Effectiveness of shared meditation involving cancer patients, health professionals and third persons on well-being and psychosocial skills: a randomised study

Abstract

Background

Mindfulness-based interventions are recommended for improving well-being. We evaluated the potential added value of shared meditation involving patients with cancer, health professionals, and third persons compared with patient-only meditation.

Methods

We designed a randomised controlled trial (CONSORT guidelines) to assess the benefit of shared meditation, where patients with cancer (target population) were assigned to receive the meditation programme in groups involving caregivers and thirds persons (experimental arm) or in groups of patients only (control arm). The study involved 97 volunteers: 65 patients, 16 caregivers, and 16 third persons (neither carers nor patients). Patients were randomised between ‘Shared’ meditation (33 patients), and ‘Patient’ meditation (32 patients). A dedicated programme on mindfulness and compassion (12 weekly 2 h-sessions and 2 half-day retreats) was administered. The primary endpoint was the sense of self-efficacy (Generalized Self-Efficacy Scale (GSES)). Perceived stress was measured by the Perceived Stress Scale (PSS), one of those subscales also focused on self-efficacy. Qualities of mindfulness, self-compassion, participants’ perception of change in their quality of life, and satisfaction following the programme were also assessed.

Results

Both patient arms experienced substantial improvement in self-efficacy scores (GSES) following the programme, without a significant difference between the arms. As secondary endpoints, perceived stress and mindfulness qualities were significantly improved in both arms, as well as several self-compassion dimensions (self-kindness, sense of common humanity, and mindfulness dimensions). Patients in the shared meditation arm showed a significant improvement in self-efficacy (PSS) and a reduction in feelings of isolation (self-compassion scale), which was not significant in patients in the patient-only arm. Patients greatly appreciated shared meditation, as evidenced by adherence to the programme and satisfaction assessments. Participants reported a perception of improvement in their quality of life.

Conclusion

The added value of shared meditation compared to patient-only meditation was not demonstrated in terms of sense of self-efficacy (GSES). Shared meditation specifically improved perceived self-efficacy (PSS subscale) and reduced the feeling of isolation. This approach could constitute a useful tool for patients to better cope with cancer and to break out of the context of illness, with the understanding that suffering is part of shared human experience.

Trial registration

ClinicalTrials.gov. NCT06041607, registered on 09/18/2023. https://clinicaltrials.gov/study/NCT06041607.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12906-026-05449-5.

Background

Owing to the disease itself and the physical and psychosocial challenges posed by its treatments, cancer induces significantly high levels of pain [1], stress [2], anxiety and depression, the latter two greatly exceeding the rate reported in the general population [3]. Since the psychological distress due to cancer is associated with increased disability and diminished quality of life [4], it is essential to empower patients with effective coping strategies that allow them to adapt to it and improve their well-being [5].

Health professionals in oncology are also exposed to stress, anxiety, and depression and the prevalence of burnout is considerable, reaching a global rate of 40% among physicians and nurses [6]. They must also look after their own well-being as well as their patients’ [7], since burnout may seriously impact them, their professional entourage, and the organizational coherence of the health care system [8].

Well-being can be defined as ‘the state of feeling healthy and happy’ [9]. Beyond the narrowly medical model which focuses on disease management and symptom reduction, the wellness approach is holistic and multi-dimensional including not only physical but also emotional, social, and environmental dimensions that are interconnected and reliant on one another [10]. Integrative oncology is an expanding field that addresses multiple aspects of patient well-being and concerns the use of complementary and integrative therapies in collaboration with conventional oncology care [11]. Integrative therapies aim not only to improve symptoms and clinical outcomes but also to allow patients to experience a sense of autonomy and to feel more in control of their care by becoming a direct partner in their management.

Among the integrative interventions, mindfulness refers to a person’s tendency to remain deliberately and nonjudgmentally attentive to their own experience, thoughts and feelings [12]. Mindfulness has been described to enhance physical and mental well-being in healthy individual [13]. This approach has gained popularity, primarily through mindfulness-based stress reduction (MBSR) originally developed by Kabat-Zinn for people with cancer [14].

Recent systematic reviews in oncology demonstrated the efficacy of mindfulness-based interventions (MBI) notably in reducing stress [15, 16], anxiety and depression [16–18], and in improving quality of life [15, 18], mindfulness skills [19], and coping skills [20, 21]. The American Society of Clinical Oncology and the Society for Integrative Oncology have recently collaborated to develop guidelines for the management of anxiety and depression in patients with cancer. They aim to provide oncology professionals with the knowledge and tools required to incorporate integrative therapies into cancer care. According to these guidelines, MBI have high-quality evidence and are highly recommended for people with anxiety and depression both during and after treatment [22, 23].

Regarding the potential benefits of mindfulness among health professionals, several meta-analyses have shown that MBI were effective in improving caregiver well-being [24–27], reducing work distress [25, 28]. Positive effects were also seen in self-compassion, empathy, and mindfulness [26, 27]. In response to the pressing need for healthcare organisations to prioritise the well-being of professionals and reduce burnout in oncology, the European Society for Medical Oncology (ESMO) Resilience Task Force (RTF) was established in 2019 to help individuals and institutions to maintain the delivery of optimal cancer care. It recently provided recommendations in which mindfulness is considered pertinent for the effective management of well-being at both at the personal and institutional level [29]. In addition, literature reports an enhancement in the well-being of health professionals through MBI, resulting in an improvement in the quality of care provided [30–32]. These observations may translate into better performance [24] and quality of communication with their patients [32].

Suffering is a shared experience, whether one is a health professional, a patient, or a third person. One may assume that professionals, patients and others could act collaboratively to improve wellness within and around them. We postulate that meditation in an open setting that associates cancer patients (target population), health professionals and third persons (‘non-patient’ and ‘non-caregiving’ subject) would provide added value. For example, Santorelli proposed conducting MBI targeting patients and health professionals together, based on the mutuality of healing relationship [33]. However, their effects have not yet been evaluated. While most interventions in oncology in the past focused on patients, the effects of meditation on patients and their relatives are receiving greater attention [34–36]. A dyadic mindful compassion program was shown to be more likely to reduce lung cancer patients’ depression than a patient-only programme [36]. In addition, a recent systematic review underlined the need to further our understanding of the health-related effects of dyadic interventions [35].

Our hypothesis, as yet unexplored, was that beyond interventions dedicated to patients alone, additional benefits might be obtained by conducting joint meditation workshops combining (1) oncology patients as the target population, (2) health professionals, to improve patient-physician understanding and communication, and (3) third persons, in order to break out of the context of the disease. The involvement of third persons might help in destigmatizing the patient as a patient and the hospital as a place of care. In the context of this project, a third party was any person, neither a health professional nor a cancer patient, who was willing to participate.

We first conducted a pilot study [37] which confirmed the relevance of such ‘shared meditation’ with a specifically designed programme and demonstrated an improvement of well-being [38]. In the present study, we designed and implemented a randomised trial to assess the added value of the programme, particularly for people with cancer randomised to follow it in mixed groups (experimental arm) or in groups with patients only (control arm) [39]. The primary outcome was the feeling of self-efficacy. Secondary outcomes included perceived stress, qualities of mindfulness and self-compassion, and perception of change in quality of life. Satisfaction and adhesion to the programme and the putative benefit of meditating together were also assessed. We herein present the data obtained.

Methods

Study design

The IMPLIC-2 study was a two-arm single-centre randomised controlled trial targeting people with cancer (https://classic.clinicaltrials.gov/ct2/show/NCT06041607), designed to assess the potential added value of shared meditation in terms of feeling of self-efficacy as primary objective, compared to the same meditation programme delivered in workshops for patients only [39].

The study adheres to CONSORT guidelines.

Study participants

Eligibility criteria are detailed in the protocol manuscript [39]. For all participants, the main inclusion criteria were as follows: participants aged 18 or over, able to complete the programme in full, able to read, understand and speak French, and having signed the study information note. An essential parameter for inclusion was motivation to be part of a study on meditation. Those recruited had to have no present or past regular or intensive practice of meditation or comparable practice [40]. Interested participants were phoned by the clinical research nurse in charge of the study to check their eligibility and their willingness to commit to the project. With regard to the specific criteria for each category of participants, people with cancer had to be in a state of health compatible with attending the sessions. Concerning the medical staff, any medical and/or paramedical staff involved in the management of patients were eligible. Any person not belonging to the above-mentioned categories was eligible as a third person, including non-medical staff at Centre François Baclesse, and people from outside the centre, irrespective of whether they were relatives of the patient.

Main exclusion criteria were the presence of a major neurological or psychiatric disorder (including an addiction to alcohol or drugs) and inability for a participant to undergo trial follow-up for geographical, social or psychopathological reasons. Causes for non-participation were considered with flexibly, with the participant’s willingness to engage remaining a determining criterion.

Randomisation

Participants with signed informed consent were enrolled. Patients were 1:1 randomised, with stratification on age (< 55 years vs. ≥55 years) and biological gender, to be assigned to one of the two arms. The allocation sequence was generated using a computerized minimization algorithm based on predefined stratification variables. Allocation was implemented centrally by a secure electronic system. The same meditation programme was delivered to groups of 16 participants each, involving 8 patients, 4 health professionals, and 4 third persons in the experimental arm, and 16 patients in the control arm. It was delivered outside the hospital (Pôle des Formations et de Recherche en Santé of Caen University, France) to participants in the experimental arm, and at the hospital (Comprehensive Cancer Centre François Baclesse) to patients in the control arm. The study was reported in accordance with the CONSORT guidelines (see CONSORT checklist, Supplementary file S1).

Mindfulness intervention

The programme, based on mindfulness and compassion, was designed and implemented by an expert in meditation, who optimised it following the pilot study [38]. The revised programme, which was validated by two patients, consisted for all participants of 12 weekly 2 h-sessions (with a 2-week break after the eighth session to allow participants to experiment meditation in autonomy). To promote its sustainability, three monthly 2 h-sessions of follow-up in remote format were added to the initial programme. Two half-day retreats took place, one between the ninth and the tenth weekly sessions and a final one at the very end of the programme (after the last remote monthly session). Finally, a focus group session was organised in the experimental arm in the days following the last retreat. Details of the programme concerning its structure and the themes covered during the weekly sessions and retreats are specified in the protocol manuscript [39].

Participants were asked to complete daily practice exercises and meditation sessions at home. Written materials designed for this purpose were provided to support them. Finally, if necessary, individual follow-up was offered outside of the sessions.

Study endpoints

The primary endpoint was the change, from baseline to the end of the meditation programme, in patients’ sense of self-efficacy on the Generalized Self-Efficacy Scale (GSES, score between 10 and 40), which assesses the ability to respond effectively to the demands and challenges of everyday life.

The secondary endpoints were the scores obtained on validated questionnaires (Perceived Stress Scale (PSS), Self-Compassion Scale (SCS)) measured at baseline and at the end of the programme in all randomised patients. The Freiburg Mindfulness Inventory (FMI) was administered in all participants at baseline and after the programme. Scales measuring the benefit of shared meditation were assessed in all participants in the experimental arm at baseline and at the end of the intervention. Three questions assessed the potential value of shared meditation in patients in the shared meditation arm after the programme. Perception of change in quality of life, satisfaction and adherence were evaluated in the total population after the programme.

Study assessment

Table 1 shows the assessments and their timing which are fully described in the protocol [39].

Table 1.

Questionnaires and scales used to assess meditation programme

	Baseline	After the 12 weekly sessions of meditation	Assessment procedures
Generalized Self-Efficacy Scale (GSES)	x	x	In all patients a
Perceived Stress Scale (PSS)	x	x	In all patients a
Self-compassion Scale (SCS)	x	x	In all patients a
Freiburg Mindfulness Inventory (FMI)	x	x	In patients, health professionals and third partiesb
Perception of a change in quality of life (-5 to + 5 scale)		x	In patients, health professionals and third partiesb
Assessment of the potential value of shared meditation: • Benefit of shared meditation (-5 to + 5 scale) • In-house questionnaire (3 questions)	x	X x	In patients, health professional and third partiesb(baseline) and in participants of the shared meditation arm (post-intervention) In patients of the shared meditation arm c
Satisfaction questionnaire		x	In patients, health professional and third partiesb
Adherence to the meditation programme		x	In patients, health professional and third partiesb

^a In all patients (randomised target population): shared meditation (n = 33) versus patient meditation (n = 32)

^b In the total population: patients (n = 65), health professionals (n = 17), third parties (n = 15)

^c In patients of the shared meditation arm (n = 33)

Participants’ sense of self-efficacy, stress, and quality of life

A self-report measure was used to assess generalized self-efficacy, i.e. general beliefs in one’s ability to respond to novel or difficult situations and to deal with any associated obstacles or setbacks (GSES [41]). The degree to which situations in one’s life were considered stressful was measured using the 10-item PSS [42]. The PSS comprises two subscales: the perceived helplessness and the perceived self-efficacy scale. This latter subscale highlights self-efficacy in a complementary way to the GSES. Participants’ perception of a change in their overall quality of life at the end of the programme was measured on a -5 (significant deterioration) to + 5 scale (considerable improvement), as retrospective assessments may be proven to be more sensitive [43].

Mindfulness and self-compassion

The brief self-report 14-item version of the FMI assessed participants’ aptitude for mindfulness in daily life [44]. Self-compassion was assessed with the SCS [45], which consists of 26 items containing three positive dimensions (self-kindness, common humanity and mindfulness) and three negative dimensions (isolation, mindfulness and over-identification). All items are assessed using a five-point Likert scale ranging from 1 (almost never) to 5 (almost always). Subscale scores of the six subdimensions were computed by calculating the mean of subscale item responses. Separate scores were used rather than the SCS total score as the employment of the total score could mask the true effects of self-compassion [46].

The potential value of shared meditation

In-house questionnaires specifically designed to shed light on the potential value of shared meditation (Supplementary file S2) were administered using an Osgood semantic differentiation scale. Participants were asked to rate their opinion on how they assessed the possible effects of meditating together between two antonymous poles: ‘extremely beneficial’ to ‘extremely harmful’, before the intervention for all participants (a priori) and after for those in the experimental arm. In addition, three 4-point Likert scales (from ‘totally disagree’ to ‘totally agree’) were proposed to patients to integrate their experience of shared mediation and their recommendations, with regard to the other two categories of participants (health professionals or third persons). The questions related to (1) the personal benefits of shared meditation, (2) whether they would recommend it, and (3) whether they considered it to be sustainable.

Participant satisfaction and adherence

Tools for assessing satisfaction and adherence were specifically developed for this study (Supplementary file S2).

The overall degree of satisfaction of participants was assessed on a visual scale ranging from 0 (not satisfied at all) to 10 (totally satisfied). Satisfaction was also measured at the end of the 12 weekly sessions by an in-house questionnaire that probed the schedule of the programme, its content, and the teaching method used, as well as the quality of the relationship with the meditation instructor and interaction with participants. Participants were asked if the programme had modified their habits and/or behaviours on a 4-point Likert scale from ‘no, not at all’ to ‘yes, totally’. They were considered adherent when they attended at least 80% of the 13 sessions, i.e. 12 weekly sessions and one half-day retreat.

Statistical considerations

For patient sample size calculation, we assumed the added value of shared meditation (vs. patient-only) to be relevant if it led to a pre/post-intervention improvement of ≥ 5% (1.5 points) on the GSES (scale 10–40), a threshold described as clinically meaningful and selected for its relevance and sensitivity in the pilot study [38]. To detect a between-arm difference of ≥ 1.5 points (SD = 2) with 80% power and a two-sided alpha of 5%, at least 58 assessable patients were required. To anticipate around 10% attrition, 64 patients (32 per arm) were planned to be included and randomised: four groups of 8 patients, 4 health professionals and 4 third parties each (experimental arm), and two groups of 16 patients each (control arm). Baseline characteristics and questionnaire scores throughout follow-up were described using means, standard deviations, medians, and ranges for quantitative variables, and frequencies and percentages for qualitative ones. Between-arm comparisons, including baseline characteristics, were performed using Student’s t-test or the Wilcoxon-Mann-Whitney test for quantitative data, and the Chi² or Fisher’s exact test for qualitative data. Participants were considered evaluable if they completed at least one meditation session. To assess the main objective, changes in GSES scores from baseline to the end of the programme were compared between arms using Student’s t-test. A mixed linear model with arm × time interaction adjusted on potential confounders (e.g., age, sex) was used to estimate the added value of shared meditation.

Ethical approval

This trial was approved by the local ethics committee (Comité de Protection des Personnes: Committee for the Protection of Persons, Data Privacy Committee Nord-Ouest III, France, ref CPP 2023-50) in September 2023. It was registered as ClinicalTrials.gov ID: NCT06041607. All participants gave their written informed consent before any study-related assessment. They could withdraw their consent at any time. The study was conducted according to good clinical practice guidelines and the ethical principles of the Declaration of Helsinki [47].

Results

A total of 98 participants (66 patients, 17 health professionals, 15 third persons) were enrolled in the study over January 2024 (Fig. 1). Among 66 randomised patients, one withdrew from the study, resulting in 65 patients who began the meditation programme.

Fig. 1.

Study design flowchart

Participant characteristics

Characteristics of participating patients are described in Table 2. The 65 patients (our target population) were mostly women (95%) and most were likely to have executives with higher intellectual professions (32%) or employees (37%). Mean age was 58 years, and breast was the predominant cancer location (86%). Patients were mainly married or cohabiting (55%) and urban-dwelling (48%). Briefly, the other two categories of participants were also predominantly women (over 87%), with health professionals (mean age 46) being slightly younger than third persons (mean age 57) and patients. There was no difference in sociodemographic characteristics between the three categories of participants.

Table 2.

Sociodemographic and clinical characteristics of patients (N = 65)

	Shared meditation arm (N = 33)	Patient meditation arm (N = 32)	P	Total (N = 65)
Age - Mean (sd)	56.1 (11.2)	60.8 (11.2)	0.089	58.4 (11.4)
Sex - N (%)
Male	2 (6.1%)	1 (3.1%)	1	3 (4.6%)
Female	31 (93.9%)	31 (96.9%)		62 (95.4%)
Tumour localization - N (%)
ENT (Ear, nose, throat)	1 (3.0%)	0	0.3	1 (1.5%)
Stomach	1 (3.0%)	0		1 (1.5%)
Colon and rectum	0	2 (6.2%)		2 (3.1%)
Breast	27 (81.8%)	29 (90.6%)		56 (86.2%)
Prostate	1 (3.0%)	0		1 (1.5%)
Others	3 (9.1%)	1 (3.1%)		4 (6.2%)
Marital status - N (%)
Single	7 (21.2%)	5 (15.6%)	0.757	12 (18.5%)
Married / Cohabiting	19 (57.6%)	17 (53.1%)		36 (55.4%)
Divorced	5 (15.2%)	9 (28.1%)		14 (21.5%)
Widow(er)	1 (3.0%)	1 (3.1%)		2 (3.1%)
Missing	1 (3.0%)	0		1 (1.5%)
Place of abode - N (%)
Rural	7 (21.2%)	5 (15.6%)	0.194	12 (18.5%)
Semi-rural	7 (21.2%)	14 (43.8%)		21 (32.3%)
Urban	18 (54.5%)	13 (40.6%)		31 (47.7%)
Missing	1 (3.0%)	0		1 (1.5%)
Last profession - N (%)
Farmers	1 (3.1%)	0	0.564	1 (1.6%)
Craftsmen	2 (6.2%)	2 (6.5%)		4 (6.3%)
Executives and higher intellectual profession	9 (28.1%)	11 (35.5%)		20 (31.7%)
Employees	11 (34.4%)	12 (38.7%)		23 (36.5%)
Intermediate occupation	4 (12.5%)	5 (16.1%)		9 (14.3%)
Other persons not in employment	5 (15.6%)	1 (3.2%)		6 (9.5%)
Missing	1 (3.0%)	1 (3.1%)		2 (3.1%)

P-values were calculated using Student’s t-test or Wilcoxon–Mann–Whitney test for continuous variables, depending on their distribution, and Chi-square or Fisher’s exact test for categorical variables, as appropriate

Effect of programme on life management

Sense of self-efficacy of patients measured using the GSES was significantly increased after the meditation programme, with a mean score of 29.4 (5.7) at baseline increasing to 33.5 (4.7) (p < 0.001) in the ‘Shared’ meditation arm, and from 28.4 (5.3) to 31.3 (5.3) (p < 0.001) in the ‘Patient’ meditation arm (Table 3; Fig. 2). This additional improvement in each arm showed no significant added value in the ‘Shared’ meditation arm compared to the ‘Patient’ meditation arm (4.0 (4.17) vs. 2.99 (4.12), p = 0.346). GSES score modelling according to confusion factors showed that the slopes from baseline to the end of the programme did not differ between the arms (beta for interaction − 1.1, p = 0.30).

Table 3.

Pre- and post-intervention exploratory outcome measures of patients according to randomisation arm

	Scale range	Shared meditation arm (n = 33)				Patient meditation arm (n = 32)
		Baseline mean (sd)	Post-test mean (sd)	Effect sizes a	P	Baseline mean (sd)	Post-test mean (sd)	Effect sizes a	P
Sense of self-efficacy (GSES)	10–40	29.4 (5.7)	33.5 (4.7)	0.78	< 0.001	28.4 (5.3)	31.3 (5.3)	0.64	< 0.001
Total score perceived stress (PSS) Helplessness Self-efficacy	0–40 0–24 0–16	23.3 (3.9) 14.1 (4.7) 9.3 (1.4)	21.3 (3) 9.4 (3.9) 10.4 (1.2)	0.51 0.76 0.52	0.006 < 0.001 0.005	23 (3.9) 12.8 (5) 10.1 (1.6)	21.7 (3.7) 9.7 (5) 10.6 (1.2)	0.28 0.41 0.26	0.003 < 0.001 0.15
Freiburg Mindfulness Inventory (FMI)	14–56	33.5 (6.5)	41.4 (5)	0.59	< 0.001	35.4 (5.5)	40.9 (5.6)	0.43	< 0.001
Self-compassion (SCS)
Self-Kindness	1–5	2.8 (0.9)	3.6 (0.8)	0.45	< 0.001	2.9 (0.9)	3.4 (0.9)	0.63	0.001
Self-Judgment	1–5	2.9 (0.4)	2.9 (0.4)	0.06	0.75	3.1 (0.4)	3 (0.4)	0.15	0.42
Common Humanity	1–5	3 (0.8)	3.5 (0.6)	0.26	0.005	3.1 (1)	3.4 (1)	0.5	0.007
Isolation	1–5	3 (0.6)	2.7 (0.4)	0.44	0.015	3 (0.7)	2.8 (0.8)	0.11	0.54
Mindfulness	1–5	2.8 (0.6)	3.5 (0.6)	0.45	< 0.001	3.1 (0.9)	3.5 (0.8)	0.61	0.001
Over-identificationb	1–5	3 (0.5)	3 (0.4)	0.08	0.65	2.7 (0.4)	2.9 (0.5)	0.31	0.09

^a Effect sizes (r) are reported for continuous variables in within-arm comparisons. When the Wilcoxon signed-rank test was used, effect sizes were computed as the ratio of the Z test statistic to the square root of the number of paired observations (), ranging from 0 to 1, with higher values indicating larger effects. When the paired t-test was used, Cohen’s d for paired samples was first calculated as the mean difference divided by the standard deviation of the differences, and then transformed into r using the formulato ensure comparability across tests

^b Significant baseline difference between both arms

Fig. 2.

Patients’ scores for sense of self-efficacy and perceived stress questionnaires (N = 65)

Effect of programme on perceived stress (Table 3)

A significant reduction in perceived stress was observed in the patient population following the programme, with a mean score decreasing from 23.3 (3.9) at baseline to 21.3 (3) (p = 0.006) in the ‘Shared’ meditation arm, and from 23 (3.9) to 21.7 (3.7) (p = 0.003) in the ‘Patient’ meditation arm (Fig. 2). Mean scores on the perceived helplessness subscale decreased significantly from 14.1 (4.7) at baseline to 9.4 (3.9) (p < 0.001) in the ‘Shared’ meditation arm, and from 12.8 (5) to 9.7 (5) (p < 0.001) in the ‘Patient’ meditation arm. Concerning the self-efficacy subscale of the PSS, mean scores were significantly increased in the ‘Shared’ meditation arm after the programme (from 9.3 (1.4) to 10.4 (1.2), p = 0.005) but failed to be significantly increased in the ‘Patient’ meditation arm (10.1 (1.6) to 10.6 (1.2), p = 0.15).

Effect of programme on self-compassion and mindfulness

Concerning self-compassion, subscale scores of self-kindness, common humanity, and mindfulness were significantly improved after the programme in both arms (Table 3; Fig. 3). In addition, a significant improvement on the isolation subscale score was observed in the ‘Shared’ meditation arm (from 3 (0.6) to 2.07 (0.4), p = 0.015) but not in the ‘Patient’ meditation arm (from 3 (0.7) to 2.8 (0.8), p = 0.54). Mindfulness quality scores were significantly improved in all participants after the programme as compared to baseline: mean FMI score from 34.5 (6.1) to 41.2 (5.3) in patients from both arms (p < 0.001); from 32.4 (7.0) to 41.7 (6.3) in health professionals (p = 0.001); from 33.8 (6.6) to 38.4 (6.2) in third persons (p = 0.028). However, no difference was observed in patients between the experimental (33.5 (6.5) to 41.4 (5), p < 0.001) and control (35.4 (5.5) to 40.9 (5.6), p < 0.001) arms.

Fig. 3.

Patients’ scores for the different dimensions of self-compassion questionnaire (N = 65)

Participants’ adherence and satisfaction, feelings about ‘shared meditation’, and quality of life

The adherence rate showed no statistical difference between the types of participants, with rates slightly higher in health professionals (82%) than in patients (77%) or third persons (67%). Among patients, the mean number of sessions attended out of 13 was similar between both arms: 10.3 (2.1) and 10.7 (2.0) in the ‘Shared’ and ‘Patient’ meditation arms, respectively. Daily meditation exercises at home were partially and fully completed by 90.9% and 6.1% of patients, respectively, in the ‘Shared’ meditation arm versus 96.9 and 0% in the ‘Patient’ meditation arm.

The degree of overall satisfaction with the programme and its organization was high in all three categories of participants: mean score of 9.1 (1) for patients in both arms, 9.4 (0.7) for health professionals, and 9.2 (1) for third persons. On average, positive satisfaction scores were reported by the participants on all components of the programme (Fig. 4). Specifically, most participants were satisfied or very satisfied with the teacher’s manner (97%), message clarity (97%), richness of interaction (92%), pedagogical methods (94%), programme duration (85%), session schedule (98%), session length (98%), and session time (91%). On average, satisfaction ratings on all components were slightly higher in patients and in health professionals and slightly lower in third persons (Fig. 4). All participants reported that the programme had changed their habits and/or behaviours, except one participant in each category.

Fig. 4.

Participants’ satisfaction per component. Each component of satisfaction was rated on a 5-point Likert scale from − 2 (very dissatisfied) to + 2 (very satisfied). Radar charts display for each component the average satisfaction of patients in the total sample (left panel) and across the two groups (right panel). The zero line divides the scale from dissatisfaction to satisfaction. The closer the point to the centre of the axis, the greater the dissatisfaction; the closer the point to the end of the axis, the greater the satisfaction

Regarding the participants’ global opinion on ‘shared’ meditation, a very positive attitude towards shared meditation was expressed with mean scores all above 3.4 on a scale ranging from − 5 (‘very harmful’) to 5 points (‘very beneficial’). When all participants were asked about their a priori opinion of shared meditation, the average scores obtained were 3.4 (1.1), 3.5 (1.3), and 3.6 (1.3) in patients, health professionals, and third parties, respectively. In people who had experienced shared meditation, the mean scores measured after the programme were slightly higher: 3.7 (1.3), 4.3 (1), 4.1 (0.9) in patients, health professionals, and third parties, respectively, reaching statistical significance for third persons (p = 0.014). No participant felt it had been even minimally harmful.

We also explored the specific feelings of patients in the experimental arm about the added value of shared meditation at the end of the intervention by asking three questions related to personal benefits, recommendations and the sustainability of meditation and compared their point of view (‘agree or totally agree’) with that of the two other categories of participants. For these patients, sharing meditation with healthcare professionals had proved beneficial on a personal level (90%), and was an activity that they would recommend (97%) and would like to be continued (90%). Sharing meditation with third parties was also felt to be positive, with 97% finding it personally beneficial, 100% recommending it, and 90% wishing it to continue.

At the end of the programme, the median score (scale from − 5 to + 5) of participants’ perception of change as an improvement in their overall health and quality of life was 3.4 (1.1), 3.2 (1.7), and 2.9 (1.4) for patients, health professionals and third persons, respectively. There was no negative rating in patients, indicating no worsening of their quality of life.

Discussion

This randomised study tested the potential added value for people with cancer of shared meditation between patients, health professionals, and third parties compared with meditation offered only to patients. Our primary hypothesis that shared meditation could improve self-efficacy to a greater extent than patient meditation was not confirmed. Sense of self-efficacy (measured by GSES as primary endpoint), perceived stress, and mindfulness qualities were significantly improved from baseline in all patients, whatever the modality of meditation. This was also the case for certain dimensions of the self-compassion scale, namely self-kindness, sense of common humanity, and mindfulness. Interestingly, patients who participated in shared meditation had a statistically significant improvement in self-efficacy (measured by the PSS subscale as secondary endpoint) and a reduction in feelings of isolation, unlike those in the control arm. Shared meditation was greatly appreciated, as evidenced by adherence to the programme and satisfaction ratings. Participants expressed positive feelings about ‘shared meditation’ and reported an improvement in their quality of life.

The originality of the project was to posit the added value for patients with cancer of meditating in groups including third persons. It was relevant to assess self-efficacy, as it proved sensitive in the pilot study [38] and enabled coping skills to be assessed. This main criterion (measured with the GSES) was improved in both arms, with no between-arm difference, not in line with our hypothesis which put forward the superiority of shared meditation over patient-only meditation. This improvement of self-efficacy following meditation practice is consistent with recent reviews showing that MBI can promote coping and enhance perceived self-efficacy in people with cancer [20, 21]. We also assessed self-efficacy as a secondary outcome using the PSS subscale, as this subscale has demonstrated satisfactory psychometric properties among people with cancer [48]. These secondary findings also highlighted a significant improvement in the feeling of self-efficacy with shared meditation, surprisingly not observed with meditation practised between patients. There is no clear evidence to explain this discrepancy, in the absence of data on the comparison of these two ways of assessing self-efficacy, that however slightly differ in their approach [49].

In addition to the physical and emotional aspects of well-being, mindfulness has been shown to provide patients with autonomy and empower them to take control of their care [50]. There is evidence that many cancer patients are able to adapt to and cope with highly stressful situations [51], and that seeking social support and making use of resources such as coping strategies may be effective for dealing with these types of events and improving well-being [52, 53]. The simultaneous reduction in stress and improvement in the feeling of self-efficacy that we observed following the mindfulness intervention may allow patients to better perceive their own perspective of themselves in a given situation and thus to better focus on their objectives. Similarly, recent meta-analyses reported better quality of life and lower stress following MBI in cancer patients [15, 18].

Also linked to a greater emotional resilience and psychological well-being is the relatively new multifaceted construct of self-compassion [54]. A meta-analysis of 60 studies found a positive association between self-efficacy and self-compassion with clinical interventions that cultivate self-compassion, leading to a greater sense of self-efficacy [55]. As Neff puts it, although beginning by ‘self’, self-compassion is a way of reducing the felt separation between people [54], which is an integral part of our meditation programme. Our data show that self-kindness, mindfulness, and sense of common humanity, i.e. three components of self-compassion, were significantly improved in all patients and in both meditation modalities. The improvement in mindfulness following the programme was confirmed in all patients by the FMI, a dedicated questionnaire. Interestingly, the feeling of isolation was significantly reduced at the end of the intervention for patients in the mixed arm but not in the patient-only arm. People feel more isolated when they have the impression that they are the only ones suffering [54]. Yet all humans suffer, since we are all mortal, vulnerable and imperfect. Therefore, self-compassion involves recognizing that suffering and personal inadequacy is part of the shared human experience – something that we all go through rather than being something that happens to ‘me’ alone [54]. We feel less isolated and alone, and even if the circumstances are different, the experience of vulnerability is shared [56]. It is likely that experiencing interdependence in mixed groups helped to reinforce a sense of common humanity and mitigate the feelings of isolation, which is all the more important as social isolation is a known risk factor for moderate to severe distress [57]. Anxiety is likely to be reduced when the health professionals and the cared-for find themselves on common ground. Sharing this mutual vulnerability could promote interactive health care for mutual benefit.

Integrative approaches in oncology such as mindfulness are patient-centred and aim to improve overall well-being [22, 57]. To this end, they must consider patients in relation to their environment, cultivate interconnection, and enhance the culture of wellness in all its dimensions [50]. The literature shows that mindfulness can be widely applied in healthcare professionals, boosting healthcare professionals’ well-being and improving the quality of care provided [30, 31]. Mindfulness and compassion are closely interrelated, and self-compassion is therefore an important skill to develop in health professionals, as it can be seen as a first step in promoting a culture of compassion towards patients [30]. In this respect, mindfulness was improved in all participants in our study including health professionals, as were various dimensions of self-compassion not only in patients but also in health professionals (including self-kindness, mindfulness, and sense of common humanity, data not shown). Beyond their personal well-being, the improved quality of life observed among health professionals is a further argument for the benefits of their presence, as there is a strong association between improved well-being in caregivers and their ability to care for patients [58]. Regarding the third parties, they reported improved mindfulness skills and a perception of a change in their quality of life. As for the patients, they were particularly enthusiastic about the programme and the fact that both health professionals and third persons were prepared to meditate together with them. This was verified by the results of our in-house questionnaire demonstrating very positive attitudes towards shared meditation whatever the type of participants, whether before the programme was delivered in this form, or afterwards, for those who had experienced it. All participants greatly appreciated the programme, whatever the arm, as demonstrated by the high adherence and satisfaction rate. In this quantitative study, we used validated tools where possible so that we could compare our findings with those in the literature. However, regarding the potential added value for patients of including third parties, we realised that a questionnaire might not fully capture patients’ experience and feelings.

For this reason, we also set up a qualitative focus group [59, 60] to establish the key determinants of the effects of shared meditation, especially for patients. Their remarks clearly indicated that the sharing of meditation enabled them to experience direct contact with others, be they the professionals or third parties. This shows how the heterogeneity of the group facilitates interconnection, creates an atmosphere that promotes social support, and benefits the process of coping with cancer [61]. Overall, our quantitative data also showed that the vast majority of patients who experienced shared meditation found it beneficial on a personal level, would recommend it, and would like it to continue.

We now aim to transfer these findings to clinical practice in an active implementation phase [62] with a view to disseminating the approach. The data obtained will make it possible (1) to make a detailed description of the programme specifying its key features and how it may be replicated, (2) to describe the necessary steps for its implementation and how the participants may be recruited, and (3) to design a training programme for instructors capable of conducting the programme and training others in its methodology with a view to wider dissemination to other care establishments, so that it may be incorporated into the care pathway.

This randomised study has some limitations. First, we compared the effects of shared meditation with those of meditation between patients alone, in a context where there are no validated tools to answer this question specifically, so it is difficult to demonstrate unequivocally the added value of shared meditation. Thus, as analyses were considered across several outcomes and subscales in an exploratory intent, no adjustment for multiple comparisons was applied which may increase the risk of type I error. Second, our population was ‘self-selected’ and mainly comprised women from a privileged socio-professional background, so the results cannot be generalized. Third, it sometimes proved complicated for healthcare professionals (especially non-doctors) to attend the sessions, which underlines the importance of providing time for training without hindering the smooth running of the hospital’s workflow.

Conclusion

This mindfulness-based intervention was greatly appreciated by all the participants, who reported the acquisition of mindfulness skills and a perception of improvement in their quality of life. All of them were enthusiastic about the concept of shared meditation. The programme had a positive effect on patients’ stress. Beyond its effects on the personal, emotional and psychological components, it improved their self-efficacy (GSES), which are related to coping skills and certain dimensions of self-compassion. We did not demonstrate superiority of the shared meditation using sense of self-efficacy (measured with the GSES) as primary outcome. Nevertheless, in secondary findings, shared meditation specifically improved self-efficacy (measured with the PSS) and also reduced the feeling of isolation, whereas no similar observations were found with patient-only meditation.

Relevance to clinical practice

Shared meditation is useful for patients with cancer because it helps them to better cope with cancer and to break out of the context of illness, with the understanding that suffering is part of shared human experience.

Abbreviations

FMI

Freiburg Mindfulness Inventory

GSES

Generalized Efficacy Scale

MBI

Mindfulness-Based Interventions

MBSR

Mindfulness-Based Stress Reduction

PSS

Perceived Stress Scale

SCC

Self-compassion scale

Authors’ contributions

VP, BC, AL and TT devised the study concept and design. TT constructed the mindfulness programme and conducted the sessions. FC, AL, and BC were responsible for methodological and statistical management. The statistics were checked prior to submission by an expert statistician (FC). VP, BC and FC wrote the manuscript. All authors (VP, FC, AL, MF, CS, TT, BC) were involved in drafting the manuscript or revising it critically for important intellectual content. VP and BC supervised the entire work. Each author participated sufficiently in the work to take public responsibility for appropriate portions of the content. All co-authors reviewed and approved the manuscript prior to submission.

Funding

This study was supported by grants from the Ruban Rose Association (Prix Ruban Rose “Qualité de vie”). The funding association was not involved in the design or conduct of the study, nor in the collection, management, analysis, or interpretation of the data. It was not involved in drafting the manuscript.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The local ethics committee (Comité de Protection des Personnes: Committee for the Protection of Persons, Data Privacy Committee Nord-Ouest III, France, ref CPP 2023-50) approved the study protocol in September 2023. It was registered at the US National Institutes of Health (ClinicalTrials.gov ID: NCT06041607) on on 09/18/2023. All participants gave their written informed consent before any study-related assessment.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

All study procedures were conducted according to relevant guidelines and applicable regulations.