A Good Life with Impairment: Illuminating and Supporting the Experiences of Women Living With Cancer through Community-Based Art Workshops

Research Design

Our study is informed by Gibson’s (2016; Gibson et al., 2018) postcritical approach to rehabilitation, which draws on critical theory and sociological and disability perspectives to interrogate rehabilitation priorities and desirable outcomes and emphasize how illness and impairment can be experienced and supported in ways other than as a biomedical issue to be fixed. Through this lens, nuanced experiences of cancer, such as from existential and social perspectives, can be gleaned to better understand a good life with cancer.

For the present study, we used arts-based and community-based research methods. Arts-based research methods can be considered an extension of qualitative methodologies and may capture perspectives that are not easily expressed in words. These qualities make them especially valuable for complex human experiences of impairment, identity, and well-being (Leavy, 2009).

Our research was also informed by community-based research principles, which emphasize positive community engagement and foster the cocreation of knowledge (Coughlin et al., 2017; R. Thomas et al., 2021). Specifically, our art workshops facilitated collaboration between researchers and participants and provided participants with opportunities to convey their experiences of living well with impairment.

Participants

Using advertising at a local cancer organization, we recruited a total of 10 women with cancer living in the Ottawa region. The recruitment poster shared an invitation for participants to engage in a supportive art workshop series, provided information on the study objectives and inclusion criteria, and specified that no experience with art or online platforms was necessary. Purposeful sampling was used to recruit women in the community who were willing to explore their personal experiences of cancer and a good life. The recruitment was done on a first-come-first-served basis over two recruitment periods. Specifically, four women were initially recruited and participated in the first workshop series in March 2021. Next, six additional participants were recruited and participated in a second workshop series, which took place in January 2022. Participants were included if they (a) were women 18 years of age or older, (b) had completed active treatment for cancer, (c) spoke English, and (d) could consent to the research requirements.

Ethics

This study was approved by the University of Ottawa’s Research Ethics Board. All participants consented to be involved in the study and agreed to be identifiable by their first name.

Community-Based Art Workshops

We offered two series of mixed-media visual arts workshops, each involving four two-hour sessions delivered over four weeks. Both workshops were delivered over Zoom, due to the COVID-19 pandemic. Workshops were developed and facilitated by a community artist and arts-based researcher (PI) based on their extensive collaboration and experience with arts programming (R. Thomas et al., 2020). The specific art activities were carefully chosen in consideration of the participants’ varying degrees of experience and comfort with visual arts, hence the different activities offered in each series. Throughout the various activities, the facilitators emphasized the importance of creating art that represented one’s perspective of a good life with impairment. Prior to the workshop, participants received a kit of art supplies and an art-making guide with foundational tips and tricks for mixed-media techniques. Each workshop session included introductory instructions, verbal and visual guidance during the art-making activity, and time allocated for participants to discuss and share their artwork and process with each other. The workshop themes and activities centered on the concept of a good life with cancer, informed by our previous research, which illuminated the experiences and stories of joy, hope, resilience, and living well with impairment (Ranger et al., 2023; R. Thomas et al., 2017). Table 1 provides a detailed description of each workshop.

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Table 1

Detailed Description of the Workshop Series

Workshop series	Series 1 (n = 4)	Series 2 (n = 6)
Structure	Once a week for 4 weeks starting in March 2021.	Once a week for 4 weeks starting in January 2022.
Description	The PI and a professional visual artist involved in health initiatives facilitated the mixed-media workshops. At the end of the workshop, each participant discussed their work.	The PI and a professional visual artist involved in health initiatives facilitated the mixed-media workshops. At the end of the workshop, each participant discussed their work.
Projects	1. Haiku activity 2. Energy: Panel with texture 3. Empathy: Panel with ink and tissue paper 4. Enthusiasm: 3D piece	1. Making of memories: Memory boxes 2. Creating courageously: Shields on book covers 3. Centering ourselves, centering our hearts: Plaster heart 4. Finding joy in movement: Making a mobile

Data Collection

Before the workshops, we met each participant virtually to obtain consent and complete a sociodemographic questionnaire. Each participant received the required electronic equipment (e.g., phone tripod, laptop stand) to engage in the workshops. ² Each session was video-recorded using Zoom by both the researchers and each participant to allow for different video perspectives. We also asked each participant to take photographs of their artwork and share them with the researchers, along with one workshop recording of their choice. Following the workshop, our research assistant conducted 60-minute, individual, semi-structured, virtual interviews with each participant. The interviews included questions about their perspectives on a good life with cancer and their experiences during the art workshops. The interviews were audio-video recorded.

Data Analysis

We used an iterative process and interpretive description guidelines for analysis. With its roots in nursing research, interpretive description is a qualitative and interpretive methodology that aims to bridge theory with clinical health practices and contexts (Thorne, 2016). Audio recordings from the workshops and interviews were transcribed, and photographs of the participants’ artwork were embedded in the transcripts to promote a holistic analysis of the textual and visual data. Using NVivo qualitative software (Lumivero version R1), three team members independently coded the same transcripts, followed by different transcripts from the first workshop series. An initial detailed coding structure was established and refined during multiple discussions. Throughout, we also reflected on the relationship between the content of the text and visual imagery. For example, noting how particular images represented or symbolized the experiences being shared in the interviews. Once the coding framework was finalized, the remaining transcripts were divided between the three members and analyzed. Reflexivity was encouraged as each member kept notes of their reflections during transcriptions. Once coding was complete, the team members met to ensure coding consistency and consensus and to distinguish major themes by identifying overlapping codes and recurring patterns.

Theme 1: Centrality of Human Connection and Social Relationships

This first theme illuminates the desire for human connection, the importance placed on long-standing relationships, and the value of new opportunities for meaningful relationships. Participants consistently expressed their need and desire to feel connected to others in almost all facets of the study (e.g., workshops, interviews, and artwork). In Figure 1, Katey’s artwork illustrates the importance of human connection using connecting hands, which she describes as “the people along the way [of the cancer journey]” (Workshop).

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Figure 1

Compassionate Lines by Katey

Many participants reflected on their present and past relationships while living with cancer, including those with their spouses, children, grandchildren, friends, and extended family. Participants emphasized that these close relationships provided necessary support and validation during challenging times. Triona shared, “If it wasn’t for the support of my friends and family, I don’t think I would have survived. Friends and family are the most important part of a good life.” (Interview)

Moreover, participants often articulated how these close social ties helped foster other elements of living well, such as feelings of safety and acceptance and the ability to be one’s authentic self. Social ties were also said to provide a grounding effect on one’s identity. Friendships were often described as a key, yet fluctuating, source of support. For example, Carolyn described the changing nature of friendships throughout her 10-year cancer journey: “You know, some friends stick, and some don’t. You meet new ones, and you lose some.” (Workshop)

For a few participants, the cancer experience led to the development of strong friendships in unexpected places. Robin explains, “It’s the idea of how the connections that we make when we’re in low places are surprising, some of the friendships that are forged in the fire of cancer are quite unique and very, very special.” (Interview)

Many participants highlighted that the art workshops provided a safe, nonjudgmental, and supportive environment through which caring and understanding relationships emerged. Robin described the importance of having opportunities to engage with other women with shared stories and experiences:

Spaces like this [the art workshop] are essential . . . there’s an unconditional compassion we have for each other. That shared experience . . . where I find in other spaces there’s a lot of explaining, when I’m around this particular peer group, it’s like there’s interest in each other; there’s no real explanation needed. (Workshop)

Some participants also expressed that the workshops helped fill a gap in community resources for cancer, which were often focused solely on discussion of cancer experiences, symptoms, and education. Participants appreciated that the creative and group process was at the forefront of the workshops, providing an opportunity to explore and share stories of the nuances of living well with cancer. Lindsey notes:

It’s unique, and it feels so good not to have cancer be the center of the conversation but to have an outlet to express it and to hold space with everyone, share space with everyone, and do creative things together. (Workshop)

While most participants described social relationships as a critical part of living well with cancer, many of the women also described challenges to remaining socially connected, including introversion, lack of understanding from others, and the social distancing restrictions from the COVID-19 pandemic. Janet specifically shared how the online format of the art workshops helped avoid feelings of isolation and highlighted the ability of online art communities to provide comfort and support:

It was a lovely feeling of companionship. Even knowing you’re on the screen, I’d look over once in a while and see somebody looking at something or painting. It was very companionable just to feel that we were all together creating because I’m usually doing it alone. (Workshop)

Theme 2: Recognizing Dynamic Processes of Transformation

The second theme relates to the participants’ perspectives on living well with cancer and impairment as a dynamic process of change and transformation. The process and the ability to make sense of one’s journey were described as foundational to a good life. The participants often depicted these experiences through their art and described the value of the shared art-making experience for infusing their journeys with meaning.

Most participants described change as an inevitable aspect of life, and “being open to change and not expecting things to stay the same” (Ange, Interview) was perceived as critical to living well with cancer. Many participants described navigating change as a singular and continuous journey. Some highlighted that, like art-making, there is no right or wrong way to undertake this process. A few participants also shared how the workshops reinforced this idea by reminding the women to trust their intuition and supporting each participant to embark on their own creative journey. Ange’s “memory box” booklet (see Figure 2) depicts her personal story of change using arrows to illustrate the different paths one can take and numerous butterflies to represent the personal metamorphosis taking place.

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Figure 2

This is My Story by Ange

Experiences of change were often described as resulting from symptoms related to having cancer or cancer treatments, such as fatigue and pain that caused disruptions to valued identities, roles, and activities. For example, many participants acknowledged the challenge of losing the ability to engage in valued activities they once saw as part of their version of a good life. Mary remarks:

There are things I used to love to do, and my husband and I’d love to do together, that I cannot do anymore, and he will not do without me: bicycling, cross-country skiing, and downhill skiing. [Before], I would have included those in a good life, and now I’ve had to adjust. (Interview)

For many, “the inability to adapt to changes that are inevitable” (Carole, Interview) was seen as a barrier to living well with cancer. They described an iterative process of acknowledging the positive and negative sides of their experiences, shifting their perspectives, and “getting out of [their] comfort zone” (Lindsey, Interview). Furthermore, many participants described how their resolution not to resist or dwell on these challenges provided a meaningful opportunity for agency and control in their lives. Some participants also described a parallel between such experiences and responding to challenges in the creative process. Below, Cynthia describes how she changed her artwork outside the workshop until it suited her vision and needs:

There was no colour balance, no size, no shape. So I continued to work after the workshop, and I changed things around so that it made me happy. I guess I like to have control. You can’t control everything, but you can control your response, and, in this case, I was able to control this little bit of art. (Interview)

In both the workshop and interviews, many participants also highlighted that a good life with cancer includes “resilience” (Robin) and “strength” (Triona), as well as “self-love” (Lindsey) and “acceptance” (Janet). Indeed, all participants shared their unique experiences of positive transformation. Many also discussed “having purpose and things to do” (Carolyn) as a facilitator to a good life. More specifically, participants discussed opportunities to learn, contribute, and engage in new roles and valued activities such as art, community advocacy groups, nature walks, and strength training, which helped support their version of a good life (Carolyn, Triona, Ange, Cynthia, Lindsey). For some women, the cancer experience was described as a catalyst for newfound meaning and power in their lives. Triona describes, “What happened is part of my life; it’s part of who I am. And, I think it [the cancer experience] has, in many ways, made me stronger.” (Interview)

Finally, many participants described the significance of undertaking their creative journeys alongside other women with shared experiences of change and transformation. They described that sharing stories and art was meaningful and inspirational and that it supported their own journey of self-determination and resilience.

Limitations

While we aimed to give voice to the overall underrepresented perspectives of women living with cancer-related impairment, the snowball sampling strategy utilized led to most of the women in our study being White, living in urban areas, well-educated, and middle-class. While this strategy was necessary given the context of the COVID-19 pandemic, future studies could utilize other sampling strategies to explore a good life with impairment with people from various cultural and socioeconomic backgrounds. We have also reflected that the online delivery of our art workshops may have deterred some potential participants who were not comfortable using technology or preferred in-person activities. Nonetheless, the online delivery of the workshops was a novel adaptation of community-based arts programming that might conversely promote accessibility.

Implications for Practice

Our study has important implications for public health and health promotion delivery and education. Notably, the iterative process of living well described by the women illuminates an ongoing need for support that is often missing later in the cancer care continuum. Our study also highlights the importance of care that goes beyond reducing impairment and optimizing function toward a practice that supports individuals in engaging in what makes life good for them (e.g., embracing opportunities to learn, to create, to engage in valued activities and their communities). Our findings demonstrate that virtual community arts workshops are a valuable tool for supporting various aspects of the good life for women with cancer, including social connection, social support, and the processes of navigating change and transformation. To foster access to community arts, public health agencies aimed at supporting patients living with cancer could provide recurring series of virtual art-based workshops on their websites or provide links to local community art programs. From a methodological standpoint, our study supports the value of arts-based research in public health research to provide essential insights into complex human experiences of illness and health.