4. Discussion
Anxiety, voice, anxiety, nervousness, distress, restlessness, and upset, ’, cancer, fatigue, pain, Fatigue, sensations, shortness of breath
METASTASIS, POSITIVE, CANCER, ADVANCED CANCER, HEAT, COMPLICATIONS
The present study assessed the therapeutic potential of nature image viewing in terms of its impact on cancer patients’ positive and negative affect, as well as the clinical symptoms associated with chemotherapy.Anxiety is one of the most prevalent mood states during cancer treatment, related to the diagnosis and treatment itself, fear of metastasis, the unpredictability of physical suffering, and the future. In comparison to the general population, cancer patients exhibit lower levels of positive emotions, as evaluated by PANAS. However, there is no significant difference in the prevalence of negative emotions, indicating similarity in negative emotional experiences [The PANAS scores for positive affect, as evaluated in our study, were approximately 25% higher both before and after the intervention, compared to patients with advanced cancer, or even the general population [All intervention groups experienced a significant reduction in negative affect. The main negative affect states that showed significant decreases included feelings of fear, nervousness, distress, restlessness, and upset. The control group also showed moderate evidence of reduced negative affect, including anxiety evaluated by the ESAS. This effect can however be expected at the end of a chemotherapy session that has transpired without complications for the study participants.Regarding video content, it is worth noting that the largest reduction in negative affect occurred for the miscellaneous video.The video contents also influenced clinical symptoms in a differentiated manner. The best-performing was the Beauty video, which reduced pain most significantly but also improved sadness and anxiety, and improved well-being and shortness of breath. Beauty is a psychological sensation perceived as a sensory impression; this sensation is pleasant and positive, which can alter the perceptual focus of pain and reduce stress and anxiety by modulating attention as well as higher-order cognitive and emotional processes [The Emotions Up video altered the perception of pain, fatigue, anxiety, and appetite. Surprisingly, the Tranquility video, consisting mainly of images of the sky and sea, with low scores of arousal, had no impact on the participants (note that even the control group showed a reduction in anxiety). This may have occurred because although the images individually evoked feelings of peace and tranquility, but when proposed in the same video, they may have become monotonous in the face of the same predominance of color and theme.Another possibility is that, similarly to what happens with experiments that use music to induce emotions, the ISO (from the Greek “isos”, meaning equal) principle may also affect visual stimuli. The ISO principle states the importance of inducing emotional changes gradually. This involves starting with music related to the subject’s initial emotion and smoothly transitioning to subsequent emotion stimuli, ultimately achieving the desired emotion. This implies that abrupt emotional shifts induced by external stimuli are not readily accepted by individuals. Therefore, it is important to modulate the induced emotions [The Miscellany video reduced fatigue, sadness, and anxiety, and presented the best performance in reducing the negative affect as assessed by PANAS. The miscellany video was compounded by different nature categories, which may confer greater mental fluctuation, without a more specific emotion or experience. Combining these diverse images may have exerted a more realistic and comprehensive result, resembling the broader experience of nature rather than the repetition of a few specific natural elements. The inclusion of elements such as working ants, butterflies, flower-filled paths, and landscapes could promote a sense of proximity and familiarity, while the vibrant colors used in the images might have influenced the perception of fatigue, making them more visually appealing. Additionally, these images presented together also gathered a variety of attributes, such as light, heat, attention, alertness, strength, curiosity, and lightness, among many others mentioned in [In the Emotions Up video, the images also comprised a thematic diversity, which may have favored distraction through the stimulation of visual neurons. Among the mechanisms related to pain relief, distraction and alteration of perceptual focus have been emphasized. These mechanisms can result in the release of endorphins, resulting from both pleasure sensations and positive memories. The brain processing of images permeates all these mechanisms. Positive emotions can help maintain a positive psychological state and neutralize negative situations, including painful experiences [Reduction of the negative affect observed in the control group may have been influenced by the researchers’ contact with the patients during data collection, potentially impacting the patients’ relaxation levels. Social contact provides a sense of connection and support, alleviating loneliness and fear. Additionally, social interactions serve as a distraction from the stress and discomfort associated with treatment, promoting a more positive emotional state. Social contact also provides a sense of normalcy and helps patients maintain a connection with the outside world, offering emotional comfort, and encouragement, and enhancing resilience [Fatigue is another symptom that is quite prevalent among patients receiving venous or oral chemotherapy. Researchers have shown that viewing nature photos for just six minutes provides a quick and temporary boost, similar to caffeine, improving executive attention in young and old adults, with a restorative influence in older adults who tend to tire more easily and experience more fatigue [A comparative study between forest photos presented on a conventional screen and urban photos presented in 360° format demonstrated that forest photos, regardless of the presentation format, are more effective in preventing mood disturbances compared to urban immersive 360° photos [Photographs, art, and virtual reality (VR) have been recommended in numerous studies as distraction interventions to alleviate patient anxiety in various clinical situations [Researchers investigated two virtual environments that simulated nature scenes, including a blue sky and a green field that participants could explore. During the tour, a voice instructed the user and told stories to evoke specific emotions, significantly decreasing negative mood scores and increasing positive mood after four brief 30-min sessions [Nature images offer more than just a distraction technique; they engage mechanisms related to aesthetic appreciation. Aesthetic experiences keep the observers focused on the moment, making room for perceived sensations and emotions provoked by the beauty of what is being observed [The implication of the presented study for the field of care assistance is the potential to offer patients a low-cost resource that provides both pleasure, through nature-related well-being images, and the ability to increase positive affect and reduce negative affect during chemotherapy. Furthermore, within the education field, it provides an opportunity to foster discussions among healthcare professionals in training about novel care practices characterized by lightweight technologies, such as the one presented in this study.One possible limitation of the findings is that the study was conducted in a single oncology service of a private hospital. Additionally, during data collection the number of refusals to participate was considerable, and many patients reported that this was the moment they had to rest or spend time talking to their companion, or that they preferred to pay attention to the medication infusion process.Future research should focus on applying the proposed intervention in other organizational contexts. The aim is to assess its effectiveness in different patient settings, encompassing various procedures, health facilities, and populations.