Walsh, S.M., Radcliffe, R.S., Castillo, L.C., Kumar, A.M., & Broschard, D.M. (2007). A pilot study to test the effects of art-making classes for family caregivers of patients with cancer. Oncology Nursing Forum, 34, 38.

To test the effects of art-making classes to reduce anxiety and stress among caregivers of patients with cancer

Art-making classes were offered as one part of an already established art program. The class involved with the research began with discussion of the study. Study participants completed self-report instruments and provided a saliva sample for cortisol testing. The art-making class was given over a two-hour period, and repeat questionnaires and saliva testing were done at the end of the session. Classes were delivered twice weekly by volunteer art interventionists in a residential facility. A variety of art-making projects were used in classes. Research team members attended each class and documented field notes during each session. Interventionists were trained in processes of caregiver experiences based on the end-of-life phase of experiential theory.

• The sample was comprised of 69 caregivers (80% female, 20% male).
• Mean caregiver age was 48 ± 14.47 (range = 18–81 years).
• Disease types of patients were not stated.
• Participants included Hispanics, Caucasians, Carribean Islanders, and individuals from other cultures.
• Of the sample, 75% were the primary caregiver of the patient, 41% had provided care for six months to one year, and 56% had high school formal education or less.

• Single site
• Other setting
• Miami, Florida, United States

• Late effects and survivorship
• Palliative care

A pretest/post-test quasi-experimental design was used.

• Beck Anxiety Inventory
• Salivary cortisol
• Field notes of participant comments

Anxiety measures showed a significant reduction in scores of the Beck Anxiety Inventory after the session, with preintervention of 7.28 ± 6.8 and postscore of 2.49 ± 4.5 (p < 0.01). No significant changes in cortisol level were reported. Field notes indicated that participants shared efforts, offered suggestions to each other, and became better acquainted. Numerous subjects refused to give samples for salivary cortisol.

Art-making classes appeared to produce a short-term reduction in anxiety level among caregivers of patients with cancer.

• The sample was small, with less than 100 participants.
• Risk of bias existed due to no control group, no binding, no random assignment, and no appropriate attentional control condition.
• Measurement validity and reliability are questionable.*
• Other/*explanation: Cortisol levels can be expected to vary according to time of day. No information is available about the time of specimen collection in the study, and it is not known whether all patients had art-making sessions at the same time of day. Pre- and postanxiety inventory measures showed high variability, suggesting that mean scores may not be representative of the group. No information is available about how many sessions people attended. Sessions were also attended by individuals who were not part of the study or who had refused to provide consent for participation. Although numerous subjects refused to give salivary samples, the authors did not say how many refused or discuss relevant missing data. The authors noted lack of funds for creative approaches used. It is not clear if changes in anxiety were truly due to the use of art in these sessions, or the support group type of interactions that occurred among participants.

Findings suggest that participation in art making may reduce anxiety among caregivers momentarily, and group participation can provide an avenue for supportive caregiver interactions.