Date Presented 04/06/19
This study explored a 10-week, equine-facilitated program for cancer survivors living in the community. Unmounted horsemanship activities were followed by guided processing of emotions within a support group. Overall quality of life increased; however quantitative analysis was limited by small sample. Qualitative analysis revealed five themes of human-equine journey, human bond through shared experience, reclaiming positive emotions, nurturing resilience, and evolution of a new identity.
Primary Author and Speaker: Lynne Murphy
Additional Authors and Speakers: Brittany Goehmann, Heather Panczykowski
PURPOSE: Nearly 40% of Americans will battle cancer, resulting in decreased physical and mental health concerns, often unaddressed by traditional therapies, and limiting occupational performance. This study aimed to explore outcomes of an equine-facilitated program and experiences of participating cancer survivors. In addition, this study served to identify the potential role of occupational therapy in equine-facilitated programs.
DESIGN: This concurrent embedded mixed-methods pilot study utilized quantitative methods to examine quality of life, and qualitative methods to understand the lived experiences of four participants, recruited from a 10-week Healing with Horses program (mean age 62 years, mean time since diagnosis 3.7 years). Healing with Horses provides one hour of horsemanship activities followed by one hour of support group discussions facilitated by an equine specialist and oncology social worker. Horsemanship activities were graded from grooming and understanding equine behaviors to leading the horses through an obstacle course and interactive tasks. Occupational therapists conducted the research and will be adding occupation-based activities in future program sessions.
METHOD: Quantitative pretest and posttest instruments included the Functional Assessment of Cancer Therapy-General (FACT-G), which measured physical, social, emotional and functional well-being; and Psychosocial Distress Screening tool, a measure of physical and emotional distress developed by the National Cancer Institute. Paired sample t-tests examined statistically significant changes to well-being and distress, indicating quality of life. Qualitative data from weekly field notes and concluding interviews were examined by three researchers through three rounds of coding, following a phenomenological approach, to validate resulting themes.
RESULTS: There was a statistically significant difference in overall quality of life score of the FACT-G (t=-5.93 p=.01); however, small sample size limits validity of quantitative analysis. Five positive themes were identified. Human-equine journey described the change from apprehension and fear to bonded, supportive relationships between the horse and human. Human bond through shared experience centered on the reciprocal support and encouragement from others. Reclaiming positive emotions was either uplifting (i.e., optimism, energizing) or calming (i.e., spiritual, soothing). Nurturing resilience described perseverance through difficult events to attain a sense of accomplishment and overcome fear. Finally, evolution of a new identity was a process of a new sense of self (introspection), a social identity (connecting to others in new ways) and emotional freedom (embracing range of emotions). Participants described the ways they made these discoveries related to the horsemanship and support activities.
CONCLUSION: Although only one quantitative measure identified statistically significant improvement to quality of life, this lends support to ongoing research to address some of the study limitations. Identification of themes reflected meaningful outcomes to facilitate return to emotional and physical health for cancer survivors. Although literature explores challenges created by cancer, this study supports non-traditional equine-facilitated therapies that can address these problems. This research builds knowledge that support referrals, participation and funding for equine-facilitate cancer programs. In addition, it lends support to further study for the role of occupational therapy in animal-assisted therapies.
References
Cella, D., & Nowinski, C. J. (2002). Measuring quality of life in chronic illness: The functional assessment of chronic illness therapy measurement system. Archives of Physical Medicine and Rehabilitation, 83(Supplement 2), S10-S17. doi.org/10.1053/apmr.2002.36959
Hunter, E. G., Gibson, R. W., Arbesman, M., D’Amico, M. (2017b). Systematic review of occupational therapy and adult cancer rehabilitation: Part 2 impact of multidisciplinary rehabilitation and psychosocial, sexuality, and return-to-work interventions. American Journal of Occupational Therapy, 71(2), 7102100040, doi.org/10.5014/ajot.2017.023572
National Cancer Institute (2017a). Adjustment to Cancer: Anxiety and Distress (PDQ) – Health Professional Version. Retrieved from https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-hp-pdq
Parisi, A., Cerulli, C., De Santis, C., & Minganti, C. (2015) Equine-assisted therapy for breast-cancer survivors. Alternative and Complementary Therapies, 21(3), 147-148. doi:10.1089/act.2015.29006.cr
