ABSTRACT Aims: This mixed methods quasi-experimental study examined the outcomes of a brief art therapy-based and a narrative interview-based intervention to address the psychosocial needs of home hospice caregivers. Methods: Participants (n = 14) chose to participate either in a narrative interview (n = 7) or arts-based interview (n = 7). Standardised self-report measures of affect, spiritual well-being, perceived stress, and self-efficacy and physiological markers of stress(salivary cortisol) and social/emotional connection (oxytocin levels) were collected before and after intervention sessions. Results: Qualitative findings indicated that caregivers (a) recognized their need for reducing stress and isolation; (b) experienced a learning curve related to illness and hospice care; (c) engaged in existential reflections on purpose and values; and were (d) living through progressive grief and loss. Quantitative findings indicated that the narrative condition group experienced improved spiritual well-being and negative affect. Both conditions were followed by improved positive affect. There were no statistically significant changes in salivary cortisol or oxytocin for either condition. Conclusion: The results suggest that caregivers might need longer term interventions for sustained changes. Implications for further research: Further research is needed to examine the role of narrative and visual self-expression among home hospice caregivers. Study limitations included a small non-randomised sample, lack of transcribed interview data, and incomplete survey and biomarker data. Plain-language summary This study examined the outcomes of an art therapy-based and a narrative intervention to address the mental, physical, and spiritual needs of family caregivers of patients at the end of life. Seven caregivers completed a therapeutic narrative interview in which caregivers shared their experiences, challenges, and sources of strength. Seven caregivers completed a collage art- based session in which they were invited to make a collage using a range of precut magazine collage images while sharing their experiences, challenges, and sources of strength as caregivers. Measures of stress (cortisol) and social/emotional connection (oxytocin) were collected before and after intervention sessions. Findings indicated that caregivers appreciated the opportunity for self-expression in both the narrative and the art-based conditions. Caregivers in the narrative condition group trended toward improvement in spiritual well-being and in reversing negative mood. Both conditions indicated a trend toward improved positive mood. Findings indicated that caregivers were consistently stressed and often isolated due to their roles. Four recurring themes were found within the qualitative data for caregivers in both conditions: (a) recognition and reduction of stress and isolation; (b) learning curve related to illness and hospice care; (c) existential reflections on death and living out values; and (d) living through progressive grief and loss. The preliminary quantitative findings suggest that narrative therapeutic approaches might be better suited for spiritual well-being. Caregivers in the narrative condition group demonstrated more improvement in spiritual well-being than those in the arts-based condition group. This finding may be the result of the format of the narrative condition in which caregivers reflected on existential concerns. In contrast, the structure of the art-making condition may have resulted in a focus on the present moment.

中文翻译：

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家庭临终关怀护理人员基于拼贴艺术和叙事性自我表达的结果

摘要目的：这项混合方法准实验研究检查了基于简短艺术治疗和基于叙事访谈的干预的结果，以解决家庭临终关怀护理人员的心理社会需求。方法：参与者 (n = 14) 选择参加叙述式访谈 (n = 7) 或基于艺术的访谈 (n = 7)。在干预之前和之后收集情绪、精神健康、感知压力、自我效能和压力生理指标（唾液皮质醇）和社会/情感联系（催产素水平）的标准化自我报告测量。结果：定性调查结果表明，护理人员 (a) 认识到他们需要减轻压力和孤立；(b) 经历了与疾病和临终关怀相关的学习曲线；(c) 对目的和价值观进行存在性反思；并且 (d) 生活在渐进的悲伤和失去中。定量研究结果表明，叙事条件组经历了改善的精神健康和负面影响。这两种情况都伴随着改善的积极影响。对于这两种情况，唾液皮质醇或催产素没有统计学上的显着变化。结论：结果表明，护理人员可能需要长期干预以实现持续变化。对进一步研究的启示：需要进一步研究来检验家庭临终关怀护理人员的叙事和视觉自我表达的作用。研究局限性包括非随机样本小、缺乏转录访谈数据以及不完整的调查和生物标志物数据。简明语言总结 本研究检查了基于艺术治疗和叙事干预的结果，以解决临终患者家庭护理人员的心理、身体和精神需求。七名护理人员完成了治疗性叙事访谈，护理人员分享了他们的经历、挑战和力量来源。七名护理人员完成了一个基于拼贴艺术的课程，他们被邀请使用一系列预剪的杂志拼贴图像制作拼贴画，同时分享他们作为护理人员的经验、挑战和力量来源。在干预之前和之后收集压力（皮质醇）和社会/情感联系（催产素）的测量值。调查结果表明，护理人员欣赏在叙事和基于艺术的条件下进行自我表达的机会。叙事条件组的照顾者倾向于改善精神健康和逆转消极情绪。这两种情况都表明积极情绪有改善的趋势。调查结果表明，照护者一直受到压力，并且经常因其角色而被孤立。在两种情况下的护理人员的定性数据中发现了四个反复出现的主题：(a) 识别和减轻压力和孤立；(b) 与疾病和临终关怀相关的学习曲线；(c) 对死亡和活出价值的存在反思；(d) 生活在渐进的悲伤和失去中。初步的定量研究结果表明，叙事治疗方法可能更适合精神健康。叙事条件组的照顾者比艺术条件组的照顾者在精神健康方面表现出更多的改善。这一发现可能是护理人员反映存在问题的叙述条件格式的结果。相比之下，艺术创作条件的结构可能导致了对当下时刻的关注。