Writing toward well-being: A qualitative study of community-based workshops with breast cancer survivors

Roanne Thomas, Wendy Gifford, Chad Hammond


Transitioning to breast cancer survivorship can be challenging, yet there are few community-based supports. Writing is a promising psychosocial intervention, but most studies have evaluated independent writing. In contrast, our qualitative study (n=12) explored women’s experiences in a community-based workshop. The analysis of workshop recordings, journals, and interviews resulted in three themes: (a) Sharing in safe spaces, (b) Seeking permission and balance, and (c) Fear and uncertainty. The themes document unmet needs related to the emotional impact of breast cancer, as well as the potential of community-based writing to enhance well-being. Such programs may address gaps in cancer survivorship care by providing safe spaces for emotional expression, while supporting participants in the crafting of new narratives focused on well-being.

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Barone, T., & Eisner, E.W. (2012). Arts based research. Thousand Oaks, CA: Sage Publications.

Boyes, A.W., Girgis, A., D’Este, C., & Zucca, A.C. (2012). Prevalence and correlates of cancer survivors’ supportive care needs 6 months after diagnosis: A population-based cross-sectional study. BMC Cancer, 12, 150. doi:10.1186/1471-2407-12-150

Bultz, B.D., & Johansen, C. (2011). Screening for distress, the 6th vital sign: Where are we, and where are we going? Psycho-Oncology, 20(6), 569–571. doi:10.1002/pon.1986

Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health and Illness, 4(2), 167–182. doi:10.1111/1467-9566.ep11339939

Camic, P.M. (2008). Playing in the mud: Health psychology, the arts and creative approaches to health care. Journal of Health Psychology, 13(2), 287–298. doi:10.1177/1359105307086698

Canadian Cancer Statistics. (2015). Special topic: Predictions of the future burden of cancer in Canada. Retrieved from http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2015-EN.pdf?la=en

Collie, K., Bottorff, J.L., & Long, B.C. (2006). A narrative view of art therapy and art making by women with breast cancer. Journal of Health Psychology, 11(5), 761–775. doi:10.1177/1359105306066632

Cox, S.M., Lafrenière, D., Brett-MacLean, P., Collie, K., Cooley, N., Dunbrack, J., & Frager, G. (2010). Tipping the iceberg? The state of arts and health in Canada. Arts & Health, 2(2), 109–124. doi:10.1080/17533015.2010.481291

Fitch, M., Ristovski-Slijepcevic, S., Scalzo, K., Bennie, F., Nicoll, I., & Doll, R. (2009). Cancer survivorship: Creating a national agenda. Cancer Oncology Nursing Journal, 19(2), 55–59.

Frank, A. (1995). The wounded storyteller: Body, illness, and ethics. Chicago, IL: University of Chicago Press.

Haltiwanger, E., Rojo, R., & Funk, K. (2011). Living with cancer: Impact of expressive arts. Occupational Therapy in Mental Health, 27(1), 65–86.

Holland, J.C., & Bultz, B.D. (2007). The NCCN guideline for distress management: A case for making distress the sixth vital sign. JNCCN — Journal of the National Comprehensive Cancer Network, 5(1), 3–7.

Howell, D., Currie, S., Mayo, S., Jones, G., Boyle, M., Hack, T., … Collacutt, V. (2009). A pan-Canadian clinical practice guideline: Assessment of psychosocial health care needs of the adult cancer patient. Toronto: Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian Association of Psychosocial Oncology.

Howell, D., Hack, T., Oliver, T., Chulak, T., Mayo, S., Aubin, M., & Tompson, M. (2011). A pan-Canadian practice guideline: Pan-Canadian guidance on organization and structure of survivorship services and psychosocial-supportive care best practices for adult cancer survivors. Canadian Partnership Against Cancer (Cancer Journey Action Group) and the Canadian Association of Psychosocial Oncology: Toronto.

Howell, D., Hack, T.F., Oliver, T.K., Chulak, T., Mayo, S., Aubin, M., … Sinclair, S. (2011). Survivorship services for adult cancer populations: A pan-Canadian guideline. Current Oncology, 18(6), e265–281. doi:10.3747/co.v18i6.956

Jensen-Johansen, M., Christensen, S., Valdimarsdottir, H., Zakowski, S., Jensen, A.B., Bovbjerg, D., & Zachariae, R. (2012). Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors—Results from a nationwide randomized clinical trial. Psycho-Oncology, 22(7), 1492–1500. doi:10.1002/pon.3193

Knowles, J.G., & Cole, A.L. (2008). Handbook of the arts in qualitative research: Perspectives, methodologies, examples, and issues. Thousand Oaks, CA: Sage Publications.

Leininger, M. (1994). Evaluation criteria and critique of qualitative research studies. In J.M. Morse (Ed.), Critical issues in qualitative research methods (pp. 95–115). Thousand Oaks, CA: Sage Publications.

Lu, Q., Zheng, D., Young, L., Kagawa-Singer, M., & Loh, A. (2012). A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychology, 31(5), 548. doi:10.1037/a0026834

Luzzatto, P., & Gabriel, B. (2000). The creative journey: A model for short-term group art therapy with posttreatment cancer patients. Art Therapy, 17(4), 265–269. doi:1080/07421656.2000.10129764

Mackenzie, C.R. (2014). ‘It is hard for mums to put themselves first’: How mothers diagnosed with breast cancer manage the sociological boundaries between paid work, family and caring for the self. Social Science and Medicine, 117, 96–106. doi:10.1016/j.socscimed.2014.07.043

Malchiodi, C.A. (2013). Art therapy and health care. New York, NY: Guilford Press.

Merz, E.L., Fox, R.S., & Malcarne, V.L. (2014). Expressive writing interventions in cancer patients: A systematic review. Health Psychology Review, 8(3), 339–361. doi:10.1080/17437199.2014.882007

Monti, D.A., Peterson, C., Kunkel, E.J., Hauck, W.W., Pequignot, E., Rhodes, L., & Brainard, G.C. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology, 15(5), 363–373. doi:10.1002/pon.988

Munhall, P.L., & Oiler-Boyd, C. (1993). Nursing research: A qualitative perspective. New York, NY: National League of Nursing.

Nicholls, S. (2009). Beyond expressive writing: Evolving models of developmental creative writing. Journal of Health Psychology, 14(2), 171–180. doi:10.1177/1359105308100201

Pelusi, J. (2001). The past sets the stage for the future: Follow-up issues facing long-term cancer survivors. Seminars in Oncology Nursing, 17(4), 263–267. doi:10.1053/sonu.2001.27921

Puetz, T.W., Morley, C.A., & Herring, M.P. (2013). Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA International Medicine, 173(11), 960–969. doi:10.1001/jamainternmed.2013.836

Rieger, K., & Schultz, A.S. (2014). Exploring arts-based knowledge translation: Sharing research findings through performing the patterns, rehearsing the results, staging the synthesis. Worldviews on Evidence-Based Nursing, 11(2), 133–139. doi:10.1111/wvn.12031

Rosedale, M. (2009). Survivor loneliness of women following breast cancer. Oncology Nursing Forum, 36(2), 175–183. doi:10.1188/09.ONF.175-183

Sinding, C., & Wiernikowski, J. (2008). Disruption foreclosed: Older women’s cancer narratives. Health, 12(3), 389–411. doi:10.1177/1363459308090055

Sonke, J., Rollins, J., Brandman, R., & Graham-Pole, J. (2009). The state of the arts in healthcare in the United States. Arts & Health, 1(2), 107–135. doi:10.1080/17533010903031580

Stuckey, H.L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), 254–263. doi:10.2105/AJPH.2008.156497

The Institute of Medicine and National Research Council. (2005). From cancer patient to cancer survivor: Lost in transition. National Academies Press.

Thomas-MacLean, R. (2004a). Memories of treatment: The immediacy of breast cancer. Qualitative Health Research, 14(5), 628-643. doi:10.1177/1049732304263658

Thomas-MacLean, R. (2004b). Understanding breast cancer stories via Frank’s narrative types. Social Science and Medicine, 58(9), 1647–1657. doi:10.1016/S0277-9536(03)00372-1

Thomas-MacLean, R. (2005). Beyond dichotomies of health and illness: Life after breast cancer. Nursing Inquiry, 12(3), 200–209.

Thompson, C.A., Stan, D.L., Solberg Nes, L., Jenkins, S.M., Lackore, K.A., & Pruthi, S. (2014). Breast cancer survivors’ self-reported needs and preferences of survivorship care. Breast Journal, 20(1), 107–109. doi:10.1111/tbj.12221

Thorne, S. (2008). Interpretive description (Vol. 2). Walnut Creek, CA: Left Coast Press Inc.

Visser, A., & Op’T Hoog, M. (2008). Education of creative art therapy to cancer patients: Evaluation and effects. Journal of Cancer Education, 23(2), 80–84.

Waller, A., Groff, S.L., Hagen, N., Bultz, B.D., & Carlson, L.E. (2012). Characterizing distress, the 6th vital sign in an oncology pain clinic. Current Oncology, 19(2), e53–59. doi:10.3747/co.19.882


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