Mindfulness: valuable medicine for patients and clinicians?

Abstract

Mindfulness can be described as an attentive awareness of the reality of things in the present moment that can impart power when coupled with a clear comprehension of what is taking place, or put another way, as a calm awareness of body, mind, and spirit supporting analysis that can lead to wisdom. Although many of us promote this practice to our patients to help them more fully live their days whether few or many, it is worth considering how this consciousness could help us, practicing oncologists, through the challenging changes we currently face in our clinical practices and to more fully participate in the transitions to high-quality cancer care, as was recently outlined in a report by the Institute of Medicine. The report emphasizes that “studies indicate that cancer care is often not as patient-centered, accessible, coordinated, or as evidence-based as it could be, detrimentally impacting patients.” Mindfulness in clinical practice would marry the scientific principles of medicine and the patient-centered art of medicine to forge a system that is better aligned with the principles of high-quality cancer care. The report recommends “a conceptual framework” for improving the quality of cancer care, which includes patients who are engaged in decisions about their care; an adequately staffed, trained, and coordinated workforce; the use of evidence-based care to inform decisions about therapies and disease management; improved information technology that can generate “real-time” analyses of patient data and thus allow for the rapid translation of evidence into clinical practice; measurement of quality of care and improvements in performance; and care that is accessible and affordable. As we finish what I believe has been a tippingpoint year in community oncology, we have seen a third of community oncology practices join larger systems of care, according to a report by the Community Oncology Alliance (see p. 368). (It’s important to note that the report does not reflect the impact of the sequester cut to cancer drugs, which is expected to further fuel hospital acquisitions of community clinics.) Many other practices have continued to close satellite clinics or even the entire practice, and some have been forced into bankruptcy. Both community and academic clinicians note increasing demands for them to see, care for, and treat higher numbers of ever more complex patients under flawed payment systems that incentivize treatment over high-quality cancer care to improve a patient’s overall health. However, a ray of light on the horizon of this burgeoning clinical care crisis is the growing number of health plan, health system, and clinician pilots for what has become known as the medical oncology home. The MOH involves a change in practice culture that involves teambased care that fully engages patients, clinicians, and payers in a patient-centered care system that delivers the most cost-effective care while minimizing suffering and maximizing a patient’s health throughout his or her life. Aligned payment methodologies are being piloted, as are data-entry and analytic systems for monitoring the delivery and costs of care, outcomes, and quality metrics, which will contribute to an ongoing learning environment that will allow for real-time improvements in care and health outcomes as well as more transparency for consumers to choose their care teams. While the care delivery system is grappling with these challenges and changes, there have been significant scientific advances in the field of oncology this year. Among the therapies for breast cancer approved by the Food and Drug Administration this year were everolimus with aromatase inhibitor for patients who have progressed on initial hormone therapy for metastatic disease and Commun Oncol 2013;10:337-339 © 2013 Frontline Medical Communications DOI: 10.12788/j.cmonc.0082 From the Editor