This randomized controlled trial aims to evaluate the effects of a parent-child mandala painting intervention conducted during the chemotherapy process on caregiver burden, psychological well-being, and child fear and pain levels in pediatric oncology patients.

Childhood cancer and its treatment are highly stressful experiences for both children and their parents. Chemotherapy-related side effects such as pain, fear, and emotional distress may negatively affect children's psychological well-being and treatment adaptation. Parents, as primary caregivers, often experience increased emotional burden, anxiety, and stress during this process.

The intervention consists of a structured parent-child mandala painting activity delivered over a two-week period, with six sessions in total, each lasting 30 minutes. Participants are randomly assigned to either the intervention group, which receives the mandala painting activity in addition to routine care, or the control group, which receives routine nursing care alone.

Outcome measures include child fear and pain levels assessed using validated pediatric scales, as well as caregiver burden and psychological distress measured through standardized questionnaires. Assessments are conducted at baseline and after completion of the two-week intervention period.

This study seeks to contribute evidence on the use of creative, non-pharmacological interventions to support emotional well-being in children undergoing chemotherapy and their caregivers.

This study is designed as a randomized controlled trial to examine the effects of a parent-child mandala painting intervention during the chemotherapy process on caregiver burden, psychological well-being, and child fear and pain levels.

The study population consists of children aged 5-12 years who are receiving chemotherapy treatment in a pediatric hematology-oncology unit and their primary caregivers. Following eligibility screening and informed consent, eligible parent-child dyads are randomly assigned to either the intervention group or the control group using an urn randomization method to ensure equal allocation.

Participants in the intervention group engage in a parent-child mandala painting activity in addition to routine nursing care. The intervention is delivered over a two-week period, consisting of six sessions, each lasting approximately 30 minutes. During each session, children and their parents are provided with mandala coloring sheets and colored markers and are encouraged to paint together in a quiet and supportive hospital environment. The activity aims to promote emotional expression, relaxation, and positive parent-child interaction during chemotherapy.

The control group receives routine nursing care without any additional structured intervention during the same two-week period. After completion of outcome assessments, participants in the control group are also offered the mandala painting activity in accordance with ethical principles.

Primary outcome measures include child fear and pain levels, assessed using the Child Fear Scale and the Wong-Baker Faces Pain Rating Scale. Secondary outcome measures include caregiver burden and psychological distress, measured using the Zarit Caregiver Burden Scale and the Depression Anxiety Stress Scale (DASS-21).

Outcome assessments are conducted at baseline prior to the intervention and at the end of the two-week intervention period. Data are analyzed to compare changes in outcome measures between the intervention and control groups.

This study aims to provide evidence regarding the effectiveness of a non-pharmacological, creative intervention in reducing psychological distress and improving emotional well-being among children undergoing chemotherapy and their caregivers.

Inclusion Criteria:

• Children aged between 5 and 12 years who are receiving chemotherapy.
• One parent or primary caregiver willing to participate with the child.
• Ability of the child to perform basic fine motor activities such as holding a pencil and coloring.
• Absence of an acute psychiatric diagnosis in the child (e.g., severe anxiety disorder, psychotic disorders).
• Willingness of both the child and the parent to participate in the study.

Exclusion Criteria:

• Children diagnosed with stage III or stage IV cancer.
• Presence of visual perception impairments in the child (e.g., color blindness, severe visual impairment).
• Refusal of the child or parent to participate in the study.

Individual participant data will not be shared due to the sensitive nature of the study population, which includes pediatric patients undergoing chemotherapy and their caregivers. The data contain personal and psychological assessment information, and sharing IPD could pose risks to participant privacy and confidentiality.