Evaluation of a Five-Minute Meditation Intervention During Weekly Palliative Care Clinical Rounds

Abstract

Introduction:

Palliative care professionals experience high levels stress and burnout. Meditation improves stress and well-being, with group interventions more promising than individual-level efforts. This study assessed participation, satisfaction, helpfulness, and integration of a five-minute group meditation during weekly educational rounds.

Methods:

Seventy clinicians were invited to complete an anonymous Qualtrics survey assessing study variables. Responses were analyzed using variations of t-tests, ANOVAs, chi-squared tests, and regression analyses in IBM SPSS (Version 23).

Results:

Twenty-three clinicians (59%) reported participation in meditation during rounds, with no significant differences by gender or years worked. Twenty-one respondents also engaged in meditation at least weekly outside of rounds (54%), averaging 53 minutes (n = 21) a week, and doing so mostly after work hours (n = 18, 72%). Participation was associated with perceived stress reduction and control, and satisfaction with meditation (odds ratio: 1.46 [95% confidence interval: 1.01–2.13], p = 0.05). Clinicians in psychosocial roles showed no different engagement outside of rounds, and those less engaged did not report greater time-related barriers.

Discussion:

Most round attendants participated in the five-minute meditation, perceived it as useful, and reported use after rounds. Findings justify further research to better characterize its potential in enhancing well-being.

Introduction

Burnout is a pervasive issue in the medical field, adversely affecting health care professionals (HCPs) and patient outcomes. HCPs experiencing burnout often face depression, decreased job satisfaction, medical errors, lack of empathy, increased turnover, and substance misuse, while patients experience longer recovery times, poorer quality of care, and decreased satisfaction.^1–3 Current burnout rates are reported around 20% for providers across specialties, with no greater levels for those in end-of-life specialties.⁴ Specific to the field of palliative care, rates show consistency, around 38.7% and 38%, although Reddy and colleagues found rates of 52% for hospice and palliative medicine fellowship-trained physicians.^5–7

Factors contributing to levels of burnout may be due to administrative burden, with palliative care physicians at one institution spending 5,300 minutes annually on mandatory institutional and regulatory agency tasks.⁸ Competing family and work obligations, differences in professional opinion, lack of boundaries between work and home, inability to meet job demands, work policies, and working long hours may also contribute to a sense of burnout.^9,10

Studies evaluating burnout interventions often focus on the individual engaging in wellness activities independently to address this phenomenon, though system factors contribute to burnout for providers and should also be addressed by the system.¹¹ One study found a self-care handbook to be useful, with respondents staying active, hydrated, and eating light.¹² An acceptance and commitment therapy intervention for palliative care clinicians showed benefits in psychological flexibility and mental well-being, though it provided minimal improvements in perceived stress, burnout, and compassion satisfaction.¹³ In a meta-analysis, meditation proved effective in reducing stress for medical providers, though more support for its impact on burnout is warranted.¹⁴

Since burnout is an important area for intervention and is job-related, improving working conditions is essential for reducing its incidence. Additionally, further research is needed regarding the impact of workplace interventions for wellness, particularly in specialties such as palliative care. This study evaluated participation, satisfaction, helpfulness, and integration of a virtual, brief meditation during weekly rounds in the Palliative Care Department at MD Anderson Cancer Center.

Methods

Participants

Seventy faculty, fellows, advanced practice providers, and psychosocial team members were invited to participate in an anonymous survey in February 2024. Eligibility included the ability to respond to an online questionnaire in English. Rotating oncology fellows, adjunct or joint faculty, and nurses were excluded due to limited participation in weekly rounds. Participants were recruited via email to those meeting inclusion criteria.

Procedures

During a weekly one-hour virtual Clinical Round, a clinician presents a complex case for discussion. The rounds incorporate a “commercial break,” allowing for a five-minute prerecorded meditation or announcements. Approximately 75% of breaks feature meditations developed by an expert in meditation (A.C.), integrating Tibetan mind–body practices aimed at promoting health and well-being. Meditation has been incorporated into the weekly clinical rounds for more than five years.

The MD Anderson Cancer Center Institutional Review Board exempted the study from review. A Qualtrics survey was distributed to eligible participants via institutional email, along with a consent form outlining the study’s purpose, data use, anonymity, and lack of compensation. Reminder emails were sent weekly for three weeks.

Aims and hypotheses

The main aim was to assess participation in meditation during rounds. Secondary aims included evaluating satisfaction, helpfulness, and integration of the meditation presented at rounds into participants’ personal and professional lives.

We hypothesized that HCPs attending weekly Faculty and Fellows Rounds would engage in meditation during these sessions, and this might lead to more frequent engagement outside the sessions, with increased perceptions of reduced stress and improved sense of control.

Measures

Demographics

Demographic data included age, gender, ethnicity/race, marital status, religion, role, clinical practice percentage, years in the department, and spiritual practices.

Perception of meditation practice

A 35-item anonymous survey, developed by the researchers, collected data on perceptions of meditation, helpfulness, and integration into professional and personal lives. It incorporated aspects of the Meditation Perception Questionnaire.¹⁵ The survey is detailed in the Supplementary Appendix.

Statistical analysis

Survey responses were analyzed descriptively and inferentially, using variations of t-tests, analysis of variances, chi-squared tests, and regression analyses as appropriate. Statistical analyses were conducted using IBM SPSS Statistics (Version 23).

Results

Thirty-nine out of 70 HCPs invited to participate completed the survey (completion rate: 56%). Most were non-Hispanic (n = 30, 77%), White (n = 17, 45%), female (n = 26, 68%), in the 35- to 44-year-old age range (n = 16, 41%), married or common law (n = 31, 80%), palliative care fellows or faculty (n = 29, 74%), with 80% effort in clinical work (n = 15, 40%), working in the department for 0–5 years (n = 17, 44%), with a spiritual/religious practice (n = 31, 80%).

Twenty-three of the 39 respondents (59%) reported participation in meditation during rounds at least once a month. Twenty-one respondents also engaged in meditation at least weekly outside of rounds (54%), averaging 53 minutes (n = 21) a week, and doing so mostly after work hours (n = 18, 72%).

Monthly participation in meditation during rounds did not differ by sex or years worked in the department. Participation in weekly meditation was higher among males (p = 0.03) but not according to years worked in the department. Time in weekly meditation did not differ by sex or years worked in the department.

Reported stress reduction from meditation was associated with frequency (p = 0.01) and duration (p = 0.03) of weekly meditation, and subjective reports of usually engaging in meditation during rounds (p = 0.02). Perceived ability to reduce stress through meditation was associated with meditation engagement outside of rounds (p = 0.04) and endorsing usual engagement in meditation during rounds (p = 0.01).

Perceived sense of control over one’s own life was associated with reported frequency (p < 0.01) and time (p < 0.01) spent in weekly meditation, and when meditation was practiced (p = 0.02). Reported control over one’s own care was associated with frequency (p = 0.02) and time (p = 0.01) spent in weekly meditation, and endorsement of usual participation in meditation during rounds (p = 0.01). Associations between demographic, stress, and control variables with engagement in meditation are shown in Table 1.

Table 1.

Significant Associations Between Demographics, Stress, and Control Variables with Engagement in Meditation

Variable relationships	Statistic	p
Demographics
Sex and frequency of weekly meditation outside of rounds	4.84^a	0.03
Stress and control
Reduced stress level and frequency of weekly meditation outside of rounds	1.11^b	0.01
Reduced stress level and time in meditation outside of rounds	9.15^b	0.03
Reduced stress level and usual participation in the meditation exercises	9.97^b	0.02
Ability to reduce stress and frequency of weekly meditation outside of rounds	8.32^b	0.04
Ability to reduce stress and usual participation in the meditation exercises	10.74^b	0.01
In control of life and frequency of weekly meditation outside of rounds	17.83^b	<0.01
In control of life and time in meditation outside of rounds	17.42^b	<0.01
Control over care and frequency of weekly meditation outside of rounds	11.94^b	0.02
Control over care and time in meditation outside of rounds	13.77^b	0.01
Control over care and usual participation in the meditation exercises	14.94^b	0.01

Analysis of Variance.

Kruskal–Wallis H test.

HCPs reported an average meditation satisfaction score of 5.53 out of 10 (standard deviation: 2.03), with 74% rating their satisfaction a 5 or above. Increased participation in meditation during rounds was linked to higher odds of satisfaction (odds ratio [OR]: 1.46 [95% confidence interval, CI: 1.01–2.13], p = 0.05).

Increased participation in meditation during rounds was linked to increased odds of usefulness (OR: 1.52 [95% CI: 0.99–2.34], p = 0.057) and optimization of productivity (OR: 1.50 [95% CI: 0.99–2.26], p = 0.055) but not peace, hopefulness, or relaxation.

Subjective reports of usually participating in the meditation exercises were associated with reported usefulness (p < 0.01), peace (p = 0.01), hopefulness (p = 0.03), relaxation (p < 0.01), and perceptions of optimized productivity (p = 0.01).

Subjective reports of usually participating in the meditation exercises were linked to frequency (p = 0.01) and time spent in weekly meditation (p = 0.03).

The psychosocial professional role was not associated with differences in study variables (p > 0.05).

Increased monthly engagement and increased time in weekly meditation were not associated with higher odds of having time to practice meditation independently. However, increased frequency in weekly meditation was associated with higher odds of having time to practice independently (p = 0.03). Endorsement of participating in meditation exercises at the same time they are presented during rounds and endorsement of usually participating in meditation during rounds were not associated with having time to practice meditation on one’s own. Associations between satisfaction, benefit, implementation of meditation, and time constraint variables with engagement in meditation are depicted in Table 2.

Table 2.

Significant Associations Between Satisfaction, Benefit, Implementation of Meditation, and Time Constraints with Engagement in Meditation During Rounds

Variable relationships	Statistic	p(95% CI ifindicated)
Satisfaction and frequency of participation during rounds	1.46^b	0.05 (1.005, 2.132)
Usefulness and frequency of participation during rounds	1.52^b	0.056 (0.987, 2.336)
Optimized productivity and frequency of participation during rounds	1.450^b	0.056 (0.992, 2.258)
Usefulness and usual participation in the meditation exercises	16.08^a	<0.01
Peacefulness and usual participation in the meditation exercises	14.12^a	0.01
Hopefulness and usual participation in the meditation exercises	10.38^a	0.03
Relaxation and usual participation in the meditation exercises	16.76^a	<0.01
Optimized productivity and usual participation in the meditation exercises	14.49^a	0.01
Frequency of weekly meditation outside of rounds and usual participation in the meditation exercises	13.53^a	0.01
Time in meditation outside of rounds and usual participation in the meditation exercises	10.77^a	0.03
No time to practice meditation exercises on my own and frequency of weekly meditation outside of rounds	0.70^b	0.03 (0.506, 0.957)

Kruskal–Wallis H test.

Ordinal regression.

CI, confidence interval.

Discussion

In this study, we found that most clinical rounds attendees reported participation in the guided five-minute meditation intervention.

We found a higher weekly meditation participation rate among male clinicians. Further research in larger studies with a qualitative component might better determine the reasons for this finding.

Associations between the sense of control over one’s own life and meditation frequency and duration suggest that meditation may support personal agency and wellness among palliative care clinicians, especially those already engaging in meditation. Likewise, perceiving control over one’s care—linked to both reported frequency and time spent in meditation, as well as reported participation during clinical rounds—suggests that clinicians who prioritize self-care may feel more empowered personally and professionally.¹⁶ This is significant given the well-documented levels of burnout and stress in this population and other providers.^4–7 Promoting regular meditation may foster a greater sense of control and resilience, enhancing well-being. Our findings suggest that these interventions should be further evaluated in our department and potentially tested in a prospective clinical trial.

Associations between weekly meditation practice and various psychological outcomes, such as feelings of usefulness, peace, hopefulness, relaxation, and perceptions of optimized productivity underscore the potential value of meditation as a wellness tool for clinicians in palliative care. These findings align with the growing body of literature finding mindfulness practices effective in reducing stress and fostering emotional resilience.^17–19 Associations between meditation and feelings of peace and relaxation show relevance in palliative care, as these clinicians face emotionally challenging situations. Regular meditation may reduce emotional exhaustion while promoting mental clarity.

Barriers to meditation participation were evident, with 41% of respondents not engaging in meditation during rounds, possibly due to competing work demands.^5,8–10,20 Limited engagement underscores the need for flexible wellness initiatives that accommodate diverse needs, especially in the post-COVID-19 context. Wellness interventions could be enhanced by organizational changes such as mandated time off, incorporating mind–body skills training, stress education, and strategies clinicians can use during their day, and fostering a wellness culture.^12,15,21

Limitations of this study include the small sample size and lack of objective measures of meditation engagement, which may introduce bias. Additionally, baseline scores were not collected to control for previous engagement in meditation, and we did not evaluate the total number of meditation sessions respondents participated in over the course of the provided initiative. The absence of qualitative data limits understanding of barriers to engagement and other wellness preferences. Furthermore, the meditation exercises were delivered via a prerecorded video during virtual rounds which may have influenced engagement, as this has been found in another study.²²

These findings suggest that integrating meditation into health care provider routines may enhance perceived well-being, at least as an addition to existing practices. This incorporation requires department practices integrated with organizational initiatives (e.g., the expansion of department-wide resources). Future studies should incorporate mixed methods, include objective engagement measures and qualitative feedback, and collect baseline data to control for previous meditation engagement. They may also consider expanding wellness initiatives beyond meditation and increasing the variety of meditations provided (e.g., mindfulness, movement, breath awareness, mantra) to improve satisfaction with meditation. Future studies aimed at improving employee wellness in the workplace across institutions can serve to mitigate burnout and promote a culture for palliative care clinicians’ well-being and optimal patient outcomes.

Footnotes

Authors’ Contributions

A.A.G. (co-first author): Conceptualization, writing—original draft, statistical analyses, reviewing, and editing. J.G.J.-T. (co-first author): Conceptualization, survey development, writing—original draft, reviewing, and editing. B.M.F.: Statistical analysis planning and review. A.C.: Development of meditation interventions, reviewing, and editing. E.B.: Conceptualization, reviewing, and editing.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Supplementary Material

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