Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2025

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Mercedes Echevarria, DNP, APRN, CDCES, CNE

Keywords

Metastatic uveal melanoma, Distress, Meditation, Non-pharmacological interventions

Abstract

Background: Patients with metastatic uveal melanoma (MUM) often experience significant distress, affecting their quality of life. Mindfulness-based interventions are increasingly recognized as effective non-pharmacological strategies for emotional and psychological well- being.

Aims: This quality improvement project aimed to assess the feasibility and usability of the UCLA Mindful app, evaluate its impact on distress levels, promote consistent engagement, and identify the need for referral.

Methods: This descriptive-comparative study recruited smartphone user patients with MUM (≥18 years) from a single cancer center over three months. Participants were instructed to use the UCLA Mindful app for at least 10 minutes daily for 8–12 weeks. The National Comprehensive Cancer Network Distress Thermometer and Problem List measured distress pre-and post-intervention. The System Usability Scale (SUS) assessed app usability. A Wilcoxon signed-rank test compared pre- and post-intervention distress levels, and Spearman’s rho evaluated correlations between app use and distress reduction.

Results: Of 55 eligible patients, 48 enrolled (87.3% response rate, Baby Boomer generation: ages 59–77; n = 32, 65.3%, Generation X: ages 43–58; n = 14, 28.6%, Millennials: ages 27–42; n = 3, 6.1%, Male: n = 22, 44.9%, and Female; n = 27, 55.1%). Baseline distress scores averaged 5.13, decreasing to 4.4 post-intervention, with 43.8% showing at least a one-point reduction. SUS scores averaged 82, indicating above average use of the mindfulness app in this study population. However, app usage was inconsistent, averaging 6 times over 8 weeks. No significant correlation was found between app use and distress reduction (p > 0.05). While 68.8% reported some benefit of the UCLA Mindful app on their exit survey, 25% were unlikely to continue app use.

Conclusion: Although findings suggest a modest reduction in distress, inconsistent engagement limits definitive conclusions on the app’s effectiveness. The long-term sustainability of mindfulness app use beyond the study period remains uncertain due to barriers such as lack of adherence, motivation, inconsistencies, the need for structured guidance, and greater clinician buy- in to promote it as a free, non-medicinal alternative. Future research should explore personalized meditation interventions, address engagement barriers, and evaluate long-term adoption in larger and more diverse oncology populations.

Open Access

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Available for download on Monday, June 30, 2025

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