Impact of a Single Art Therapy Session on Mood and Symptom Burden in Palliative Care

Evaluating the Impact of a Single Art Therapy Session on Mood and Symptom Burden in Palliative Care Patients

The goal of this observational study is to explore whether a single art therapy session can improve mood and reduce symptom burden in adult palliative care patients at a Canadian inpatient unit. The main questions it aims to answer are:

• Does a single art therapy session reduce overall symptom burden, as measured by the Edmonton Symptom Assessment System (ESAS)?
• Does a single art therapy session improve mood, as measured by the Positive and Negative Affect Schedule (PANAS)?

Participants will:

• Complete two short questionnaires (ESAS and PANAS) before and after the session
• Participate in a 30-60 minute individual art therapy session

Study Overview

• Status: Enrolling by invitation
• Conditions: Pain; Anxiety; Emotional Distress
• Intervention / Treatment: Behavioral: Single Art Therapy Session

Detailed Description

This is a single-centre, prospective, observational pre-post study conducted at the QEII Health Sciences Centre, VG, 7A Palliative Care Unit. The aim is to evaluate whether a one-time, individualized art therapy session can positively impact emotional well-being and symptom distress in adults receiving inpatient palliative care.

Participants will be approached by the charge nurse and invited to participate if they meet the eligibility criteria. Following informed consent, participants will complete two validated self-report tools: the Edmonton Symptom Assessment System (ESAS) and the Positive and Negative Affect Schedule (PANAS). These assessments will be administered immediately before and again immediately after a 30-60 minute art therapy session, which will include open-ended creative engagement using simple materials such as watercolor and pastels.

The Study Objectives are:

1. To determine whether participation in a structured art therapy session improves mood and symptom burden in palliative care patients
2. Examine whether engagement in coloring activities influences emotional well-being as measured by the Positive and Negative Affect Schedule (PANAS) and symptom burden as measured by the Modified Edmonton Symptom Assessment System (ESAS).
3. Is there a difference in as-needed (PRN) opioid, benzodiazepine, and Z drug use in the 48 hours before and after the session
4. Examine whether specific patient characteristics, such as primary diagnosis or time from admission to intervention, impact the observed effects.

All data will be de-identified and analyzed descriptively and inferentially to assess trends in mood and symptom change following the intervention. This study does not involve randomization or a control group. It is designed to inform future research and program development in supportive care interventions within palliative settings.

• Study Type: Observational
• Enrollment (Estimated): 20

Contacts and Locations

Study Locations

• Canada
  • Nova Scotia
    • Halifax, Nova Scotia, Canada, B3H 1V7
      • Nova Scotia Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Palliative Care In-Patients at the VG, 7A Palliative Care Unit

Description

Inclusion Criteria:

• inclusion if they are adults (=18 years old)
• admitted to the PCU
• have the ability to communicate
• complete self-assessments with or without facilitator assistance
• possess the ability to engage in a 30-60 minute art therapy session

Exclusion Criteria:

• Patients will be excluded if they are under 18 years of age
• within 48hrs of admission or discharge
• experiencing severe cognitive impairment, uncontrolled symptoms, or delirium.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Positive and Negative Affect Scores Measured by PANAS Before and After Art Therapy	The Positive and Negative Affect Schedule (PANAS) will be administered immediately before and immediately after a single art therapy session. PANAS is a self-reported 20-item scale measuring two mood domains: positive affect (10 items) and negative affect (10 items). Each item is rated on a scale from 1 (very slightly or not at all) to 5 (extremely), with subscale scores ranging from 10 to 50. Higher positive affect scores indicate more positive mood; higher negative affect scores indicate more distress.	Immediately before and immediately after the art therapy session
Change in Symptom Burden Measured by Modified ESAS Before and After Art Therapy	The Edmonton Symptom Assessment System (ESAS) will be used to assess physical and emotional symptom burden immediately before and immediately after the art therapy session. ESAS consists of 9 core symptoms (e.g., pain, fatigue, nausea, anxiety, depression) each rated on a numeric scale from 0 (none) to 10 (worst possible severity). A total symptom score is calculated as the sum of all items, with higher scores indicating greater symptom burden. We will be using a modified version that does not include nausea, drowsiness, loss of appetite and dyspnea. The symptom "sadness" will be added to our assessment.	Immediately before and immediately after the art therapy session

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in PRN Opioid Use in the 48 Hours Before and After Art Therapy	The total dosage (mg), number of doses, medication type, and route of administration of PRN opioid medications (e.g., hydromorphone, morphine) will be extracted from the medical chart for each participant for the 48 hours before and the 48 hours after the art therapy session. Data will be converted to oral morphine equivalents as applicable. Data will be analyzed to assess changes in frequency or total daily dose following the intervention.	48 hours before and 48 hours after the art therapy session
Changes in PRN Benzodiazepine and Z-Drug Use in the 48 Hours Before and After Art Therapy	The total dosage (mg), number of doses, medication type, and route of administration of PRN benzodiazepines (e.g., lorazepam) and Z-drugs (e.g., zopiclone) will be recorded from participant medical charts for the 48 hours before and after the art therapy session. Data will be analyzed to assess changes in frequency or total daily dose following the intervention.	48 hours before and 48 hours after the art therapy session

Collaborators and Investigators

• Sponsor: Nova Scotia Health Authority
• Collaborators: Dalhousie University
• Investigators: Study Chair: Caitlin Lees, MA, MSc, MD, FRCPC, Nova Scotia Health Authority; Principal Investigator: Jonathan Clements, BSc, Dalhousie University; Study Chair: Lindsay Flinn, MD, CCFP (PC), Nova Scotia Health Authority

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): August 1, 2026

Study Registration Dates

• First Submitted: March 31, 2025
• First Submitted That Met QC Criteria: April 10, 2025
• First Posted (Actual): April 11, 2025

Study Record Updates

• Last Update Posted (Actual): February 17, 2026
• Last Update Submitted That Met QC Criteria: February 13, 2026
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: quality of life; Palliative; art therapy; End of life
• Additional Relevant MeSH Terms: Neurologic Manifestations; Mental Disorders; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Anxiety Disorders; Death
• Other Study ID Numbers: 2025060172580

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No