Patient perceptions of an art-making experience in an outpatient blood and marrow transplant clinic

Creative Arts Therapy Among Children With Cancer: Symptom Assessment Reveals Reduced Anxiety

BACKGROUND

Symptom distress is related to decreased quality of life (QOL) among children with cancer, with high levels of pain, nausea, and anxiety reported. Creative arts therapy (CAT) has been related to improved QOL and symptoms in pediatric oncology, but the quality of evidence is mixed.

OBJECTIVE

This article aims to examine the QOL symptom subscales in relation to CAT over time in children during the first year of cancer treatment.

METHODS

A secondary analysis of prospective data was performed with linear mixed modeling on 267 observations with predictors of 2 groups: No CAT (n = 18) vs CAT (n = 65). The covariate of time (6 months) was used to explore the CAT relationship with the Pediatric Quality of Life Inventory (PedsQL) symptom subscales (pain and hurt, nausea, procedural anxiety, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication).

RESULTS

Children (n = 83) were between 3 and 17 years old (M = 6), 51.2% female, and 32% minority. All tumor types were represented: liquid (37.3%), solid (24.1%), and central nervous system (38.6%). Reduced child report of procedural anxiety was significantly related to receiving CAT with a medium magnitude of association (adjusted effect size = 0.58, P = .01).

CONCLUSION

Creative arts interventions were associated with a longitudinal improvement in anxiety in children with cancer. Further work is needed to target interventions to the appropriate specific burdensome symptoms.

IMPLICATION FOR PRACTICE

Pediatric oncology nurses can advocate for CAT as an effective intervention to ameliorate the burdensome procedural anxiety experienced by patients.

Evaluation of art making activity as a pain management strategy for older adults and their experience using an art making intervention

Chronic pain is a common and bothersome experience for older adults. Consequently, pain management is critical to maintaining their function and well-being. Art making, a non-pharmacological approach, has gained empirical support and is used for functional and cognitive improvement in older adults. However, it has rarely been used to manage chronic pain. The purpose of this descriptive qualitative study was to understand older adults' experience using a newly designed art making intervention and its influence on their pain. Overall, 11 older adults used the intervention and reported its quality to be appropriate. Moreover, older adults reported that art making was an engaging, diversional activity which reduced their pain severity and improved their mood. The findings of this study will be used to inform a future pilot study to assess the impact of art making on pain management in older adults with chronic pain.

Effects of Creative Arts Intervention on Anxiety, Depression and Sleep Quality Among Bone Marrow Transplantation Patients During Protective Isolation

BACKGROUND

Protective isolation remains part of the standard of care for patients undergoing hematopoietic stem cell transplant in many places of the world. The consequences of protective isolation include increased anxiety and depressive symptoms.

OBJECTIVE

The aim of this study was to determine the effects of creative interventions performed during the protective isolation period on anxiety, depression symptoms, and sleep quality of patients who underwent bone marrow transplantation (BMT).

INTERVENTIONS/METHODS

This study was a randomized, controlled, pre-post pilot design. A total of 20 patients made up the sample group. Participants were randomly assigned to the experimental (n = 9) or control group (n = 11). Hospital Anxiety and Depression Scale was applied to patients on the first day of admission to the unit and on the day of discharge. Questions prepared by researchers on sleep quantity and quality were administered every day during the patients' hospitalization. The patients in the experimental group carried out creative arts intervention for a total of 60 minutes a day, 3 to 4 days a week, while they were in the unit.

RESULTS

There was no difference in depression, anxiety, and sleep quality scores between the groups after intervention. However, depression and anxiety scores significantly decreased after the intervention in the experimental group, and sleep quality scores improved significantly.

CONCLUSION

Creative arts intervention may be beneficial for anxiety, depression, and sleep problems among patients undergoing BMT.

IMPLICATIONS FOR PRACTICE

Creative arts intervention is effective in coping with anxiety, depression, and sleep problems that patients may experience due to social isolation during the BMT process.

Psychosocial interventions with art and music during stem cell transplantation: An integrative review

OBJECTIVES

The objective of this study is to systematically review the literature with the following aims: to survey the art and music interventions offered to the stem cell transplant population; to define the interventions' beneficial properties by conceptualising themes; to analyse these themes using behavioural activation principles as a lens and explore their value in alleviating isolation-related distress.

BACKGROUND

Patients undergoing stem cell transplant are at great risk of psychological morbidity, partly on account of prolonged hospital stays in protective isolation. This risk extends beyond discharge and into ambulatory care, negatively affecting quality-of-life and survival rates of the transplant recipients.

DESIGN

Integrative review methodology.

METHODS

A systematic search of 10 bibliographic databases was undertaken using terms relating to art, music and stem cell transplantation for the years 2012 to 2019. Records were assessed for quality and risk-of-bias using a critical appraisal tool and following the PRISMA Systematic Review checklist to guide reporting. Studies were analysed narratively and thematically.

RESULTS

The 16 papers were of mixed quality. Findings and treatment effects differed between and within studies. The beneficial attributes of the treatments were clustered and divided into two groups. The first consisted of intrinsic, patient-focussed factors: (1) Creative outlet or acquisition of a new skill; (2) achievement of normality; (3) mutual or peer-support; (4) relationship-building and (5) meaningful recreation, distraction and diversion. The second group considered extrinsic factors: (6) Improved communication; (7) enhanced spiritual care and (8) better healthcare experience.

CONCLUSIONS

Several art and music interventions have been attempted which were beneficial to patients and generated a sense of achievement, connection and enjoyment. The interventions appear to uphold the principles of person-centred holistic care and have potential to generate a high-quality, supportive healthcare and working environment.

RELEVANCE TO CLINICAL PRACTICE

Psychosocial interventions with art and music have improved the care and experience of patients undergoing stem cell transplant.

Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions

Art making has been adopted across multiple disciplines as a health intervention. However, our understanding of art making as a health intervention and how it differs from art therapy is still limited. Therefore, we conducted a concept analysis to better understand art making as a health intervention guided by Walker and Avant's approach. We examined 85 studies in which we found 4 defining attributes, 4 antecedents, and physical, cognitive, emotional, and psychological consequences. We suggest several nursing research and practical implications for nurse researchers and clinicians to aid in designing and implementing art making health interventions.

Does Creative Arts Therapy Improve Distressing Symptoms in Children with Cancer? A Synthesis of Extant Literature

Introduction: Children with cancer experience symptom distress which has been correlated with decreased quality of life (QOL). Creative arts therapy (CAT) encompasses the therapeutic use of creative arts which may improve QOL among children with cancer by affecting symptoms. Therefore, the research question was asked: Does CAT affect symptoms of pain, nausea, fatigue, anxiety, and mood in children with cancer? Methods: Based on the study question, a comprehensive literature search of PubMed, CINAHL, PsycINFO, and Embase was completed. Inclusion criteria limited articles to specific symptom outcomes in two-group intervention studies in the English language. Selected articles were confirmed for inclusion by the study team, followed by group discussion to develop matrices with levels of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation (Grade) guidelines. Results: Initial searches revealed 1,391 articles, screened to 44 for systematic review. Based on the inclusion criteria, 11 articles remained. Four studies had evidence levels graded as low, three were low to moderate, and four were moderate. Outcomes of mood and anxiety were measured in five studies, pain in four, fatigue in two, and nausea in one study. Discussion: Psychological outcomes were measured more commonly than physical outcomes. Evidence reached a moderate grade in four studies. Summary: Through this synthesis of intervention studies with CAT in children with cancer, improvement in distressing symptoms has potential, but the state of the science for symptom management with CAT could be strengthened for nurses to promote CAT to improve QOL among children with cancer.

Development of a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis

BACKGROUND

Patients with end-stage kidney disease who receive haemodialysis experience a protracted treatment regimen that can result in an increased risk of depression and anxiety. Arts-based interventions could address this unique issue; however, no arts-based interventions have been developed for delivery within a haemodialysis unit and evaluation within a randomised controlled trials (RCTs).

AIM

To develop a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis.

METHODS

The development process utilised the Arts in Health framework (Fancourt, 2017). The framework was addressed through the establishment of an interdisciplinary advisory group, collaboration and consultation with stakeholders, a scoping and realist review, shadowing of artists-in-residence, personal arts practice and logic modelling.

RESULTS

The intervention involved six 1-h long, one-to-one facilitated sessions focused on creative writing and visual art. Patients could choose between art form and self-select a subject matter. The sessions had a primary focus on skill development and were delivered using principles derived from the psychological theory of flow.

CONCLUSION

The Arts in Health framework provided an appropriate and pragmatic approach to intervention development. Complex arts-based interventions can be developed for the purpose of evaluation within a trial framework. This intervention was designed to strike a balance between standardised components, and a person-centred approach necessary to address existential boredom.

Creative Art Expression: Using Hand-Lettering Techniques to Reduce Stress and Anxiety in Patients With Cancer

A creative art expression intervention using hand lettering was implemented on an outpatient oncology unit and evaluated for feasibility and its relationship with stress and anxiety in patients with cancer. Results suggest that a hand lettering intervention is feasible in this type of setting and may benefit patients experiencing stress and anxiety during outpatient treatment.

A Retrospective Thematic Analysis of Patient, Family, and Staff Creative Art Tiles Developed on a Tertiary Palliative Care Unit

OBJECTIVES

Clinical use of the creative arts in palliative care is well established, yet there are few evaluation studies of these programs.

METHODS

In this first phase of a 3-phase evaluation of a creative arts program entitled "Tile Tales," we conducted a retrospective thematic analysis of 85 painted tiles and accompanying stories that were publically displayed on a tertiary palliative care unit. Each story was independently coded, using content analysis. Themes were derived through consensus, using the constant comparative method.

RESULTS

Tiles were created by staff (n = 36, 42%), family (n = 32, 38%), patients (n = 9, 11%), or patients and family (n = 8, 9%). Six major themes emerged from the artwork: "Spirituality," "Relationships," "Journey," "Story," "Symbolism," and "Paradox."

SIGNIFICANCE OF RESULTS

These results illustrate how the creative arts can support the expression of diverse palliative care experiences, for patients, their families and palliative care staff, when words alone may not suffice.

Creative Arts Therapy in the Context of Children With Cancer: A Concept Analysis

Aim: To report an analysis of the concept of creative arts therapy (CAT) in the context of pediatric cancer. Background: Literature supports the intuitive conclusion that creative interventions improve a patient's journey through the cancer trajectory. However, a new definition is needed to encompass CAT and creative expression interventions in order to better understand the concept of creativity in health care, specifically in pediatric oncology. Design: Concept analysis. Data Sources: The scientific databases CINAHL, PsycInfo (Ovid), AMED (Allied and Complementary Medicine), and PubMed were queried for English language research articles published between 2008 and 2018 using the search terms: creative arts therapy and cancer. Method: The Walker and Avant method of concept analysis was implemented. Results: CAT is a broad concept bringing creative arts in a therapeutic manner to children with cancer. Attributes include expression of feelings; creating art, music, or movement; and improvement of symptoms. CAT is frequently measured using quality of life and symptom assessment scales. Antecedents include the diagnosis of cancer, the distress caused by cancer, and a child's willingness to participate in creative activity. Consequences include improved quality of life, improved sense of well-being, decreased psychosocial symptoms, and less cancer pain. Conclusion: The literature supports CAT as a concept that may decrease distress for children with cancer.

A Qualitative Investigation of Swimming Experiences of Children With Autism Spectrum Disorders and Their Families

OBJECTIVE

To understand the swimming experience from the perspective of children with autism spectrum disorder (ASD) and their families.

METHODS

We interviewed 12 diverse families using a semi-structured interview with follow-up probing questions related to their swimming experiences. Interviews were transcribed verbatim and coded by researchers.

RESULTS

Themes included family water activities, safety, characteristics of ASD, instructional methods, swim skills, swimming preferences, barriers/challenges, and benefits of swimming. Findings indicate positive experiences and skill acquisition were prevalent when instructional methods matched a child's unique needs. Parents revealed they were more confident in safety as their children's swimming competence improved. Individualized instructional methods and unique characteristics of ASD may influence perceived safety.

Patient perceptions of a 1-h art-making experience during blood and marrow transplant treatment

Patients with various forms of cancer receiving blood and marrow transplant (BMT) treatment at an outpatient clinic develop chemotherapy-related symptoms and an increased desire to use complementary and alternative medicine in order to address these symptoms. Art-making offers an inexpensive way to pass time and relieve symptoms during long hours in treatment. Twenty-one BMT patients painted a tile and participated in research. Researchers used semi-structured interviews to understand patients' experiences with art-making. Interviews were recorded, transcribed and coded independently by researchers who met to agree on themes. Ten themes emerged from the data including, meaningful activity (32.2%), expression (18.7%), passing time (13.2%), BMT process (12.1%), social outlet (8.1%), therapy-related symptoms (7.3%), negative aspects of painting (5.9%) and encouragement to paint (2.6%). The results of this study revealed that art-making experience can provide patients a meaningful activity during treatment and an outlet to express their feelings.

The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis

Protective isolation is aimed at preventing infection in neutropenic patients, but it is implemented inconsistently across centres and is supported by recommendations with poor evidence. This review and metasynthesis explored the experiences and the psychological implications of protective isolation in patients with haematological malignancies undergoing bone marrow (BMT) or haematopoietic stem cell transplantation (HSCT). A systematic search of multiple databases for qualitative studies exploring BMT or HSCT patients' experiences of protective isolation was completed. The metasynthesis followed the meta-aggregative method from the Joanna Briggs Institute, with four procedural steps: (1) comprehensive search, (2) quality appraisal, (3) extraction of relevant findings and (4) synthesis of the identified findings. Twenty-six findings were extracted from 11 articles included in the review. The synthesising process yielded seven categories, aggregated into three synthesised findings: (1) isolation is a source of suffering, (2) isolation can lead to relating with oneself and (3) the person does not close the door to the outside world. This metasynthesis sheds light on patients' suffering from being isolated, and the possibility of overcoming this suffering thanks to relationships that patients have with themselves and with the external world. Healthcare providers should reconsider this practise in order to avoid unnecessary patient suffering.