Arts in Medicine

Title: Arts in Medicine - Facilitator of Spiritual Transformation and Psychosocial Growth for Persons Dealing with a Life-Threatening Illness?

Purpose: The goal of the proposed quantitative/qualitative study is to test (a) if creative arts/guided imagery interventions for patients with advanced cancer and their primary informal caregivers will promote spiritual transformation and psychosocial growth in both patients and caregivers; (b) if a high intensity intervention is more effective than a low intensity intervention; and (c) if spiritual transformation and psychosocial growth will lead to better social relationships, enhanced subjective well-being, more accepting attitudes toward death and, ultimately, a better dying experience of the cancer patients. Spiritual transformation and psychosocial growth are conceptualized as increases in wisdom, spirituality, personal growth, self-acceptance, forgiveness, purpose in life, and mastery. Dying well is defined as conveying positive and accepting attitudes toward death, being able to cope with physical pain, having made peace with God and the world, having given and asked for forgiveness, feeling the love and support of others, and being calm and content when death approaches.

Significance and potential impact: The end of life can either be a depressing, painful, and isolating experience or a time of great love and beauty. When a person experiences spiritual transcendence, the individual's experience of death is transformed and a spiritual healing can take place. Based on a previous qualitative study by one of the Co-PI's, we propose that a high-intensity creative arts/guided imagery intervention will lead to spiritual transformation, psychosocial growth, and, ultimately, a better dying experience for both advanced cancer patients and their loved ones. The study is also designed to yield quantitative comparisons between a cheap and simple intervention (listening to a generic guided imagery tape at least twice a week) and a potentially more beneficial, complex, and expensive creative arts/guided imagery program, which could prove useful in future resource allocation decisions.

Methodology: Patients, 21 years or older, with advanced cancer and a life expectancy of 12 months or less and their primary informal caregivers will be recruited through the University of Florida Cancer Center. Ninety ambulatory patients and their primary caregivers will be enrolled in the study in less than two years by inviting all eligible patients and their primary caregiver to participate in a creative arts/guided imagery program. Patient-caregiver dyads will be randomly assigned in equal numbers to either a low- or high-intensity intervention. All participants will be taught the practice of guided imagery by a guided imagery therapist. The 30-minute session will be audio-recorded, and the tape will be given to participants for their personal use. The low-intensity control group will be encouraged to listen to the tape at least twice a week for six weeks. The high-intensity experimental group will be visited by artists from the Shands Arts-in-Medicine Program at the University of Florida one or two times a week for a total of six weeks at the patient's place of residence. Each visit will last approximately 90 minutes and will start with 10 minutes of guided imagery practice. The subsequent creative arts session will be individualized to the participants' needs, and artist will offer participants a choice of music, visual arts, journaling, or dance that they can either actively participate in or passively watch the artist perform. Both low- and high-intensity intervention groups will be interviewed by blinded interviewers using a standardized questionnaire through face-to-face interviews at baseline and again seven weeks after the initial guided imagery intervention. Shortly after the posttest, semi-structured qualitative interviews with patients and caregivers will be conducted that will inquire about their experiences with the creative arts process. In addition, the primary informal caregiver will be asked to notify the research team after the death of the patient to give information about the circumstances of the death and how exactly the patient died. The quantitative data will be analyzed using repeated measurement MANOVA, ANOVA, correlation, multivariate regression, and latent variable analyses. The transcribed semi-structured qualitative interviews will be analyzed through Van Manen's method of phenomenological hermeneutic. The primary purpose of the analyses will be to examine if cancer patients from the experimental group did indeed experience greater spiritual transformation and psychosocial growth and were more likely to die well than did cancer patients from the control group.

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