Table 1.

MODEL Care Intervention Summary.^a

	Session Theme	Mindfulness Practices	Didactics	Home Practice
1	Awareness: Meeting ourselves where we are in honesty and kindness	Mindful eating (raisin exercise) Body scan (focusing on awareness of breath and body sensations)	Course introduction and guidelines. Defining mindfulness as being present for our lives just as they are. Mindfulness as a means for enhancing connection with those we love, identifying what is important to us, and enabling us to choose to proceed from personal values rather than emotional reactions. Introduction of interpersonal mindful dialogue skills, including listening attentively with curiosity and non-judgment, without needing to give advice or comment on others’ sharing.	Body scan daily Eat one meal mindfully Mindfulness of one daily activity
2	Perception and creative responding: Struggle against “life as it is” as a source of suffering; wholeness no matter what’s here	Body scan Introduction of gentle hatha yoga stretching Awareness of breath (AOB) sitting meditation	Role of perception, habit-driven conditioning, and other mental factors in the self-appraisal of stress. Recognizing with kindness, struggle as it is reflected in the body. Use of mindfulness to enhance comfort in living with elements of life that are difficult or challenging, incorporating compassion and non-judgment.	Alternate body scan and yoga daily Sit 10 min daily with AOB Arriving for rest: short body scan prior to sleep Keep calendar of one pleasant event each day and how it is reflected in mind and body.
3	Relational presence: Mindfulness in dialogue with the body as a place to learn; offer hospitality to one’s experience	Sitting meditation Yoga practice Mindful dialogue	Physiological and psychological bases of stress reactivity are reviewed along with relevant mindfulness research. Guidelines for mindful dialogue are introduced in greater depth and practiced: Pause, Relax, Open-Allow. Compassion as both attitude and behavior relating to self and others is highlighted as integral to and an outcome of practice.	Sitting meditation, yoga, or body scan daily Keep daily Reactivity-Responsivity Calendar as relates to communication
4	Mindful dialogue: Cultivating compassion & responsiveness in speech and action; communication on ACP as empowerment	Sitting meditation Yoga practice Mindful dialogue Lovingkindness practice	Expansion of mindful speaking and listening guidelines allowing previously learned mindfulness practices to support patients and their family caregivers in non-habitual, non-reactive communication. Mindful dialogue about present moment challenges related to 1) being with change and uncertainty, and 2) discussing goals of care with healthcare providers and family members. Participants invited to open dialogue about what they value. Participants are provided information about ACP, including the POST form52 and palliative care programs in the area.	Sitting meditation, yoga, body scan, or lovingkindness practice Read ASCO Advanced Care Planning booklet77 and review POST form together in mindful dialogue.
5	Mindful dialogue associated with challenging thoughts and feelings: Meeting with practice what impedes open communication	Sitting meditation Yoga practice Mindful dialogue Lovingkindness practice	Using mindful dialogue guidelines, deeper discussion of ACP as an ongoing process shared by patients, their family members, and oncology providers grounded in the patient’s values and preferences for goals of care. Benefits of making timely decisions about desired scope of treatment are highlighted, as well as consideration of surrogate decision-makers. ACP tools, including the POST form, are further reviewed as a means of facilitating individual choices. This dialogue honors the wide variance of beliefs and values in the room within the themes of the shared human experience of coping with the unpredictable nature of life’s changes and the preciousness of life.	Sitting meditation, yoga, or body scan with recorded guidance or self-guidance daily. Practicing mindful dialogue guidelines in everyday life. Consider how to support ongoing practice and mindful dialogue after the class.
6	The rest of your life: Making the practice your own	Body scan Yoga Sitting meditation Lovingkindness practice	Emphasis on the growing capacity of all participants to adapt more easily and effectively to everyday challenges and stressors, particularly those associated with advanced cancer. Taking a mindful, open, conscious, and responsive—rather than reactive—approach is emphasized. Utilizing mindful communication skills, inviting each patient and family caregiver to share what has been learned in practice and any lingering questions concerning process and decisions about care preferences. Invitation for patients to continue discussing care preferences with oncology team and sign POST form at next appointment with oncologist if ready to do so. Review of core mindfulness skills and sharing of resources to support mindfulness practice after the class concludes.	Mindfulness resources handout

Abbreviations: ACP, advance care planning; ASCO, American Society of Clinical Oncology; POST, Physician Orders for Scope of Treatment.

^aAll sessions were two hours and included provision of compact discs with audio recordings of guided meditations of body scan, sitting meditation, gentle hatha yoga, and lovingkindness meditation practices created by the facilitator for home practice.