An Art Therapy Workbook for Pediatric Patients with Cancer Receiving Palliative Care: Program Design and Effects.

Purpose: This study aims to develop an art therapy workbook for pediatric patients with cancer receiving palliative care and evaluate its effects on anxiety and stress. Methods: A one-group pretest-posttest quasi-experimental design was employed. The art therapy workbook comprised six sessions structured along a sequence of introduction, emotional expression, and discovery of hope. Participants were pediatric patients with cancer receiving palliative care at S Hospital, affiliated with C University; data from 14 patients who completed at least five of the six sessions were analyzed. Anxiety and stress were assessed using the Numeric Rating Scale (NRS), and stress-coping ability was assessed using the Person-in-the-Rain (PITR) drawing test. Data were analyzed using the Wilcoxon signed-rank test. Results: Following application of the workbook, participants' anxiety (Z=-3.20, P<0.01) and stress (Z=-3.07, P<0.01) scores decreased significantly. Although the change in PITR scores was not statistically significant (Z=-0.81, P=0.42), counseling and drawing analyses confirmed that the children externalized helplessness and negative emotions associated with the illness and experienced positive psychological changes. Conclusion: The art therapy workbook was confirmed as a useful intervention for reducing anxiety and stress in pediatric patients with cancer receiving palliative care. As a flexible program that enables children with substantial physical limitations to express their emotions safely, it may serve as a psychosocial intervention model for children diagnosed with various illnesses in both clinical and home settings.