{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:04:00Z","timestamp":1781251440130,"version":"3.54.1"},"reference-count":44,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Integrative and Complementary Medicine"],"abstract":"\n Background:<\/jats:title>\n Caregivers of patients receiving palliative care frequently experience high levels of stress and anxiety, which may negatively affect their quality of life.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n This study aimed to investigate the effects of mandala coloring on perceived stress, anxiety, and quality of life (primary outcomes) among caregivers of patients receiving palliative care.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n This cluster randomized controlled trial included 80 caregivers, allocated to an intervention group (\n n<\/jats:italic>\n = 40) or a control group (\n n<\/jats:italic>\n = 40). The intervention group participated in mandala coloring sessions 4 days per week for 4 weeks (16 sessions total), while the control group received no intervention. Data were collected using the Perceived Stress Scale (PSS), State Anxiety Scale, and Short Form-36 (SF-36) Health Survey. Postintervention outcomes were analyzed using analysis of covariance, controlling for baseline scores. The study was conducted and reported according to CONSORT cluster extension guidelines.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n After adjustment for baseline scores, the intervention group showed significantly lower PSS (F = 133.29,\n p<\/jats:italic>\n < 0.001, \u03b7p\n 2<\/jats:sup>\n = 0.634) and state anxiety scores (F = 38.57,\n p<\/jats:italic>\n < 0.001, \u03b7p\n 2<\/jats:sup>\n = 0.334) compared with the control group. Postintervention SF-36 physical (F = 86.31,\n p<\/jats:italic>\n < 0.001, \u03b7p\n 2<\/jats:sup>\n = 0.529) and mental health scores (F = 112.05,\n p<\/jats:italic>\n < 0.001, \u03b7p\n 2<\/jats:sup>\n = 0.593) were significantly higher in the intervention group. In the control group, perceived stress and anxiety increased significantly, and quality of life scores decreased over the study period (\n p<\/jats:italic>\n < 0.05). No adverse events, discomfort, or intervention-related withdrawals occurred, indicating that the intervention was safe and well-tolerated.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Mandala coloring effectively reduced perceived stress and anxiety and improved the quality of life in caregivers of palliative care patients. Given its noninvasive, low-cost, and safe nature, it may be recommended as a supportive nurse-led intervention in palliative care settings.<\/jats:p>\n <\/jats:sec>\n \n Relevance to Clinical Practice:<\/jats:title>\n Mandala coloring can be integrated into routine palliative care as a nurse-led nonpharmacological intervention to support caregiver well-being.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/27683605261456027","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T07:54:28Z","timestamp":1780991668000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Mandala Coloring Applied to Caregivers of Palliative Care Patients on Perceived Stress, Anxiety Level, and Quality of Life: A Cluster Randomized Controlled Trial"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0061-9490","authenticated-orcid":false,"given":"Fatma","family":"Karaaslan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Nursing, F\u0131rat University Institute of Health Sciences, Elazig, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fclcan Bah\u00e7ecio\u011flu","family":"Turan","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Health Sciences, F\u0131rat University, Elaz\u0131\u011f, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.17159\/obiter.v41i4.10474"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2006.06.008"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.5505\/tjoncol.2011.461"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(03)00609-3"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2015.01.004"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.5750\/ejpch.v3i3.1003"},{"issue":"2","key":"e_1_3_4_8_2","first-page":"132","article-title":"T\u00fcrkiye\u2019de palyatif bak\u0131m hizmetleri","volume":"4","author":"K\u0131van\u00e7 MM","year":"2017","unstructured":"K\u0131van\u00e7 MM. 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