Repeated use of rich pictures to explore changes in subjective experiences over time of patients with advanced cancer

Abstract

Background: The combination of verbal and visual tools may help unravel the experiences of advanced cancer patients. However, most previous studies have focused on a specific symptom, at only one moment in time. We recently found that a specific visual tool, originating from systems thinking, that is, rich pictures (RPs), could provide a more comprehensive view of the experiences of patients with advanced cancer.Aims: To examine whether the repeated use of RPs can make changes in subjective experiences of patients living with advanced cancer visible over time. Methods and results:We performed a prospective study with a generic qualitative approach that was mostly informed by the process of grounded theory. We invited patients to make an RP twice, at the start of the study, and again after 2 months.Both RP drawing sessions were directly followed by a semi-structured interview.Patients with all types of solid tumors, above the age of 18, and with a diagnosis of advanced, incurable cancer, were eligible. Eighteen patients participated and 15 patients were able to draw an RP twice. In eight RP-sets, considerable differences between the first and second RP were noticeable. Two patterns were distinguished:(1) a change (decline or improvement) in physical health (five patients), and/or (2) a change in the way patients related to cancer (three patients). Conclusion:RPs are a valuable qualitative research method that can be used to explore the experiences of patients with advanced cancer, not only at a single point in time but also over time.

The ‘Rich Pictures’ Method: Its Use and Value, and the Implications for HRD Research and Practice

“…As Manojlovich et al (2015) state, however researchers can often "fail to recognize that one technique alone cannot capture the phenomenon of interest" (p. 68). While RPs can elicit tacit data about experiences that may be hard to put into words (Crilly et al, 2012;Morse, 2009) for example how clinicians perceive and respond to complex situations (LaDonna et al, 2018), how medical students handle moral dilemmas (Ribeiro et al, 2021) or how individuals cope with cancer (Bood et al, 2021(Bood et al, , 2022 interviews extend exploration of the topic and can clarify the use and meaning of images. Unsurprisingly then, most RP research involves participants completing a 'rich picture' alongside an interview.…”

“…RP of 'competence circle'. Bood et al, 2021;Cristancho et al, 2015). Guidance specific to content analysis of RP data is also provided by Bell and Morse (2013a) who adapted Carney's (1994) analytical framework.…”

This is what life with cancer looks like: exploring experiences of adolescent and young adults with cancer using two visual approaches

“…Participants were asked to make an RP about their experience of living with cancer, followed by a semi-structured interview. An example of a RP was shown to the participants to give them an idea of which icons and symbols they could use and how an RP might look when completed [ 19 , 22 ]. When the RP was completed, the interviewer asked the participant to explain what she/he had drawn, starting with the open question, and then asked more specific questions about elements of the RP (e.g., about the colors, shapes, and specific elements).…”

“…RPs are drawings that one creates to express one’s experiences, which may encompass different elements, e.g., people, interactions, and feelings [ 9 – 11 , 20 , 21 ]. We recently conducted a study with a group of adults (mean age 62) with advanced cancer who were asked to draw an RP about their experience of living with cancer [ 19 , 22 ]. The findings suggest that RPs can help patients to tell their story about how cancer affects their lives.…”

“…The findings suggest that RPs can help patients to tell their story about how cancer affects their lives. The RPs can provide insight into what is most important to the patient and may shed light on how multiple aspects of well-being, such as physical, emotional, and social well-being, are affected by cancer [ 19 , 22 ]. Nonetheless, RP research has not yet been performed amongst AYAs with cancer.…”