Our physical health directly impacts our mental and emotional health, and it can be even more intense for those facing a terminal diagnosis. Breathing struggles. Intense pain. Delicate skin sores. Fear and anxiety. All of these threaten the quality of life and dignity for patients on hospice care.

But practices like mindfulness are proven to have a positive effect on hospice patients — and incorporating meditation and other contemplative exercises improve comfort, peace and quality of life.

What is Mindfulness?

Mindfulness is “paying deliberate attention to present moment experiences with openness, curiosity and willingness to be with what is” (Smalley and Winston via the NHPCO’s mindfulness resource*). While it may be natural to want to cope with an end-stage illness through avoidance, mindfulness can guide patients to face present realities in a healthier way that yields positive psychological results and even alleviates physical symptoms.

One review by Sage Journals examined multiple studies that focused on mindfulness-based interventions and found “mindfulness benefits patients in PALC [palliative care] by easing their perceived suffering level, reducing anxiety and depressive symptoms and by improving patients’ spiritual well-being, as well as of their marital caretakers.” 

Mindfulness Techniques

Meditation, or deep breathing exercises, is one of the most common mindfulness practices. In hospice, multidisciplinary care team members can teach and assist patients with mindfulness, from nurses to social workers, spiritual care coordinators to volunteers. The NHPCO outlines a typical mindfulness practice:

  • Assume a meditation posture (most often the patient is lying down).
  • Focus attention on “an anchor,” typically the breath.
  • Deliberately, kindly, and non-judgmentally notice whatever arises in the present moment – thoughts, emotions, physical sensations, mental images, sounds, smells.
  • When the mind wanders – to past, future, or imagined events – the key is to notice and return attention to the anchor and present moment.
  • Breath training is a common and effective anchor, concentrating on the air in and out of the nostrils, plus the rise and fall of the chest. Other anchors may include the sensation of what is touching your feet or hands or a visual object in the environment.

Body scan meditation is also an impactful form of mindfulness. To feel more connected to your physical and emotional self, it involves scanning your body for pain, tension or any out-of-the-ordinary sensation. For hospice patients, body scanning can help you connect to the realities of your body while also producing a calming effect, self-compassion and reduced pain and anxiety. 

Healthline describes a body scan as a “mental X-ray slowly traveling across your body.” The steps include:

  • Getting as comfortable as possible.
  • Focusing on your breathing.
  • Choosing a part of your body to focus on, like the top of your head or one of your feet.
    • Focus on that spot as you breathe deeply and slowly.
    • Pay attention to any pain, discomfort or sensation in that part of the body.
    • Take your time, anywhere from 20 seconds to one minute noticing the sensations.
    • Acknowledge your emotions without judgment related to the sensation — anger, discomfort, sadness.
    • Breathe and imagine the tension decreasing with each exhale.
    • Release your focus on that body part and strategically move onto the next part to scan.
  • If your thoughts drift, gently redirect them to the part of the body you’re focusing on.
  • When you’ve completed “scanning” each body part, let your awareness take in your whole body and inhale and exhale as you do so.
  • Finally, release and refocus on your surroundings.

While based in ancient wisdom traditions like Buddhism, mindfulness is commonly accepted and used to improve psychological and physiological health in a variety of settings including healthcare, mental health, education, business, military and law enforcement. Individuals can benefit from mindfulness alongside medications, counseling, supplemental therapies (like music, art or pets) and personal faith traditions like prayer. 

The Benefits of Mindfulness

The NHPCO states that palliative care and hospice patients who utilize guided mindfulness helps:

  • Cultivate awareness of both internal and external stimuli as they happen.
  • Reduce reactivity to these stimuli.
  • Increase the potential to deepen self-awareness and interpersonal presence with and attunement to others.

Mindfulness can occur any time of the day without any required assistance or extra tools. From coping with painful bandage changes to refocusing intrusive thoughts about the future, the benefits to mindfulness during hospice are many. These include:

Reducing anxiety and fear: Self-awareness and staying present can help calm anxious thoughts, alleviate fear of death and eliminate the troublesome “what-if” game that often occurs.

Enhancing emotional wellbeing: Through self-compassion, patients can kindly process your illness, work through grief, find acceptance and practice gratitude.

Improving physical comfort and pain management: Mindfulness-based stress reduction techniques are shown to help alleviate physical pain and aid the patient in relaxation and comfort.

Deepening connection and meaningful relationships: Mindful communication techniques also help caregivers and patients create space for meaningful conversation with loved ones, processing illness and grief together. Mindfulness exercises also deepen connections with the hospice care team.

End-of-life support that includes mindfulness ushers in comfort, compassion and connection. Ask your hospice team about implementing meditation into your care plan to discover the benefits for you and your loved ones.

*Source: National Hospice and Palliative Care Organization, Palliative Care Resource Series, Integrating Mindfulness into Palliative Care: Caring for Patients and Families