J Pediatr Nurs. 2026 Feb 13;88:34-43. doi: 10.1016/j.pedn.2026.02.007. Online ahead of print.
ABSTRACT
OBJECTIVES: This study investigated the effect of the puppet-assisted House-Tree-Person Test (HTP-T) on fear and anxiety levels in children undergoing chemotherapy treatment and the factors influencing these outcomes.
METHODS: The study employed a one-group pretest-posttest quasi-experimental design combined with HTP-T analysis. The study was conducted with 29 children aged 5-12 years receiving chemotherapy at the pediatric hematology-oncology outpatient clinics of a university hospital in the Eastern Black Sea Region of Türkiye during the 2022-2024 years. Data were collected using “the Demographic Information Form for Children and Parents, the Children’s State Anxiety Scale (CSA), the Children’s Fear Scale (CFS), and HTP-T”. Data analysis was performed using descriptive statistics, repeated measures ANOVA, and HTP-T analysis.
RESULTS: Statistically significant differences were observed in children’s mean CSA (F = 3.898, p = 0.026, η2 = 0.122) and CFS (F = 5.313, p = 0.008, η2 = 0.159) scores across the pre-treatment, during-treatment, and post-treatment measurements. The HTP-T analysis revealed that children had difficulty regulating anxiety and fear, expressed concerns about family and environmental events, reported feelings of loneliness, and exhibited strong emotional attachment to their families.
CONCLUSION: The study demonstrated that incorporating puppet-assisted HTP-T during chemotherapy contributed to reducing children’s fear and anxiety and offered a useful approach for identifying influencing factors.
IMPLICATIONS FOR NURSING PRACTICE: HTP-T, a therapeutic play technique incorporating puppetry and projective methods, may be effective in reducing fear and anxiety among children undergoing chemotherapy.
PMID:41689903 | DOI:10.1016/j.pedn.2026.02.007
