Shared Meditation Involving Cancer Patients,Health Professionals and Third Persons: Perceptions of Participants Through a Focus Group Study

Abstract

People with cancer often experience psychological distress and in addition, the practice of oncology is one of the most stressful areas of medicine for health professionals. Mindfulness meditation has been used to alleviate stress-related symptoms. We therefore ran a pilot study to assess the feasibility of a mindfulness intervention involving cancer patients, health professionals, and third persons together, as part of a comprehensive project aiming to evaluate the added value of ‘meditating together’. Following on from our quantitative analyses of the project, we investigated its qualitative aspects through focus groups to explore the perceptions of participants regarding their experience. Focus groups conducted in 7 patients, 7 health professionals, and 8 third persons after the intervention showed that ‘meditating together’ was generally appreciated, particularly by patients, who found it motivating and a way to relieve their feelings of loneliness in the face of illness. All participants reported better stress management. They also shared benefits and difficulties concerning the practice of meditation and the programme’s modalities. In addition, they all stated that the programme should be lasting. The opinion of the patients (our target population) will be decisive in building an optimized programme that will suit them the best. In conclusion, the protocol and the qualitative findings of the present study validate the rationale for conducting a fully powered randomized trial to demonstrate the potential added value of shared meditation and how it improves well-being by promoting bridge-building between cancer patients, health professionals and others.

Trial Registration: ClinicalTrials.gov. NCT04410185. Registered on June 1, 2020

Introduction

People with cancer often experience emotional distress as a result of the diagnosis of a life-threatening disease, the effects of the tumour and treatments, the changes in life style that occur, and concerns about its possible recurrence. ¹ The prevalence of psychological distress among these patients is higher than in the general population, and it increases the risk of developing clinical levels of anxiety and depression, which affect up to 10% and 20% of cancer patients, respectively. ² Consequently, strategies and treatment options for common cancer-related symptoms, such as fatigue, mood, pain, and impaired quality of life are essential. The use of complementary therapies is gaining ground in the West, as a result of easier access to health information and an increase in concern about the side-effects of treatments and drugs. ³ Routine supportive care is therefore required if cancer care is to be fully holistic. In addition, oncology is one of the most demanding and stressful areas of medicine for health professionals, with burnout levels reaching about 30% among oncologists. ⁴ Excessive stress impairs personal well-being and professional satisfaction and can also impact quality of care. Strategies and approaches that can alleviate stress in oncology health professionals are thus needed before the onset of burnout. ⁵

Mindfulness meditation is mind-body intervention designed to alleviate stress-related symptoms and to promote well-being. Mindfulness is the psychological process of focussing one’s attention on the present moment with an attitude of non-judgement, acceptance and openness. ⁶ Most mindfulness interventions are based on Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) programme, initially developed for chronic pain patients. ⁷ Mindfulness interventions appear to be effective for reducing symptoms of depression and anxiety in many populations,^8,9 including in healthy individuals.^10,11

In people with cancer, recent meta-analyses concerning mindfulness interventions have demonstrated a significant improvement in psychological distress, and in various psychological and physical symptoms such as anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain. ¹² A metanalysis of 13 studies found that all MBSR interventions had a positive impact on stress-related outcomes, despite mixed results reported in 4 of them. ¹³ In 14 studies involving more than 1500 breast cancer patients, MBSR programmes were found to have a significant benefit on emotional well-being, anxiety, stress, and depression. ¹⁴ Moreover, reductions in anxiety and depression up to 6 months post-intervention were associated with mindfulness interventions in adults with cancer. ¹⁵ Finally, in a total of 3476 adult cancer patients or survivors included in 29 studies, those who received mindfulness-based interventions reported significantly lower anxiety, depression, fatigue, and stress and greater quality of life compared to those randomized in control groups. ¹⁶

In health professionals, previous meta-analyses have shown a significant reduction in work distress with mindfulness, ¹⁷ as well as an improvement in caregiver well-being.^17-19 Physicians perceived both benefits (enhanced self- and other-understanding) and challenges (time limitations and feasibility) associated with mindfulness-based interventions. ¹⁹ Although few studies have investigated the putative effect of mindfulness on interactions between health professionals and patients, some suggest that the positive impact on professionals’ well-being leads to an improvement in the quality of communication with their patients, who in turn feel better understood. ²⁰

The potential benefit of meditation therefore concerns both patients and health professionals. In the context of oncology, the question arises whether offering patients and professionals the possibility of meditating together could promote their mutual well-being and understanding, an issue that has received very little attention. A pioneering exploration in this area was conducted by Jon Kabat-Zinn at the Massachusetts Stress Clinic, where patients and medical staff meditate together to build bridges between the two. ²¹ Our hypothesis is that additional benefit may be gained when meditation workshops are offered simultaneously to patients, carers and to third parties, that is, non-patients and non-medical staff. The aim is to destigmatize the patient as a patient and the hospital as a place of care, breaking out of the context of illness and going beyond the perceived bounds of the disease. Vulnerability is inherent to the human condition and does not affect only those who experience illness, ²² and suffering is common to every human being. We hypothesize that the sharing of vulnerability, which mindfulness can help to relieve, could improve communication and understanding and lead to more collaborative and interactive health care. However, the feasibility of shared meditation needs to be validated, because it is essential to know whether patients find it acceptable to be in the company of (their) health professional outside the hospital setting, whether suffering carers appreciate being with patients outside working hours, and whether third parties can be confronted with the illness.

The IMPLIC pilot study reported herein is part of the preliminary stage of a comprehensive project aiming to evaluate the added value of ‘meditating together’. We sought (i) to validate the relevance of meditating together, and (ii) to evaluate the effects of mindfulness on improving well-being. From the outset, the study protocol ²³ provided for the integration of a complementary qualitative approach through focus groups ²⁴ after completion of the meditation programme, in order to finetune the quantitative data obtained from the self-questionnaires. ²⁵ From a methodological point of view, the collection of participants’ verbatim statements brings out their feelings and points of view relating to affects, which cannot not captured by quantitative methods of exploration. We thus expected the focus groups at the end of the programme to allow us to validate and clarify a set of hypotheses to be explored in our future randomized study, and even to reveal other relevant issues raised by the participants.

We present the analysis of the qualitative data obtained in the focus groups. This analysis should reveal the most relevant and productive modalities of shared meditation in order to construct an appropriate randomized study answering our research hypothesis. It will also help to develop and implement similar projects elsewhere in the context of supportive care if the benefit of meditating together is fully validated.

Methods

Study Design and Participants

The IMPLIC study is a pilot prospective single-centre study. It enrolled 30 participants (10 patients/10 health professionals/10 third persons) who followed a dedicated programme on mindfulness and compassion over 12 weekly sessions of face-to-face shared meditation and a half-day retreat from 10 September 2020 to 18 February 2021, with a lockdown due to COVID-19 pandemic. Indeed, the weekly sessions were originally scheduled to end on 26 November 2020. Unfortunately, the second nationwide lockdown at the end of 2020 required a 12-week break in the meditation programme after the eighth session. To maintain contact with the participants during this lockdown period up to the possibility to resume shared meditation sessions, the meditation instructor encouraged each of them to continue their practice him/herself at home using the audio material already provided. In addition, she provided them an additional supportive audio session as well as the possibility to contact her if needed. When it proved complicated for participants to attend the sessions, one-off catch-up sessions had to be organized by videoconference.

All participants provided written informed consent.

Eligibility criteria concerning the recruitment of participants in this pilot study as well as the detailed methodology are fully described elsewhere. ²⁵ Briefly, the main parameter for inclusion was curiosity about meditation and motivation to be part of a study on it. Those recruited had to have no current or previous experience of regular or intensive meditation or comparable practice. Cancer patients and health professionals were recruited at the François Baclesse Comprehensive Cancer Centre (Caen, France). The health status of cancer patients had to allow them to attend the sessions. To be eligible, medical and/or paramedical health professionals had to be involved in the management of cancer patients (physicians, nurses, nursing assistants, radiotherapy/radiology operatives). Any person not belonging to the above-mentioned categories was eligible as third person, including people from outside the centre. The eligibility of subjects presenting significant vulnerability such as very advanced cancer stage with life-threatening consequences, alcohol or drug dependence, severe depression, severe social anxiety, etc. was assessed on a case-by-case basis.

Overall, 28 participants completed the programme (9 patients, 9 health professionals, 10 third persons). As main objective, we validated the feasibility of shared meditation, with 70% of participants who completed at least 80% of the programme. Using standardized validated self-questionnaires, we also demonstrated the relevance of shared meditation and a significant improvement in well-being following meditation. ²⁵

In the present article, we analysed the qualitative interview with the focus group conducted 1 week after the end of the programme. Participation in the focus group was offered to the 28 participants who completed the programme. Only volunteers willing to participate attended the focus group session. Written informed consent for study participation included the guarantee for anonymity and medical confidentiality, the participant’s agreement to the recording of the interviews and their anonymous transcription onto a written medium, and the guarantee that all recordings would be destroyed after analysis of the data for confidentiality reasons.

Mindfulness Intervention

An expert in meditation was responsible for setting up the workshops and designing the programme on ‘meditating together’. Compared to the MBSR protocol, sessions were numerous but shorter, in order to better suit people with cancer. Briefly, 12 weekly sessions of 1.5 hours of meditation and a half-day retreat of 3 hours were proposed over a 3-month period. ²⁵ The themes addressed during these shared meditation sessions concerned mindfulness and empathy. In particular, breathing, sensations, sounds and body scan were explored. Empathy was addressed through themes such as interdependence, benevolence, compassion, and wisdom. Each weekly session included the welcome of participants, followed by the presentation of the theme covered for the session, meditation on this theme, a feedback session, a second period of meditation and mindful movements, a break, a question-and-answer session addressing the points raised by the session, and lastly refocusing and presentation of daily exercises to be practiced at home. The half-day retreat took place in silence. Participants explored meditation in more depth over a longer period, to allow them to take onboard the meditation techniques discussed during the sessions. The goal was to allow participants to ‘reconnect’ with themselves, to meditate on the theme of taste at lunchtime, to meditate while walking outside, and to discuss their experience with others at the end of the session.

As part of the programme, participants were required to complete daily practice exercises and self-practiced meditation sessions at home. To guide them, audio recordings specially designed for this purpose by the teacher were also provided. Finally, individual follow-up was offered by phone, video call or face-to-face discussion to resolve any problems raised during the shared meditation sessions that could not be managed within the group. The shared meditation sessions and the deepening session (retreat) took place outside the hospital (Pôle des Formations et de Recherche en Santé of Caen University), a pleasant setting conducive to exchange, close to the Centre François Baclesse.

Focus Group Procedures

Three two-hour focus group sessions were planned, with up to 10 participants from each category (patients, health professionals, third persons) per session in order to guarantee the homogeneity of each group and to ensure fruitful and equitable discussion.

Focus group sessions were based on a preselected set of 6 open-ended questions pertaining to thoughts, feelings, and perceptions of participants’ experiences of the ‘shared meditation’ programme. Sessions were conducted by an external moderator (specialist in ethical issues) who launched the questions to be discussed, and a neutral observer (taking notes during the session). The questions to be discussed were the following:

• - What fears or hesitations did you have before starting ‘shared meditation’ (involving patient, health professionals, and third persons)?

• - How did you personally experience being in a meditation group involving patients, health professionals and third persons?

• - What difficulties and obstacles have you personally encountered in this context of ‘shared meditation’?

• - What do you see as the advantages or benefits of this kind of meditation?

• - What would be your expectations and needs regarding shared meditation?

• - How could the sessions and the programme be improved?

For the first 5 questions, each group considered them sequentially with respect to the other 2 groups. For example, for the patients, the difficulties and possible benefits related to the presence of third persons was discussed, then those related to the presence of health professionals. The focus group was planned to last approximately 2 hours for each group, in order to obtain complete answers to the questions and therefore generate sufficient information for data saturation.

Qualitative Analysis

Qualitative data analysis was performed by an independent qualitative analysis specialist external to the team that performed the study. The data analyses were based on the verbatim transcripts of the recorded discussions, the observer’s notes and the debriefing between moderator and observer. The axial coding of the verbatim transcripts (by category) using a content analysis grid constituted part of the descriptive analysis. All interview transcripts were imported into the qualitative software programme NVivo 12 for coding. A reflexive thematic analysis method was used, with a combination of deductive and inductive identification of themes. ²⁶ The results were transmitted to the research group for discussion as part of an interpretative analysis. The findings are presented by key content emerging from the guided responses to each open-ended question and illustrated by verbatim quotes (specified in italics).

Results

Characteristics of Study Participants

The total study population (n = 30) was predominantly female (87%) and most participants had at least baccalaureate-level education with no previous experience of meditation (87%), as described in detail elsewhere. ²⁵ The third parties were found to have no connection with the patients or health professionals. Of the 28 participants who completed the programme, 22 participated in the focus group session (7 patients: 6 women, 1 man; 7 female health professionals; 8 third persons: 6 women, 2 men). Complete answers to the questions were obtained within 2 hours, with sufficient information ensuring data saturation.

Fears or Hesitations Before Starting Shared Meditation

Irrespective of their group, all participants expressed their confidence in the shared meditation because it was a university-hospital research project supported by the institution (Centre François Baclesse). However, some of them were apprehensive about the nature of the activity because of their lack of practice (fear of not being able to do it, physically or mentally), their knowledge, their representations (mystical activity, collective activity) or their attendance (availability, scheduling problems, etc).

Apprehension towards shared meditation was expressed differently by the participants. For third persons, it was not an obstacle at all and mostly was not even questioned: ‘For me, it was not an issue’. Conversely, some health professionals did question it, some looking benevolently upon it even before it began, others feeling somewhat apprehensive, either because they were afraid of being in the presence of known patients, or because they had the feeling that they would still be within the bounds of the health professional-patient relationship. On the other hand, patients saw it as a form of motivation, ‘an extraordinary way of sharing together’ and of meeting the health professionals outside the institution, which has sometimes aroused a certain curiosity. For the patients, meditation seemed to be either the logical continuation of other supportive care, or a means of ‘absorbing the shock’ or as a need when faced with a sense of desperation.

Experience of Shared Meditation

Most participants in the 3 groups used terms evocative of sharing, interactions and meeting others, and these were used repeatedly to describe the experience of shared meditation (Figure 1). Thus, the predominant feeling among third persons was that of equality with regard to practising meditation, leading to the sharing of an experience and fruitful discussion on the subject. ‘I also think that the human being is at the heart, that is to say, whether one is a health professional, a patient or . . . People are put on the same level, which allows for a real exchange’. Being a health professional, patient or third person was not a relevant factor in the intimate, personal experience shared: ‘ the exchanges were rich as you said, but regardless of the category of the person . . . It was the person who expressed himself but not as . . . patient, health professional or third person’. Meditation concerns the person, not their status.

Figure 1.

Visual representation of the lexical field of shared meditation.

Nevertheless, the health professionals mentioned that they sometimes felt a sense of empathy and benevolence for those they had identified as ‘patients’ because of the physical or psychological difficulties they perceived in the exercises they had to do. Thus, while shared meditation was experienced as an opportunity to get out of the professional circle, they still felt that it was difficult to detach oneself from one’s professional status both in their posture and the values they held.

The patients experienced shared meditation positively. They saw it as an opportunity to meet the health professionals outside their professional capacity. However, it sometimes fell short of their expectations. While the status of each person was no longer evident during meditation, it returned during the breaks and other moments of conviviality. However, for certain aspects of meditation, the uniqueness of the experience was real, as in the difficulty of maintaining the postures or the pain which could be physical pain of sitting for a long time or psychological pain, notably for the patients.

Difficulties Encountered During Shared Meditation

The difficulties mentioned were of an organizational, physical or psychological nature and were raised by all the groups. At the organizational level, the place was generally appreciated because it was situated outside the institution, could pose a problem in terms of its layout (not suited for meditation, parking difficult, etc), especially for the carers. The proposed time slots were problematic for some (either too close to mealtimes, or too late at the end of the day, or too early), as well as their frequency (difficulties in organizing workload). The breaks were also seen in differing terms: either positively because they allowed for exchanges and the creation of relationships; or negatively because they brought people back to reality and gave the impression of being in a ‘training session’).

Regarding meditation per se, the difficulties were clearly shared. First, from a psychological point of view, it was sometimes difficult to get into the right frame of mind for the proposed exercises, either because of the mental workload for the health professionals, or because of the illness for the patients. Sometimes motivation was also lacking, especially during the breaks when participants were on their own. From a physical point of view, the practice of meditation posed difficulties owing to the long sitting posture (difficult or painful) and breathing (difficult or noisy), but with no particular difficulties reported by the patients. Finally, outside of the sessions, the lack of reference points or insufficient audio recordings were sometimes mentioned as a source of difficulties for the participants.

Advantages and Benefits of Shared Meditation

The advantages and benefits of meditation were recognized by all participants. All testified to a general improvement in their quality of life thanks to the acquisition of a form of awareness and a slowing down of their rhythm, allowing them to step back, to feel better in the present moment, allowing them to put things in perspective. The third persons said that shared meditation led to a calmer, more understanding relationship with the other by increasing their feeling of benevolence and by being able to verbalize their personal feelings. As for the health professionals, they saw meditation as a useful tool in their professional activity. They mentioned better listening ability, better empathy, and especially a way to establish a break between their professional activity and their personal life. Thus, they recognized in meditation a way to distance themselves, to better manage their emotions and their stress in order to better position themselves in their activity and to feel more available in their personal life.

The patients perceived meditation as an additional resource to better live the disease. They felt that it helped them not to resist pain, emotions or stress and thus to put things into perspective by improving self-management through self-acceptance. The experience of the disease (psychological experience, medical check-up, delays in diagnosis, preparation for treatment, recurrence, etc) was considered as being improved by stepping back from it, thereby seeing oneself as an actor. Shared meditation made the words and emotions of others and oneself more acceptable. It allowed everyone to discover a tool to control their emotions.

Expectations and Needs Regarding Shared Meditation

Expectations and needs were common to all 3 groups and concern primarily the continuity of practice through institutional support. The participants also expressed a desire for understanding through more in-depth information. They also expressed a wish for greater diversity in the composition of the groups (socio-cultural diversity and in particular more men).

While meditation is possible alone and was practiced individually between shared sessions and during the lockdown due to COVID-19 up the resumption of the programme, the notion of group was salient in their expectations: ‘meditating together once a week and giving us the opportunity to know how our week went and how we experience meditation when we are together, that’s something important’. The participants also felt that having the activity supported by the institution established a reassuring framework and ensured the continuity of the activity, while providing the opportunity to form permanent groups. This institutional support was considered essential by the health professionals because it allowed them to free up the time needed to practice. The patients also saw it as an opportunity to have this activity recognized as part of their care. They emphasized the healthy lifestyle and psychological support provided by shared meditation, which relieves the loneliness of their illness.

Avenues for Improvement

Avenues for improvement mentioned by the participants included the need for better material organization (time slots, place, information, diversity of groups. . .) and the continuity of the meditation programme and individual follow-up. The proposed time slots and place were appreciated to differing degrees by the participants. Similarly, the need for information and understanding was not the same for all of them: some would have liked to be more informed about the project before participating, while others preferred not to know too much about it in order to undertake without any preconceptions. However, almost all participants expressed a need for feedback on the study, which they received a couple of weeks after the focus groups.

Continuity and follow-up were also mentioned by all groups. In general, all participants regretted that their meditation practice was only part of a study project and therefore not sustainable over time. Many expressed the wish to be able to practice meditation on a long-term basis.

Impact of COVID-19 Lockdown

The circumstances of the pandemic obviously forced a break in the project. Although lockdown had its disadvantages, such as the loss of momentum, frustration, uncertainty and even total dropout for some, it had an unexpected advantage for the majority. Most seized the opportunity to begin self-practiced meditation to live better through the lockdown and to take a step back from current events. Moreover, the lockdown and the audio recordings were felt to give the participants the opportunity to measure their degree of autonomy in practicing meditation by themselves and to invest what had been taught in a more concrete and personal way. This is surely the reason why everyone agreed on the need to have more audio supports during lockdown.

Discussion

Depending on the studies and participating populations, the prevalence of distress in people with cancer varies from 35% to 55%, ²⁷ thereby justifying the use of complementary medicines. The perception of participants is a key factor in validating integrative approaches, which are difficult to assess with quantitative tools, especially in the context of an innovative hypothesis for which there are no dedicated standardized validated questionnaires. Mindfulness is a subtle approach for which focus group analysis seems relevant, although a few qualitative studies have been conducted to date, for example, in online mindfulness,^28,29 mindfulness at school, ³⁰ in surgeons,^31,32 and schizophrenic patients. ³³ The qualitative approach was found to be effective to identify important areas for further studies in people with cancer and to test the feasibility and acceptability of mindfulness-based interventions.^28,34,35

To our knowledge, this is one of the first studies to investigate the feasibility of conducting a dedicated mindfulness programme to improve the well-being of cancer patients in a context of shared meditation involving patients, health professionals and third persons. Our previous work demonstrated that it is feasible to mix groups. ²⁵ Although not designed as an efficacy trial, our findings suggest that the well-being of these participants improved as a result of the intervention. The complementary qualitative analysis in a focus group setting revealed the key determinants of the effects of shared meditation, especially for patients, our target population.

Positive Perceptions of the Meditation Programme

The focus group analysis confirmed the quantitative data obtained by questionnaires ²⁵ in terms of satisfaction with our adapted programme (satisfaction questionnaire, evaluation of ‘meditating together’), which was high for all participants, especially the patients. The benefits of shared meditation are depicted in Figure 2. The participants in all groups expressed their confidence in shared meditation before starting the programme and then experienced it positively. This emphasizes the importance of sharing a sense of common humanity, regardless of the status of the participants. The sharing of meditation was a source of strong motivation for the patients and alleviated their feelings of loneliness in the face of the disease. In addition, all participants agreed that meditation led to better stress management and an improved quality of life.

Figure 2.

Participants’ views on the benefits and disadvantages of shared meditation.

Negative Perceptions of the Meditation Programme

The limitations of shared meditation, as expressed by the participants, are depicted in Figure 2. Regarding the organization and modalities of the programme, the time slots, the place and its layout, breaks, etc were appreciated variously and independently of the groups, so it is difficult to make generalizations as to what works and what does not work. Regarding the practice of meditation, the psychological (full attention) and physical (feeling of discomfort) difficulties were clearly shared. The COVID-19 lockdown prevented from realizing in a continuous way the shared meditation programme as planned over 12 continuous weekly sessions plus a half-day retreat since it required a 12-week break in the programme after the 8 session. Yet, this lockdown-induced postponement did not compromise the realization of the whole programme. It even allowed most participants to be more autonomous in the practice of self-meditation thanks to the audio recordings, of which some would have liked to have more. All 3 groups stated that the offer of meditation should not be dependent upon the existence of a research project, which is necessarily only temporary. Furthermore, they felt that institutional support should be available so that they could continue to practice shared meditation.

Limitations

This study suffers from several limitations. In the context of this pilot study, the sample was self-selected on the basis of motivation. Moreover, it was primarily female from a privileged socio-professional background, and the groups lacked social diversity. These are significant limitations making it difficult to generalize the findings.

As above mentioned, the programme started during the COVID-19 pandemic, which necessitated a 12-week break in the programme after the eighth session. This broke the rhythm of the sessions, although it did not appear to have a significant impact on adherence. ²⁵ Moreover, unavoidable social distancing measures and mask-wearing were not conducive to exchange between participants, yet this is one of the major objectives of face-to-face shared meditation. Regarding this objective of promoting communication, particularly between patients and carers, it proved difficult to recruit health professionals directly involved with patients, such as nurses (only one) or nursing assistants (none) into the programme, thus underlining the need to optimize the hospital’s workflow to allow all staff to follow the programme if they so wish.

Finally, the participants completed the interview shortly after the intervention. It is possible that other longer-term effects would have emerged if they had been recruited into the focus groups several months after the mindfulness intervention. Although the focus groups allowed us to better characterize the benefit of shared meditation, the design of the study, that is, pilot study with a single group of mixed participants, did not allow us to definitively establish the added value of this type of meditation.

Towards a Future Randomized Study

Our protocol and qualitative results provide the outline for a larger, fully powered randomized study. Our future comparative trial will allow us to evaluate the putative added value of shared meditation by comparing it with the same programme conducted only in patients, with a larger number of participants and greater methodological power. The qualitative data collected in this pilot study provide valuable insight into participants’ concerns about a new approach to shared meditation, a characteristic that is difficult to assess with quantitative tools. They also suggest the following areas of improvement for a randomized study. First, we will include more patients because this is our target group and satisfaction was the greatest in this group whether assessed by focus group or quantitatively. ²⁵ The future experimental group will include 50% patients, 25% health professionals and 25% third parties, thereby ensuring that the groups are mixed, a fundamental source of satisfaction for the patients. We will also make sure that the ratio of patients to professionals and third parties is not impacted detrimentally by the greater turnover of patients compared to that of staff.

Concerning the programme and its components, the content will remain largely the same while its organization will be improved. The 12 weekly sessions will last 2 hours including a break, a format appreciated by all the participants. However, between the eighth and ninth week, the programme will be interrupted for 15 days to allow the participants to experiment with meditation independently. The first 3-hour retreat will take place after the ninth week. After the 12 face-to-face sessions, there will be 3 monthly 2-hour follow-up sessions to allow participants to integrate meditation into their daily practice. The programme will finish with a second retreat, to which the researchers who will have participated in the project will be invited. A focus group session similar to the one conducted in this study will be proposed the following week to identify what is required for the programme to be rolled out elsewhere. In total, the programme will last 6 months, not only to answer the unanimous request made by the participants for a longer programme but also to hold a booster or follow-up sessions in order to maintain the long-term benefits, as suggested by others. ¹⁵ Particular attention will be paid to the user-friendliness of the room in which the sessions will take place, since this seems to be an important factor in addition to accessibility, especially for the health professionals. To this end, designing this university classroom with a decorative wall fabric and green plants for example could make it more lively and warm and therefore more conducive to meditative practice. Finally, patient feedback on the questionnaires used in the pilot study will enable a more limited but appropriate choice of assessment tools to be used in the future study. The patients’ opinion collected during the focus group is of paramount importance in building a programme that suits them best, which is why 2 patients from the pilot study will be consulted to discuss and validate the new programme and its modalities.

Conclusions

These qualitative findings confirm the quantitative data obtained in the preliminary study. They attest to the value of shared meditation and therefore justify the implementation of a future randomized trial. The aim will be to demonstrate the potential added value of shared meditation in the way it cultivates our sense of common humanity, fosters links and improves well-being among actors who share the stressful circumstances of cancer and its treatment.