Date of Award

Spring 5-17-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Expressive Therapies

First Advisor

Robyn Cruz, PhD

Second Advisor

Donna Owens, PhD

Third Advisor

Carlos Roldan, MD

Abstract

Considered the 6th vital sign, distress, a combination of hopelessness, anxiety, fear, and depression, can impact patients’ quality of life, treatment adherence, and mortality. While screening is required in oncological centers, distress remains under-detected. This study examined the use of Icanfeel, a novel digital art-based tool, to complement traditional psychometric assessments such as Edmonton Symptom Assessment System (ESAS), to support patients’ expressions of symptoms and distress detection. Hospitalized adult oncological patients (N = 22) engaged twice with Icanfeel and with an active control condition. At various time points during the protocol, patients self-reported symptom burden using ESAS, self-disclosure using the Distress Disclosure Index, and distress intensity using the Distress-Thermometer and Problem-List. In terms of feasibility, 80% of participants rated their use of Icanfeel positively and as accessible. Quantitatively, distress disclosure remained unchanged but a statistically significant reduction in reported symptom burden following Icanfeel sessions was observed (p < 0.001, effect size = 0.96). Qualitative findings highlighted the diverse ways patients used images as metaphors to articulate symptoms, with text/audio data categorized into adaptive, maladaptive, and neutral emotions. The novel integration of a scalable art-based intervention with standardized symptom assessments offered a nuanced understanding of distress expression. Limitations included a small and homogenous sample precluding generalization of results. Future research should expand the sample size and diversity, incorporate technological refinements such as AI-generated personalized imagery, and assess long-term effects on self-disclosure. Icanfeel aligns with trends in digitalized health and patient-centered innovation, emphasizing the importance of patient-reported outcomes in improving quality of care.

Creative Commons License

Creative Commons Attribution-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.

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