The Effects of Mandala Coloring Applied to Caregivers of Palliative Care Patients on Perceived Stress, Anxiety Level, and Quality of Life: A Cluster Randomized Controlled Trial.

BACKGROUND

Caregivers of patients receiving palliative care frequently experience high levels of stress and anxiety, which may negatively affect their quality of life.

OBJECTIVES

This study aimed to investigate the effects of mandala coloring on perceived stress, anxiety, and quality of life (primary outcomes) among caregivers of patients receiving palliative care.

METHODS

This cluster randomized controlled trial included 80 caregivers, allocated to an intervention group (n = 40) or a control group (n = 40). The intervention group participated in mandala coloring sessions 4 days per week for 4 weeks (16 sessions total), while the control group received no intervention. Data were collected using the Perceived Stress Scale (PSS), State Anxiety Scale, and Short Form-36 (SF-36) Health Survey. Postintervention outcomes were analyzed using analysis of covariance, controlling for baseline scores. The study was conducted and reported according to CONSORT cluster extension guidelines.

RESULTS

After adjustment for baseline scores, the intervention group showed significantly lower PSS (F = 133.29, p < 0.001, ηp2 = 0.634) and state anxiety scores (F = 38.57, p < 0.001, ηp2 = 0.334) compared with the control group. Postintervention SF-36 physical (F = 86.31, p < 0.001, ηp2 = 0.529) and mental health scores (F = 112.05, p < 0.001, ηp2 = 0.593) were significantly higher in the intervention group. In the control group, perceived stress and anxiety increased significantly, and quality of life scores decreased over the study period (p < 0.05). No adverse events, discomfort, or intervention-related withdrawals occurred, indicating that the intervention was safe and well-tolerated.

CONCLUSION

Mandala coloring effectively reduced perceived stress and anxiety and improved the quality of life in caregivers of palliative care patients. Given its noninvasive, low-cost, and safe nature, it may be recommended as a supportive nurse-led intervention in palliative care settings.

RELEVANCE TO CLINICAL PRACTICE: Mandala coloring can be integrated into routine palliative care as a nurse-led nonpharmacological intervention to support caregiver well-being.