Integrating Creative and Expressive Therapies into Person-Centred Cancer Nursing: A Qualitative Study and Conceptual...

To explore oncology nurses' experiences, perceptions, and practices regarding the integration of creative and expressive therapies into person-centred cancer nursing, and to develop a conceptual framework for assessment, symptom support, and therapeutic communication within a Saudi Arabian regional hospital context.

A qualitative interview study informed by reflexive thematic analysis was conducted in the Al-Ahsa region, Saudi Arabia. Thirty registered nurses and oncology-specialized nurses with direct patient care responsibilities were recruited through purposive and snowball sampling from XXX Hospital and affiliated oncology centers. Semistructured in-depth interviews were conducted between October and December 2025. Data were analyzed using Braun and Clarke's six-phase reflexive thematic analysis. Rigor was established through member checking, peer debriefing, thick description, and an audit trail; reflexivity was addressed through ongoing reflexive journaling and critical engagement with researcher positionality throughout the analytic process.

Four overarching themes were generated: (1) "Bridging Silence with Creativity," which described how art and symbolic expression enabled patients to communicate distress that was difficult to verbalize; (2) "More Than Medication," which reflected nurses' perceptions that music, writing, movement, and art-making could support relief of anxiety, pain, fatigue, anticipatory nausea, and emotional distress; (3) "Navigating the Space Between Healing and Doing," which captured role ambiguity, limited training, time pressure, and insufficient institutional support; and (4) "Witnessing Transformation," which highlighted meaning-making, spiritual comfort, family involvement, and cultural attunement in the Saudi oncology context. These findings informed a five-domain conceptual framework comprising person-centred assessment, creative and expressive modality selection, therapeutic communication interface, symptom support outcomes, and cultural-contextual adaptation.

Creative and expressive therapies represent a promising but underdeveloped dimension of person-centred cancer nursing. Oncology nurses perceived these approaches as valuable for facilitating emotional expression, strengthening therapeutic communication, supporting holistic symptom assessment, and promoting meaning-making and spiritual comfort. However, safe integration requires clearer professional boundaries, structured training, institutional support, and culturally responsive protocols.

The proposed framework provides oncology nurses with an empirically informed guide for assessing patient readiness, selecting appropriate creative or expressive modalities, using these approaches within therapeutic communication, and recognizing when referral to specialist psychosocial or creative arts therapy services is needed.

ClinicalTrials.gov. Not applicable; this was a qualitative interview study and did not involve a clinical trial.