Mindfulness-Based Programs for People with Chronic Obstructive Pulmonary Disease: a Mixed Methods Systematic Review

Objectives To identify, summarize, and aggregate the quantitative and qualitative evidence on the use of mindfulness-based programs in people with chronic obstructive pulmonary disease (COPD), to describe the possible barriers and facilitators and derive recommendations for the implementation of mindfulness-based programs in people with COPD. Methods A mixed methods review was conducted following the Joanna Briggs Institute methodology. After a systematic search in eight relevant databases, seven papers presenting five studies were included. Two researchers independently extracted the data and assessed the methodological quality of the studies. Results No significant changes in levels of anxiety, stress, respiratory symptoms, or other physiological outcomes were found, despite the perception of most participants that mindfulness had a positive influence on their psychological and physical well-being. Only one study showed the effectiveness of mindfulness-based programs in reducing depressive symptoms when combined with pulmonary rehabilitation. Participation in and completion of mindfulness-based programs were hampered by personal beliefs, psychological factors, and practical aspects. Furthermore, the characteristics of the mindfulness-based protocols and the different methods of provision could encourage or discourage program attendance. Conclusions The limited published studies to date have not demonstrated the efficacy of mindfulness-based programs in COPD. Further methodologically sound studies with bigger sample sizes and with consistent outcome measures are needed to verify their effectiveness. Due to the fluctuations in symptoms of the disease, and patients' difficulties in leaving the house, home-based, web-delivered, and shorter protocols could be further tested as they could facilitate the adherence of people with COPD to mindfulness practice.