For decades, our understanding of the mind-body connection has evolved, effectively broadening the way we define health. It is well known that quality of life is a crucial determinant of health decision making and outcomes.1 Furthermore, we know that living with chronic disease can pose a significant threat to quality of life across physical, psychological, and social domains.1 High symptom burden, impairment in daily function, psychological distress, polypharmacy, and treatment burden are among the many factors that can diminish quality of life in patients with chronic disease.1 Although some individuals are resilient in the face of their diagnosis, it is not uncommon for individuals with chronic disease to encounter difficulty adapting to and coping with the realities of their illness.

Regardless of successful biomedical intervention and relative control of a disease process, individuals may still experience chronic stress, depression, anxiety, and diminished social capital for weeks, months, or even years after diagnosis.1,2 These experiences not only lead to lower quality of life but can contribute to relapse and even increased mortality in some cases.1 For this reason, scientists and clinicians have recognized the need for holistic treatment of chronic disease, addressing the physical, psychological, and social needs of patients to achieve optimal outcomes.

In this issue, Heo et al3 present work in which they examined the feasibility, acceptability, and initial efficacy of a holistic meditation intervention in patients with heart failure. Meditation is (generally) defined as the action of deeply focusing attention and awareness, with an attempt to let go of stressors and promote feelings of physical and mental well-being.4 Meditation can be performed in silence, guided by voice (eg, another person, an audio-recording) or by music, performed in seated or lying position, or even performed while walking or working.4-7 It can be used for relaxation or can be deeply purposeful (eg, focused thoughts of self-compassion and affirmation).5 With its promise as a stress reduction technique, it is not surprising that some studies have indicated that meditation may improve quality of life by helping people achieve a relaxed physical state, improve sleep, improve blood pressure, combat negative emotions, and even relieve unpleasant symptoms (eg, pain, anxiety, depression).4,6,8,9

Despite their potential, meditation interventions are in relative infancy stage in the literature. To date, many meditation intervention studies have been conducted with small samples and have methodological limitations such as lack of control, high variability of intervention delivery and evaluation, and lack of information on intervention follow-up and dosing.4-6,8-11 This has led to modest (although typically positive) results and many recommendations for more rigorous research in this area. This is quite understandable considering the rather nebulous nature of meditation as a practice. There is no specific method and very little information suggesting that 1 form of meditation is better or more effective than another. However, the results of both quantitative and qualitative inquiry on this topic suggest that meditation may be a promising self-management strategy.5,6,8,11

Taking a closer look at the potential of meditation as a health intervention reveals that it is a strategy with a great deal of potential to help people but is also quite ambiguous and difficult to comprehend. Apart from formal courses and materials, it is free of cost and can be performed almost anywhere. Although not a recommended solution for acute health crises or a replacement of biomedical treatments, the reported benefits of meditation correspond to traditional clinical wisdom such as encouraging a positive outlook, suggestions to eliminate unnecessary stressors, and getting sufficient rest. Meditation may enable individuals to find relief from some of the most persistent and damaging health problems for which treatments remain elusive (eg, stress, negative thinking, etc).4

This raises the question: why don't more clinicians recommend meditation to their patients? The answer is likely multifactorial. First and foremost, the previously mentioned limitations in meditation research (as seen in many complementary and alternative therapies) create an inadequate scientific framework and thus a lack of strong empirical knowledge.4 Recent data suggest that, although many clinicians (RNs, physicians) report positive attitudes toward the idea of meditation, they lack sufficient knowledge about meditation and how to best implement it.11,12 Interestingly, interventions consistent with meditation have long been part of clinical training and practice such as relaxation and distraction techniques, breathing exercises, positive self-talk, and guided imagery. Another possibility is that clinicians may be hesitant to use the term meditation because it may be misunderstood. In an article published in the Washington Post, physician Dr Manoj Jain discussed the possibility that, despite its potential benefit, patients may reject a recommendation to meditate because of its common affiliation with religion or dismiss it as lacking scientific foundation.13 Finally, it is possible that, because meditation begins and ends within a patient's thought life, clinicians may feel that there is no pragmatic way to teach it, explain it, or verify that it is being practiced. However, there is little doubt that clinicians possess the ability to encourage meditation and other self-management practices in patients, as seen in research on patient-provider trust.

Heo et al3 take an innovative approach to teaching meditation skills to patients with heart failure by combining the strengths of known meditation techniques (mindfulness, compassion) and completing the intervention within the patient's home environment. Similar to other meditation studies in samples of patients with heart failure,7 they found the meditation intervention to be acceptable to their sample and saw a trend toward improvement in quality of life across all 3 domains. Across studies and synthesized reviews are statements of modest potential and a consistent call for larger efficacy trials to determine the efficacy of meditation as a health intervention.4-7,9-11 Furthermore, there is a pronounced need to integrate simple, pragmatic education and training on meditation for healthcare workers if we hope to more consistently translate meditation into clinical practice. Hopefully, by taking these steps, we will provide patients with an affordable and empowering self-management strategy to accompany biomedical treatment and help to promote a high quality of life.

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