Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care.
Aim:
To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice.
Design:
A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes.
Data sources:
PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed.
Results:
Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice.
Conclusion:
Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists’ engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.
SepúlvedaCMarlinAYoshidaT, et al. Palliative care: the World Health Organization’s global perspective. J Pain Symptom Manag2002; 24(2): 91–96.
2.
KnaulFMBhadeliaARodriguezNM, et al. The Lancet Commission on palliative care and pain relief—findings, recommendations, and future directions. Lancet Glob Health2018; 6: S5–S6.
3.
MeierDEBrawleyOW. Palliative care and the quality of life. J Clin Oncol2011; 29(20): 2750–2752.
4.
LongCO. Cultural and spiritual considerations in palliative care. J Pediatr Hematol Oncol2011; 33(Suppl. 2): S96–S101.
5.
RomanoffBDThompsonBE. Meaning construction in palliative care: the use of narrative, ritual, and the expressive arts. Am J Hosp Palliat Med2006; 23(4): 309–316.
6.
CharmazK. Measuring pursuits, marking self: meaning construction in chronic illness. Int J Qual Stud Health Well Being2006; 1(1): 27–37.
7.
GreerJAApplebaumAJJacobsenJC, et al. Understanding and addressing the role of coping in palliative care for patients with advanced cancer. J Clin Oncol2020; 38(9): 915–925.
8.
HensonLAMaddocksMEvansC, et al. Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol2020; 38(9): 905–914.
FancourtDFinnS. What is the evidence on the role of the arts in improving health and well-being? A scoping review. Copenhagen: WHO Regional Office for Europe, 2019.
11.
FancourtDOckelfordABelaiA. The psychoneuroimmunological effects of music: a systematic review and a new model. Brain Behav Immun2014; 36: 15–26.
12.
BungayHCliftS. Arts on prescription: a review of practice in the UK. Perspect Public Health2010; 130(6): 277–281.
13.
FancourtDWarranKFinnS, et al. Psychosocial singing interventions for the mental health and well-being of family carers of patients with cancer: results from a longitudinal controlled study. BMJ Open2019; 9(8): e026995.
14.
World Health Organization. Intersectoral action: the arts, health, and wellbeing. Government brief. WHO Website. Copenhagen: Regional Office for Europe, 2019.
15.
WrefordG. The state of arts and health in Australia. Arts Health2010; 2(1): 8–22.
16.
CliftSM. CamicPChapmanB, et al. The state of arts and health in England. Arts Health2009; 1(1): 6–35.
17.
CoxSMLafrenièreDBrett-MacLeanP, et al. Tipping the iceberg? The state of arts and health in Canada. Arts Health2010; 2(2): 109–124.
18.
SonkeJRollinsJBrandmanR, et al. The state of the arts in healthcare in the United States. Arts Health2009; 1(2): 107–135.
19.
PengCSBaxterKLallyKM. Music intervention as a tool in improving patient experience in palliative care. Am J Hosp Palliat Med2019; 36(1): 45–49.
20.
AndersonKGCLangleyJO’BrienK, et al. Examining the artist–patient relationship in palliative care. A thematic analysis of artist reflections on encounters with palliative patients. Arts Health2019; 11(1): 67–78.
21.
CallawayMVConnorSRFoleyKM. World Health Organization public health model: a roadmap for palliative care development. J Pain Symptom Manag2018; 55(2S): S6–S13.
22.
World Health Organization. Strengthening of palliative care as a component of integrated treatment throughout the life course. J Pain Palliat Care Pharmacother2014; 28(2): 130–134.
23.
HartleyN. End of life care: a guide for therapists, artists and arts therapists. London: Jessica Kingsley Publishers, 2013.
24.
ButchersADobbsSSandsM, et al. The creative arts in palliative care. London: Jessica Kingsley Publishers, 2008.
25.
JarrettL. (ed.) Creative engagement in palliative care: new perspectives on user involvement. Oxford: Radcliffe Publishing, 2007.
26.
RollinsJARiccioLL. Art is the heart: a palette of possibilities for hospice care. Pediatr Nurs2002; 28(4): 355–363.
27.
CarswellCReidJWalshI, et al. A mixed-methods feasibility study of an arts-based intervention for patients receiving maintenance haemodialysis. BMC Nephrol2020; 21(1): 497–506.
28.
CarswellCReidJWalshI, et al. Complex arts-based interventions for patients receiving haemodialysis: a realist review. Arts Health2021; 13(2): 107–133.
29.
FancourtDWilliamonACarvalhoLA, et al. Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. Ecancermedicalscience2016; 10: 631.
30.
PearsonJStansfieldK. P-1 Arts and palliative care at the prince and princess of wales hospice. BMJ Support Palliat Care2015; 5(Suppl. 3): A1.1–A1.
31.
HaraldsdottirEChristieLMcArthurJ. P-12 Art and hospice care-building a strategic relationship. BMJ Support Palliat Care2015; 5(Suppl. 3): A4.3–A5.
32.
DileoCBradtJ. On creating the discipline, profession, and evidence in the field of arts and healthcare. Arts Health2009; 1(2): 168–182.
33.
BroderickS. Arts practices in unreasonable doubt? Reflections on understandings of arts practices in healthcare contexts. Arts Health2011; 3(2): 95–109.
34.
RawALewisSRussellA, et al. A hole in the heart: confronting the drive for evidence-based impact research in arts and health. Arts Health2012; 4(2): 97–108.
35.
MossHO’NeillD. What training do artists need to work in healthcare settings?Med Humanit2009; 35(2): 101–105.
36.
SonkeJ. Professionalizing the arts in healthcare field. In: LambertP (ed) Managing arts programs in healthcare. London and New York: Routledge, 2015, pp.50–62.
37.
WhiteM. Developing guidelines for good practice in participatory arts-in-health-care contexts. J Appl Arts Health2010; 1(2): 139–155.
38.
HastwellR. Strengthening the links between arts, education and health promotion: a case for building the capacity of artists to work across sectors. Int J Arts Soc2012; 6(5): 243–258.
WhittemoreR. Combining evidence in nursing research: methods and implications. Nurs Res2005; 54(1): 56–62.
41.
WhittemoreR. Rigour in integrative reviews. In: WebbCRoeB (eds) Reviewing research evidence for nursing practice: systematic reviews. Oxford: Blackwell Publishing, 2008, pp.149–156.
42.
CooperHM. Scientific guidelines for conducting integrative research reviews. Rev Educ Res1982; 52(2): 291–302.
43.
MoherDShamseerLClarkeM, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev2015; 4(1): 1.
44.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6(7): e1000097.
45.
PageMJMoherDBossuytPM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ2021; 372: n160.
46.
HawkerSPayneSKerrC, et al. Appraising the evidence: reviewing disparate data systematically. Qual Health Res2002; 12(9): 1284–1299.
47.
PluyePGagnonMPGriffithsF, et al. A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed studies reviews. Int J Nurs Stud2009; 46(4): 529–546.
48.
PommeretSChruscielJVerlaineC, et al. Music in palliative care: a qualitative study with patients suffering from cancer. BMC Palliat Care2019; 18(1): 78.
49.
SindingCGrayRFitchM, et al. Staging breast cancer, rehearsing metastatic disease. Qual Health Res2002; 12(1): 61–73.
50.
Sánchez-CamusR. The art of dying: aesthetics and palliative care. J Appl Arts Health2011; 2(2): 155–164.
51.
KennettCE. Participation in a creative arts project can foster hope in a hospice day centre. Palliat Med2000; 14(5): 419–425.
52.
McLoughlinD. Transition, transformation and the art of losing: some uses of poetry in hospice care for the terminally ill. Psychodyn Couns2000; 6(2): 215–234.
53.
SonkeJPesataVLeeJB, et al. Nurse perceptions of artists as collaborators in interprofessional care teams. Healthcare2017; 5(3): 50.
54.
ArmstrongMKupeliNFlemmingK, et al. Complementary therapy in palliative care: a synthesis of qualitative and quantitative systematic reviews. Palliat Med2020; 34(10): 1332–1339.
55.
VedelIKaurNHongQN, et al. Why and how to use mixed methods in primary health care research. Fam Pract2019; 36(3): 365–368.
56.
WatkinsDGioiaD. Mixed methods research. New York: Oxford University Press, 2015.
57.
GallagherA. A pilot evaluation of the arts for life project in end-of-life care. Nurs Stand2008; 22(50): 42–46.
58.
CollinsAAyreSBrulotteT, et al. A retrospective thematic analysis of patient, family, and staff creative art tiles developed on a tertiary palliative care unit. Am J Hosp Palliat Med2021; 38: 266–275.
59.
CollinsA. “It’s very humbling”: the effect experienced by those who facilitate a legacy project session within palliative care. Am J Hosp Palliat Med2019; 36(1): 65–71.
60.
O’CallaghanCByrneLCokalisE, et al. “Life within the person comes to the fore”: pastoral workers’ practice wisdom on using arts in palliative care. Am J Hosp Palliat Med2018; 35(7): 1000–1008.
61.
TeesBBuddJ. The sound of spiritual care: music interventions in a palliative care setting. J Pastoral Care Counsel2011; 65(1): 1–10.
62.
HansenBWErlandssonLKLeufstadiusC. A concept analysis of creative activities as intervention in occupational therapy. Scand J Occup Ther2021; 28: 63–77.
63.
La CourKJosephssonSTishelmanC, et al. Experiences of engagement in creative activity at a palliative care facility. Palliat Support Care2007; 5(3): 241–250.
64.
FerrellBViraniRJacobsHH, et al. Arts and humanities in palliative nursing education. J Pain Symptom Manag2010; 39(5): 941–945.
65.
CentenoCRobinsonCNoguera-TejedorA, et al. Palliative care and the arts: vehicles to introduce medical students to patient-centred decision-making and the art of caring. BMC Med Educ2017; 17(1): 257.
66.
MurrantGMRykovMAmoniteD, et al. Creativity and self-care for caregivers. J Palliat Care2000; 16(2): 44–49.
67.
GlenisterD. Creative spaces in palliative care facilities: tradition, culture, and experience. Am J Hosp Palliat Med2012; 29(2): 89–92.
68.
SalzanoATLindemannETronskyLN. The effectiveness of a collaborative art-making task on reducing stress in hospice caregivers. Arts Psychother2013; 40(1): 45–52.
69.
BurnsideLDKnechtMJHopleyEK, et al. Here: now - conceptual model of the impact of an experiential arts program on persons with dementia and their care partners. Dementia2017; 16(1): 29–45.
70.
RobertsonJMMcCallV. Facilitating creativity in dementia care: the co-construction of arts-based engagement. Ageing Soc2020; 40(6): 1155–1174.
71.
CousinsETischlerVGarabedianC, et al. A taxonomy of arts interventions for people with dementia. Gerontologist2020; 60(1): 124–134.
72.
WestheimerOMcRaeCHenchcliffeC, et al. Dance for PD: a preliminary investigation of effects on motor function and quality of life among persons with Parkinson’s disease (PD). J Neural Transm2015; 122(9): 1263–1270.
73.
BekJArakakiAILawrenceA, et al. Dance and parkinson’s: a review and exploration of the role of cognitive representations of action. Neurosci Biobehav Rev2020; 109: 16–28.
74.
BrookJBoothA. May I have this dance: examining a community based dance program for people living with Parkinson’s disease. Res Dance Educ. Epub ahead of print 26 November 2020. DOI: 10.1080/14647893.2020.1853693.
75.
HadleyREastwood-GrayOKiddierM, et al. “Dance like nobody’s watching”: exploring the role of dance-based interventions in perceived well-being and bodily awareness in people with Parkinson’s. Front Psychol2020; 11: 531567.
76.
UlmanABakerNThakkerJ, et al. Dance, cognitive outcomes and Parkinson’s disease (PD)—a scoping review. Am J Occup Ther2020; 74(4 Suppl. 1): 7411515354p1.
77.
BrueraEWilleyJCohenM, et al. Expressive writing in patients receiving palliative care: a feasibility study. J Palliat Med2008; 11(1): 15–19.
78.
MosherCEJohnsonCDicklerM, et al. Living with metastatic breast cancer: a qualitative analysis of physical, psychological, and social sequelae. Breast J2013; 19(3): 285–292.
79.
LowCAStantonALBowerJE, et al. A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer. Health Psychol2010; 29(4): 460–466.
80.
MiaskowskiCPaulSMSnowbergK, et al. Stress and symptom burden in oncology patients during the COVID-19 pandemic. J Pain Symptom Manag2020; 60(5): e25–e34.
81.
The Lancet. Palliative care and the COVID-19 pandemic. Lancet2020; 395(10231): 1168.
82.
IobEFrankPSteptoeA, et al. Levels of severity of depressive symptoms among at-risk groups in the UK during the COVID-19 pandemic. JAMA Netw Open2020; 3(10): e2026064.
83.
MakHWFluhartyMFancourtD. Predictors and impact of arts engagement during the COVID-19 pandemic: analyses of data from 19,384 adults in the COVID-19 social study. Front Psychol2021; 12: 62–63.
84.
PhilipKELewisAJefferyE, et al. Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial. BMJ Open Respir Res2020; 7(1): e000737.
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