Integrating MEditatioN inTO heart disease care (The MENTOR Study)
- Publication Type:
- Thesis
- Issue Date:
- 2020
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๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ: Depression and anxiety symptoms after a cardiac event are often under-recognised and undertreated, reducing the ability of people living with heart disease to effectively manage their symptoms and to fully optimise the opportunities afforded by cardiac rehabilitation programs.
๐๐ถ๐บ๐: The Integrating MEditatioN inTO heaRt disease care (MENTOR) Project aimed to generate contextual knowledge to understand the capacity for meditation to improve the psychological wellbeing of people participating in a cardiac rehabilitation program.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐: A three-phased explanatory sequential mixed methods project, composed of four discrete yet interrelated studies. The MENTOR Project is underpinned by two complementary interrelated frameworks: 1) the World Health Organisationโs Innovative Care for Chronic Conditions Framework; and 2) Banduraโs Self-Efficacy Model.
Phase 1 identified the burden of depression and anxiety in cardiac rehabilitation programs, and included a longitudinal cohort study, and a systematic review of meditationโs feasibility in reducing depression and anxiety symptoms. Phase 2 tested the feasibility and acceptability of a meditation intervention, and included a phase II RCT and semi-structured interviews of i) people living with heart diseaseโs perspectives on participating in a meditation intervention; and ii) health professionalsโ perspectives of the barriers and facilitators to integrating this self-care strategy into existing cardiac rehabilitation programs. Phase 3 recommendations for meditation research and practice were generated during the meta-inference of the integrated data from Phases 1 and 2.
๐ฅ๐ฒ๐๐๐น๐๐: Meta-inferences generated from the MENTOR Project found that a range of supports are required to integrate meditation at the patient, health organisation and health systems levels of heart disease care. Compared with the general population, moderate depressive symptoms were higher in people who attended cardiac rehabilitation programs (18% vs 5%). Anxiety and stress were the strongest predictors of moderate depression in people living with heart disease (p<0.001), and depression was a strong predictor of anxiety (p<0.001). While cardiac rehabilitation contributed to modest reductions in depression and anxiety symptoms, these symptoms reduced the capacity for people living with heart disease to adhere to cardiac rehabilitation programs (depression: 24% vs 13%; p<0.001; anxiety: 32% vs 23%; p<0.001).
The preliminary phase II results suggest it is feasible to recruit people in a future phase III trial and may also increase cardiac rehabilitation attendance and adherence. Integrating a meditation intervention into cardiac rehabilitation was also considered to be acceptable to health professionals and people living with heart disease.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: Better monitoring of depression and anxiety symptoms throughout cardiac rehabilitation programs is required, and the integration of psychological support strategies is warranted. An integrated approach to care that is inclusive of meditation has the potential of improving psychological well-being and the self-efficacy of people living with heart disease and increase their adherence to cardiac rehabilitation programs. Building the effectiveness and efficacy evidence of the role of mediation in cardiac rehabilitation is critical to ensuring that the relevant supports and processes are available to integrate this non-pharmacological strategy into existing programs. In the meantime, implementing the MENTOR Project recommendations at the patient, health organisation and health systems levels will do much to improve the psychological care of people living with heart disease in Australia.
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