The Mediating Effects of Decentering on Self-Management of Stress and End of Life Planning

Investigators will conduct a randomized trial pilot study to examine two arms of the intervention among 20 caregivers of patients with advanced cancer. Investigators will collect mixed methods data to describe changes in proximal and distal outcomes. Investigators have chosen the time points to capture neural and behavioral changes associated with the intervention and to capture end of life quality of life (QOL) for a majority of caregivers after death of their loved one. Investigators aim to:

• Evaluate the short and longer-term effects of the end of life care with medication (EOL_M) and meditation only (M_Only) interventions on stress reduction and end of life (EOL) planning behaviors and determine if there are different effects between EOL_M and M_ Only interventions.
• Evaluate the short-term and long-term effects of the intervention on caregiver distress, decisional regret, and EOL values and goals of care for treatment.
• Evaluate the impact of decentering on the association between the interventions, self-management behaviors (stress reduction and EOL planning behaviors) and distress, anxiety, concordance between EOL values and goals of care for treatment, decisional regret and satisfaction with EOL care.
• Describe the neural activity processes that are associated with increased self-management activities.

Inclusion criteria

• caregivers of patients who have been diagnosed with Stage IV gastrointestinal (GI) cancer
• coming with the patient at the Seidman Comprehensive Cancer Center at University Hospitals Case Medical Center (UHCMC)
• have access to the internet and a computer, tablet, or smart phone, and
• speak and comprehend English.

Exclusion criteria

• currently practicing mindfulness-based interventions (yoga, meditation, deep breathing)
• require psychotherapy within the last three months
• have a history of dementia, major neurological illness
• pregnant
• history of a medical condition or procedure that is contraindicated for functional magnetic resonance imaging (fMRI) scanning (i.e. cardiac pacemaker, sternal wires, or metal implants); and
• claustrophobia requiring anxiolytics or sedation; or
• expect to relocate from Northeast, Ohio within 2 months