Mindfulness-Based Spiritual Interventions for Patients with Advanced Cancer Receiving Palliative Care: A Systematic Review of Randomized Controlled Trials

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Background: Psychological and spiritual distress are highly prevalent in patients with advanced cancer, yet conventional interventions often fail to address their interconnected nature. While mindfulness-based interventions (MBIs) are widely used in oncology, their integration with spiritual or meaning-centered components remains insufficiently synthesized in high-level evidence. Objective: This review aimed to evaluate the effectiveness and characteristics of mindfulness-based spiritual interventions on psychological and spiritual outcomes in patients with advanced and palliative cancer. Methods: A PRISMA-guided systematic review of randomized controlled trials (RCTs) was conducted using PubMed, Scopus, and CINAHL databases (2015-2025). Eligible studies included adult patients with cancer receiving mindfulness-based interventions incorporating explicit spiritual, religious, or existential components. Methodological quality was appraised using the Joanna Briggs Institute checklist, and findings were synthesized using qualitative descriptive and narrative synthesis. Results: Thirteen RCTs were included. The interventions were categorized into (1) hospital-based interventions and (2) remotely delivered interventions. Across these categories, five outcome domains were identified: psychological well-being (anxiety, depression, distress, quality of life), spiritual well-being (meaning, peace, faith, existential acceptance), attrition and treatment engagement, intervention acceptability, and mixed or inconsistent findings. Conclusion: Mindfulness-based interventions that explicitly integrate spiritual or meaning-centered elements offer a comprehensive approach to addressing multidimensional distress in advanced cancer. These findings suggest that integrative psycho-spiritual care models may be beneficial in oncology and palliative care. Future research should prioritize standardized intervention frameworks and mechanism-driven evaluation across diverse populations.