Ridvan AKDOGAN, Gamze Aksu BAYSAL, Derya Karadeniz SIR, Kamuran KARAMAN
Eastern Journal of Medicine (EJM) - 2026;31(3):561-571
Chemotherapy places a dual burden on pediatric patients and their caregivers, yet few non -pharmacological interventions simultaneously target both. This study aimed to evaluate the effectiveness of a dyadic parent -child mandala coloring intervention on caregiver burden, psychological well -being, and children's fear and pain during chemotherapy. In this two -arm, parallel -group trial, 54 parent -child dyads involving children aged 5 -12 years receiving chemotherapy were randomly assigned to either a six -session mandala coloring intervention delivered over two weeks or standard care. Outcomes were assessed using the Wong -Baker Faces Pain Scale, Children's Fear Scale, Zarit Caregiver Burden Scale, and Depression Anxiety Stress Scale -21 (DASS -21). Data were analyzed using independent t -tests, ANCOVA, and effect size calculations. Groups were homogeneous at baseline. Post -intervention, the mandala group showed significantly lower pain (mean 2.14 vs. 3.14; p < 0.001; d = 0.74) and fear scores (mean 1.55 vs. 3.85; p < 0.001; d = 0.76) compared to controls. Caregiver burden decreased markedly (mean 58.14 vs. 73.92; p < 0.001; d = 0.81). Parental depression, anxiety, and stress scores improved significantly, with the largest effect in stress (d = 0.68). Improvements remained significant after adjusting for baseline anxiety. Dyadic mandala coloring during chemotherapy significantly reduced children's fear and pain while improving parental well -being and caregiver burden. The intervention is low -cost, feasible, and aligns with family -centered pediatric oncology care. Its dual focus offers a novel, holistic approach for integration into routine supportive care protocols.
