The Beads of Courage Program for Children Coping with Cancer

Abstract

Interventions which ameliorate the late effects of cancer treatment, and promote adjustment for children coping with cancer are needed (Kazak, 2005). The Beads of Courage® (BOC) Program (Baruch, 2002), is an arts-in-health program developed to strengthen resilience and alleviate suffering in children receiving treatment for cancer. Through the BOC Program, children receive different colored beads that serve as visible symbols of the many procedures they experience during cancer treatment. Despite the wide use of the BOC Program by more than 70 children's hospitals, the BOC Program has never been formally evaluated.The purpose of this study was to evaluate the BOC Program using qualitative descriptive methods. The specific aims of the program evaluation were to: 1) Describe the BOC Program process; 2) Describe how the BOC Program is implemented; and 3) Describe the potential outcomes of the BOC Program.Data collection methods with four BOC Program stakeholders included: Semi-structured interviews with children (N=6); focus groups with clinicians (N=10) and parents (N=5); and open-ended surveys with clinicians (N=9), parents (N=8) and bead artists (N=6). Findings indicate that the BOC Program is operating according to design (process and implementation), and the overall satisfaction and perceived worth of the BOC Program is high. Emerging categories from the content analysis describe the BOC Program as a form of narrative medicine that provides a reflective tool, a symbol of accomplishment, and joy and encouragement for children receiving treatment for cancer. Preliminary data support the BOC Program theory, with resilience-based protective factors (positive coping, derived meaning, social support) supported, and risk factors (uncertainty in illness, defensive coping) decreased in children who received the BOC Program. Future studies should include quantitative measures of factors of resilience to determine change over time in children receiving the BOC Program during cancer treatment. Findings from this study support theory development to further strengthen the body of knowledge on psychosocial adjustment issues for children coping with cancer. The findings also provide evidence to support the role that arts-in-health programs have in alleviating the experience of suffering in children coping with cancer.