The Impact of Mindful Compassion on Sexual Functioning and Quality of Life in Home Hospice Care

Hospice care is a specialised form of palliative care provided during the later stages of life. Although these two types of care share some similarities, they can differ in timing, location, and available treatments. Hospice care can be delivered at home or in a hospice healthcare centre. While the main treatments are generally discontinued, pain management and support for other health issues, such as high blood pressure or psychological distress like anxiety or depression, may continue. Hospice care, as a component of palliative care, prioritises quality of life and overall well being. Additionally, hospice support can be provided at any point during the patient's condition, not solely in its final stages. A combination of in-home and healthcare support, as well as inpatient care, is also available. Among women, lung cancer, followed by breast cancer, is the most reported cancer in hospice.

The quality of life in palliative care and hospice is vital, given the challenges faced by patients, caregivers, practitioners, families, and partners. It includes overall well being, covering physical, psychological, social, and spiritual aspects. Palliative care provides essential support when addressing the biopsychosocial components of quality of life. However, issues emerge when discussing sex. Despite recognition by organisations such as Marie Curie and Macmillan, there seems to be a reluctance to raise awareness or support research on this topic.

A range of psychosocial interventions is available for individuals after cancer treatment. An increasingly popular approach involves using mindfulness and mindful compassion to support psychosexual functioning. Mindful compassion has been utilised in psychosexual services, including various sexual issues such as sexual pain disorder. Indeed, the three systems model can be used to map out, validate, and normalise different emotional experiences as well as to illustrate how they can influence sexual arousal and enjoyment.

Research on mindfulness and mindful compassion for women after cancer treatments is limited and remains scarce among those in hospice end of life care. This is a sensitive but vital area, as sexual intimacy should not cease with a prognosis. The sense of connection to others is essential at the end of life, and this does not exclude sexual intimacy. This study aimed to assess the effectiveness of an online mindful compassion intervention, based on the 3 system model of emotions, among women with cancer and those receiving hospice care at home.

It was hypothesised that mindful compassion would improve sexual functioning, mindfulness, well-being, and quality of life among women following cancer treatment and in palliative care. Questionnaires were limited because the team did not want to overburden these women, as the focus was on the experience of brief mindful compassion.

Inclusion criteria

• Were in hospice care with a cancer diagnosis/terminal
• We're receiving support and care
• Identified as female
• Registered with a healthcare service or charity
• Self-perceived satisfactory sexual intimacy before cancer diagnosis (Acquired)
• Aged 18 years or older
• Had a computer, laptop, mobile phone- intervention was online.
• Read and wrote English, as the intervention was delivered in English
• Patient Health Questionnaire 9 screening (score range from minimal to moderate, 0-14).
• Mental Capacity Mini Cog outcomes 3,4,5 (cognitive comprehension)

Exclusion criteria

• Were not in hospice care with a cancer diagnosis/terminal
• Did not identify as female
• Were very late-stage palliative/hospice care in which capacity (medication) may be compromised, or discomfort is experienced
• Were aged below 18 years old
• Had reading and writing difficulties in English
• Had a moderate to severe to high Patient Health Questionnaire 9 screening score (ranging from moderate to severe 15-27).
• Mental Capacity Mini Cog outcomes 0,1,2 (problematic cognitive comprehension)