The Effect of Art-Based Mandala on Mental Health in Bone Marrow Transplant Patients
Condition: Mental Health; Bone Marrow Cancer; ART
MeSH terms: Bone Marrow Neoplasms
Study type: Interventional

Summary: 
      According to the World Health Organization (WHO), health is not only a state of complete
      well-being in terms of illness and disability, but also physical mental and social
      well-being. Mental health, on the other hand, is a state of goodness in which the individual
      is aware of his own abilities, copes with the normal tensions of life, can work productively
      and efficiently and contributes to the society in which he lives.

      It has been shown in many studies that mental health problems negatively affect the existing
      disease process. For example, research shows an association between depression and anxiety
      and cardiovascular and cerebrovascular diseases . In the New York Health Survey, 10,000
      individuals representing 33 communities were surveyed by phone; it was found that the general
      health status of people who reported significant emotional distress was three times worse
      than those who did not report it .

      Realizing that mental health is more than just a disease will guide individuals and
      caregivers. Developing a more comprehensive clinical approach by focusing on a person's
      healthy, strengths, abilities and personal efforts is important in strengthening mental
      health. Applications for strengthening mental health include improving nutrition and housing
      conditions, increasing access to education, strengthening social networks, creating support
      environments.

      In the acceptance and stability therapy study of Bash and Dirik with cancer, it was
      determined that the negative psychological symptoms of the patients decreased and their
      expectations of life and quality of life increased. In another study , it was determined that
      the spiritual support practices provided to 150 individuals with breast cancer positively
      affected the state of spiritual, psychological and physical well-being.

      Cancer is a life-threatening disease that is common all over the world and affects the
      individual both physically and psychologically. Hematologic cancers are caused by bone
      marrow, the place of production of blood, and include diseases such as acute-chronic
      leukemias and multiple myelomas. Chemotherapy, radiotherapy, surgical methods in the
      treatment of hematologic cancers; hormonal and biological treatment and bone marrow
      transplantation (CIS) may be preferred.

      Among the applications aimed at strengthening mental health are art-based applications (music
      therapy, applications for visual arts-painting, painting, mandala, clay works, etc.),
      collage, carving, sculpture, poetry therapy, etc.) as subheadings for the creation of
      supportive environments. we come across it. When the literature is examined, it is stated
      that the participation of individuals with art-based applications increases the adaptation
      process, helps them to find the meaning of life, increases their awareness of cancer and
      their life, is better adapted to disease and treatment, their emotional expression is more
      effective, and the state of spiritual and psychological well-being improves positively .
      Art-based applications provide a significant reduction in anxiety levels in adult cancer
      patients ; health-related quality of life . In other studies with cancer patients, it was
      found that art therapy practices reduce the feeling of anxiety and depression and cause a
      significant increase in health-related quality of life, patients feel more valued and strong,
      self-esteem increases, interpersonal relationships develop and they are more social .
    

Detailed description: 
      There is a limited number of studies, it is emphasized that art-based applications should be
      used as a complementary medicine method in cancer patients, nurses who have the most contact
      with patients in the care dimension use art-based applications to diagnose and control the
      symptoms. The aim of this study is to investigate the effect of art-based mandala on mental
      health in CIS patients who are cancer patient groups.

      The research will be carried out at Istanbul University Istanbul Faculty of Medicine
      Department of Internal Medicine, Hematology Department Bone Marrow Service and Autologous
      Transplantation Unit.

      Bone Marrow Service, which has a six-bed and isolated service feature, has 1 specialist
      doctor, 1 assistant doctor and 10 clinical nurses and an average of 18 allogenic bone marrow
      transplants are performed annually.

      The twelve-bed Autologous Transplant Unit has 2 specialist doctors and 11 clinical nurses,
      and an average of 28 autologous transplants occur annually. Post-discharge complications are
      also monitored in the unit, which is not isolated service.

      The study will be conducted between 15 January 2022 and 31 December 2022. The G*Power 3.1
      program was used for power analysis calculations of the experimentally designed study. Taking
      into account Dogan's work, which is similar to the purpose and design of the study; the
      experimental group's desperation pretest score average of 5.05 (±3.72) to determine the
      sample size; final test score average 2.59 (±1.9); α margin of error: 0.05 and 1- β (power):
      0.80. In this way, the sample size was calculated as 42; however, taking into account factors
      such as not participating in the study, leaving the study, etc.; design effect:1.1 and the
      final sample size was determined as 46. 46 patients to be included in the study; It was
      randomized with the IBM SPSS v.21 package program.The data will be collected with Patient
      Information Form , External Thermometer , Spielberger Continuous Anxiety Inventory, Beck
      Desperation Scale and Diener Psychological Well-Being Scale.

      who are routinely scheduled for bone marrow transplantation are admitted to the unit one week
      before the transplant and treatment is started and transplantation is performed a week later.
      All patients in the intervention and control group will be filled out forms upon
      hospitalization after receiving their informed consent at the beginning of the study.
      Subsequently, patients in the intervention group will be given art-based mandala painting,
      which is sampled below, for 30 minutes for a week, accompanied by instrumental music
      featuring natural sounds in a room with light-heat control. Mandala painting templates and
      crayons will be provided by the researcher. The researcher will not intervene in any way
      other than time management during the preparation and painting of the environment. The
      researcher participated in training on art-based mandala and made preliminary preparations.

      No intervention will be made to the control group except for routine clinical applications.

      analysis of quantitative data obtained from the research will be done using IBM SPSS v.21
      package program. For descriptive statistics for variables, mean, standard deviation, number
      (n) percentage (%) representation, and square-square test will be used for relationships
      between categorical variables. All analyses will be evaluated in a 95% reliability range.
      P<0.05 criteria will be taken for meaningfulness in all statistical analyses.

      If the evaluation of both the experiment and the control group in the first interview, the
      comparison of evaluation scores before and after transplantation is provided with the
      assumption of normality, single-factor repetitive measurements are paired ANOVA test; if the
      assumption of normality is not provided, it will be examined by the Friedman test.

      Permission will be obtained from the Scientific Research and Publication Ethics Board of
      Sabahttin Zaim University in Istanbul in order to carry out the research. The necessary
      permission will be obtained from the Department of Hematology of istanbul University Istanbul
      Faculty of Medicine, Department of Internal Medicine, where the research will be carried out.
      Those who are willing to participate in the study will be informed before the study and
      written consent will be obtained from the individuals. Since personal data will be collected
      in the research, all necessary measures will be taken to protect personal data in accordance
      with the Personal Data Protection Law No. 6698 and related legislation, and all necessary
      obligations will be carefully fulfilled.
    

Intervention name(s): art-based mandala application
Intervention type(s): Other
Intervention description(s): Patients who are routinely scheduled for bone marrow transplantation are admitted to the unit one week before the transplant and treatment is started and transplantation is performed a week later. All patients in the intervention and control group will be filled out forms upon hospitalization after receiving their informed consent at the beginning of the study. Subsequently, patients in the intervention group will be given art-based mandala painting, which is sampled below, for 30 minutes for a week, accompanied by instrumental music featuring natural sounds in a room with light-heat control. Mandala painting templates and crayons will be provided by the researcher. The researcher will not intervene in any way other than time management during the preparation and painting of the environment. The researcher participated in training on art-based mandala and made preliminary preparations.
No intervention will be made to the control group except for routine clinical applications.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care