Effect of Bedtime Mindfulness Meditation on Anxiety and Spiritual Well-Being in Hemodialysis Patients

This randomized controlled trial investigates the effectiveness of Bedtime Meditation Based on Mindfulness (BM-BOM) in reducing anxiety and improving spiritual well-being among patients undergoing maintenance hemodialysis.

Hemodialysis patients frequently experience psychological distress, including anxiety, emotional burden, and spiritual challenges associated with long-term treatment dependency, physical limitations, and uncertainty about health outcomes. Although standard hemodialysis care focuses primarily on physiological management, psychosocial and spiritual needs are often insufficiently addressed. Mindfulness-based interventions offer a structured, non-pharmacological approach that promotes present-moment awareness, emotional regulation, relaxation, and adaptive coping. However, evidence regarding their combined effects on anxiety and spiritual well-being in hemodialysis populations remains limited.

This study employs a single-blind randomized controlled design with pre- and post-intervention measurements. Eligible participants are adult patients with stage V chronic kidney disease who have been receiving outpatient hemodialysis for at least three months and are able to communicate effectively and provide informed consent. Participants with severe cognitive impairment, diagnosed psychological disorders, or medical conditions that prevent participation in the intervention are excluded.

A total of 58 participants are randomly allocated in a 1:1 ratio to either the intervention group or the control group using a computer-generated randomization sequence. Participants are blinded to group allocation. Outcomes are assessed using self-reported standardized questionnaires administered at baseline and again after completion of the four-week intervention period.

Participants in the intervention group receive a structured mindfulness program. The program begins with a single 2.5-hour face-to-face training session delivered by a certified mindfulness practitioner, introducing core principles of mindfulness, breathing awareness, and body awareness. Following the training, participants practice guided BM-BOM at the beginning of each hemodialysis session, twice weekly for four consecutive weeks. Each session lasts approximately 15 minutes and is delivered using standardized audio guidance in the Indonesian language. The audio guidance includes three sequential components: focused breathing awareness (approximately 5 minutes), body scan and bodily awareness (approximately 7 minutes), and closing reflection and grounding (approximately 3 minutes). Attendance and adherence are monitored during each session.

Participants in the control group follow the same schedule, setting, and duration but do not receive mindfulness guidance. They are instructed to rest quietly with eyes closed during the first 15 minutes of hemodialysis. This approach controls for time, attention, and environmental exposure while minimizing expectancy effects.

The primary outcomes are changes in spiritual well-being and anxiety levels from baseline to post-intervention. Spiritual well-being is measured using the Indonesian version of the Spiritual Well-Being Scale (SWBS), and anxiety is assessed using the Indonesian version of the Zung Self-Rating Anxiety Scale (ZSARS). Both instruments have demonstrated acceptable validity and reliability in Indonesian populations.

Data analysis includes descriptive statistics to summarize participant characteristics and inferential testing to compare within-group and between-group changes. Normality and homogeneity assumptions are evaluated prior to hypothesis testing. Paired statistical tests are used to assess pre- and post-intervention changes within groups, and independent statistical tests are used to compare outcome differences between groups. Effect sizes are calculated to support interpretation of clinical relevance.

Ethical approval is obtained from the institutional research ethics committee, and all participants provide written informed consent prior to participation. Participant confidentiality is maintained throughout the study in accordance with ethical guidelines.

The findings of this trial aim to provide evidence on the feasibility, safety, and effectiveness of guided mindfulness meditation as a complementary intervention that can be integrated into routine hemodialysis care to support psychological and spiritual well-being.