Background: Family caregivers of cancer patients can often suffer as much distress as the patients themselves throughout the course of cancer treatment. They may experience a decrease in time spent in social activities, energy, emotional well-being and the ability to cope with stress. Conversely, their relationships with the patient and the rest of their family may improve as a result of the care giving. Literature has reported on the effectiveness of art therapy in relieving patients' stress and improving quality of life. However, it is unknown if a similar effect can be found for family caregivers of cancer patients.
Objectives: The objective of this review was to synthesize the best available evidence of the effects of art therapy for family caregivers of cancer patients.
Inclusion criteria: Types of participants
This review considered studies that included adult family caregivers, aged 18 years and above who provided care for a patient with cancer. A family caregiver can be defined as the person who is primarily responsible for the care of the patient.
Types of intervention(s)/phenomena of interest
This review considered all artwork-related activities; for example, a creative arts intervention, or an art-making class provided by either trained or untrained personnel.
Types of studies
This review considered all experimental study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies and before and after studies for inclusion.
Types of outcomes
This review considered studies that included anxiety, stress and emotional wellbeing as outcome measures.
Search strategy: The three-step search strategy aimed to find both published and unpublished studies in the following databases: Medline, CINAHL, Embase, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials, ProQuest Dissertations and Theses and the US National Institutes of Health, published between 2003 and 2013, as this review considered the most current evidence and with no language restrictions. Where studies published in languages other than English were deemed as potentially eligible for inclusion in the review, translation services were obtained. Initial keywords used were art therapy, family caregiver and neoplasm.
Methodological quality: Both studies were considered to be of moderate methodological quality, using a quasi-experimental (pre-post) study design. The data collection instruments were objective and reliable. Data analysis using paired samples t-tests was appropriate for this review.
Data collection: Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Data synthesis: Quantitative data was, where possible, pooled in statistical meta-analysis using the statistics software package StatDirect. Weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. No categorical data was used in this review. Where statistical pooling was not possible, the findings were presented in a narrative summary.
Results: A total of 1634 studies were identified using the search strategy outlined above. Only two studies were included in the review after the study selection of process. There were 109 participants included in the meta-analysis. The forest plot of the effect sizes for family caregiver anxiety level showed the pooled weighted mean difference = 4.83 (95% CI = 3.12 to 6.55), p<0.001. In addition, art therapy was found to reduce stress and increase positive emotion for family caregivers of cancer patients.
Conclusions: Art therapy was effective in reducing anxiety, stress and negative emotionality in family caregivers of patients with cancer. Further research using randomized controlled trials or qualitative research studies on the impact of art therapy in coping among family caregivers of cancer patients will add further insight to this field of research.