Outcomes of collage art-based and narrative self-expression among home hospice caregivers

ABSTRACT

Aims: This mixed methods quasi-experimental study examined the outcomes of a brief art therapy-based and a narrative interview-based intervention to address the psychosocial needs of home hospice caregivers.

Methods: Participants (n = 14) chose to participate either in a narrative interview (n = 7) or arts-based interview (n = 7). Standardised self-report measures of affect, spiritual well-being, perceived stress, and self-efficacy and physiological markers of stress(salivary cortisol) and social/emotional connection (oxytocin levels) were collected before and after intervention sessions.

Results: Qualitative findings indicated that caregivers (a) recognized their need for reducing stress and isolation; (b) experienced a learning curve related to illness and hospice care; (c) engaged in existential reflections on purpose and values; and were (d) living through progressive grief and loss. Quantitative findings indicated that the narrative condition group experienced improved spiritual well-being and negative affect. Both conditions were followed by improved positive affect. There were no statistically significant changes in salivary cortisol or oxytocin for either condition.

Conclusion: The results suggest that caregivers might need longer term interventions for sustained changes.

Implications for further research: Further research is needed to examine the role of narrative and visual self-expression among home hospice caregivers. Study limitations included a small non-randomised sample, lack of transcribed interview data, and incomplete survey and biomarker data.

Plain-language summary

This study examined the outcomes of an art therapy-based and a narrative intervention to address the mental, physical, and spiritual needs of family caregivers of patients at the end of life. Seven caregivers completed a therapeutic narrative interview in which caregivers shared their experiences, challenges, and sources of strength. Seven caregivers completed a collage art- based session in which they were invited to make a collage using a range of precut magazine collage images while sharing their experiences, challenges, and sources of strength as caregivers. Measures of stress (cortisol) and social/emotional connection (oxytocin) were collected before and after intervention sessions.

Findings indicated that caregivers appreciated the opportunity for self-expression in both the narrative and the art-based conditions. Caregivers in the narrative condition group trended toward improvement in spiritual well-being and in reversing negative mood. Both conditions indicated a trend toward improved positive mood. Findings indicated that caregivers were consistently stressed and often isolated due to their roles. Four recurring themes were found within the qualitative data for caregivers in both conditions: (a) recognition and reduction of stress and isolation; (b) learning curve related to illness and hospice care; (c) existential reflections on death and living out values; and (d) living through progressive grief and loss.

The preliminary quantitative findings suggest that narrative therapeutic approaches might be better suited for spiritual well-being. Caregivers in the narrative condition group demonstrated more improvement in spiritual well-being than those in the arts-based condition group. This finding may be the result of the format of the narrative condition in which caregivers reflected on existential concerns. In contrast, the structure of the art-making condition may have resulted in a focus on the present moment.

KEYWORDS:

• Art therapy
• hospice care
• narratives
• family caregivers

Acknowledgements

We would like to acknowledge Ms. Pamela Fried for her assistance in editing the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on contributors

Girija Kaimal, led the study design, data collection, qualitative data analysis and writeup for the study.

Janell L. Mensinger, did the data analysis and write up of quantitative results.

Katrina Carroll-Haskins, helped with qualitative data analysis and write up of the literature review.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The study was funded by the Foundation for Spirituality and Medicine (https://www.foundationspiritmed.com/) and a Doctoral Student fellowship to author KC-H from Drexel University .