 measures: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). The ProQOL has 3 measures: compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS).
Implications for Practice
These results suggest that mindfulness skills delivered to busy HCPs via an abbreviated, 8-week, structured format can be very effective in decreasing perceived stress, and, to a lesser degree, in decreasing compassion fatigue and burnout. Although studies show a positive impact on the patient experience, further projects are needed to confirm whether these skills translate into better patient care in the US healthcare system. It is clear, however, that participants felt calmer, less stressed, and more present during the workday.
Mindfulness instruction in a variety of formats can be an effective tool for caregivers to be more present and mindful during the workday, to better manage stress, and be more focused, present, and compassionate with their patients. This has implications for improved safety measures, decreased medical errors, and increased staff and patient satisfaction.
1. Hofmann SG, Sawyer AT, Witt, AA, Oh, D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169-183. doi: 10.1037/a0018555.
2. Ludwig DS, Kabat-Zinn J. Mindfulness in Medicine. JAMA. 2008;300(11):1350-1352. doi: 10.1001/jama.300.11.1350.
3. Geary C, Rosenthal S. Sustained impact of MBSR on stress, well-being, and daily spiritual experiences for 1 year in academic health care employees. J Altern Complement Med. 2011;17(10):939-944. doi: 10.1089/acm.2010.0335.
4. Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med. 2012;43(2):119-128.
5. Condon P, Desbordes G, Miller WB, DeSteno D. Meditation increases compassionate responses to suffering. Psychol Sci. 2013;24(10):2125-2127 doi: 10.1177/0956797613485603.
6. Beach MC, Roter D, Korthuis PT, et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013;11(5):421-428. doi: 10.1370/afm.1507.
7. Krasner MS, Epstein RM, Beckman H, et al. Association of an education program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-1293. doi: 10.1001/jama.2009.1384.
8. Fortney L, Luchterhand C, Zakletskaia L, et al. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11(5):412-420. doi: 10.1370/afm.1511.
9. Aikens KA, Astin J, Pelletier KR, et al. Mindfulness goes to work, impact of an online workplace intervention. J Occup Environ Med. 2014;56(7):721-731. doi: 10.1097/JOM.0000000000000209.
10. Zeidan F, Johnson SK, Diamond BJ, et al. Mindfulness meditation improves cognition: evidence of brief mental training. Conscious Cogn. 2010;19(2):597-605. doi: 10.1016/j.concog.2010.03.014.