'Art for Recovery': Expanding Access for the Underserved

Institution: Stanford University
Investigator(s): Kate Collie, Ph.D. -
Award Cycle: 2003 (Cycle IX) Grant #: 9FB-0115 Award: $83,368
Award Type: Postdoctoral Fellowship
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (2003)
Cancer is considered to be the most stressful disease and breast cancer the most stressful type of cancer. Support groups are the most common way of addressing the emotional, social, and psychological challenges presented by breast cancer. However, support groups are not available to all women with breast cancer—for example, women in rural communities, women with certain disabilities, and low-income women. The number of women who get breast cancer and the number who survive are both increasing, so it is important to find ways to provide support services to as many women with breast cancer as possible. This project is a study of the 'Art for Recovery' program at the UCSF Comprehensive Cancer Center. This is a well-established program offering a variety of support services for women with breast cancer (as well as people with other illnesses), all of which involve visual creative expression and therefore do not rely on verbal expression or on talking about things that may be considered taboo. The program includes outreach to underserved parts of the San Francisco area.

The purpose of this study is to: (1) find out how well the 'Art for Recovery' program is meeting the emotional, psychological, and social support needs of women with breast cancer, especially the needs of women from groups that are considered to be underserved; and (2) to find out how to improve the program to meet these needs better. A guiding question will be whether there are successful aspects of 'Art for Recovery' that could be offered to more women with breast cancer by providing them in innovative ways, for example by using videoconferencing to community clinics.

The evaluation part of the study will be done by first gathering information about the emotional, psychological, and social support needs of women with breast, and then studying the 'Art for Recovery' program to find out how well it addresses these needs. The main component of the study will be interviews with people who are or who have been involved with 'Art for Recovery, particularly women with breast cancer from underserved groups. The information that is collected will be compiled and analyzed to find out which parts of the program are working best at meeting the needs of underserved women with breast cancer and which parts could be expanded or improved.

The study is about an innovative form of psychosocial support for women with breast cancer that has not been studied very much. Although there are art programs that serve women with breast cancer in other cities, 'Art for Recovery' is unique in several ways. It has a much longer history than most other hospital art programs, it is expanding every year mainly due to the demand from women with breast cancer (many programs are shrinking because there is no research to show how well they work), and outreach to underserved women is built into the program. If this study shows that 'Art for Recovery' is meeting needs of women with breast cancer that otherwise would not be met, it could be used as a model for innovative programs in other hospitals or community centers.


Final Report (2006)
Support groups significantly improve coping and reduce distress for women with breast cancer. However, many women with breast cancer from underserved groups (low-income, little or no formal education, ethnic minority, lesbian, advanced in age, disabled) do not participate in support groups. It is important to address barriers that prevent participation and to consider alternatives to standard support group formats, such as art groups, that may be more appealing to non-mainstream women. To investigate this issue, in-depth interviews were conducted with fifteen women with breast cancer from underserved groups living in the San Francisco Bay Area. Additionally, 11 interviews were conducted with people involved in developing and/or offering support services for Bay Area women with breast cancer that have a focus on creative expression. The interviews with the women with breast cancer were analyzed using 'Narrative Analysis,' a method of qualitative analysis that is used to bring forward voices that have been excluded from mainstream discourse and to interpret responses in relation to participants' social and cultural contexts.

The analysis of the interviews with the women with breast cancer conveys the women’s perceptions of social, cultural, and psychological barriers to support group participation and their perspectives on how art groups could overcome these barriers--by allowing more emotional privacy than standard support groups, being offered in a more familiar format than a therapy-style group, emphasizing the resources of the women in the group, having pleasurable appeal, providing an opportunity to learn something new, and providing positive distraction.

Barriers to reaching women with breast cancer from underserved groups were overcome with the help of Chinese-speaking and Spanish-speaking breast cancer survivors who invited Chinese-speaking and Spanish-speaking women to participate and translated during interviews. I did not expect that it would be difficult to speak with people involved developing/offering support services, but I did not succeed in speaking to several key people.

Nevertheless, the analysis of the interviews with underserved women with breast cancer yielded valuable new insights that will help in expanding access to support groups for women with breast cancer from underserved groups.

The next step is to conduct a pilot study using the recommendations of the participants in this study.


Symposium Abstract (2005)
One of the primary goals of this study is to determine how best to use art/craft-based programming to expand access to psychosocial support for women with breast cancer from underserved groups. There is wide agreement that support groups and other forms of structured psychosocial support that favor emotional expression can improve quality of life for women with breast cancer and possibly increase survival. Therefore, it is necessary to make structured psychosocial support available to as many women with breast cancer as possible. Support groups based on talking may not be appropriate for all women, due to such things as language barriers, cultural taboos, social stigma, and differing communication styles. Art and craft activities show promise as a life-affirming alternative that promotes emotional expression and social interaction and that avoids the stigma of ‘therapy’ and minimizes language barriers. Analysis of in-depth interviews with 15 women with breast cancer from underserved groups has yielded guidelines for how to: (a) incorporate arts and crafts in support services for underserved women with breast cancer, and (b) reach women who are hard to reach.