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This randomized controlled pilot study developed an art-making program (AM-I-FCR) for lung cancer patients and evaluated feasibility and preliminary effects. The program was built through intervention mapping and implemented at a tertiary hospital in Fuzhou, China. 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BMC Medicine (2026) 24:198 [https://doi.org/10.1186/s12916-026-04722-1](https://doi.org/10.1186/s12916-026-04722-1)  \nBMC Medicine  \n RESEARCH Open Access  \nFeasibility and preliminary efficacy  \nof an art-making program to manage fear of cancer recurrence (AM-I-FCR) in lung cancer patients: a randomized controlled pilot study  \nJialing Lin1†, Zhixuan Kang1†, Chenxing Zhang1, Rachel Arbing2, Wei-Ti Chen2 and Feifei Huang1*  \nAbstract  \nBackground Fear of cancer recurrence (FCR) imposes a significant psychological and physical burden on cancer patients. Art-making interventions may offer a novel approach to alleviating FCR. This study aimed to develop an artmaking program (AM-I-FCR) and assess its feasibility and preliminary effects on FCR in lung cancer patients.  \nMethods The AM7-I-FCR was developed and evaluated via intervention mapping from March to December 2023. Step 1 (needs assessment) involved qualitative interviews. Step 2 (setting objectives) included translation and matrix creation. Step 3 (program design) involved a theoretical framework and a systematic review. Step 4 (program production) conducted expert meetings and collected patient feedback. Step 5 (implementation) and Step 6 (program evaluation) involved a pilot-randomized controlled trial (RCT) from August to December 2023 at a tertiary hospital in Fuzhou, China. The participants were randomized to receive either standard care or AM-I-FCR plus standard care. Data were collected at baseline, midpoint, and post-intervention and analyzed using intention-to-treat analysis and generalized linear mixed models. Feasibility was assessed by participation rates, satisfaction, and adverse events. Fidelity was evaluated via standardized checklist, supervision meetings, audio recordings, and qualitative interviews. Results Based on the first four steps, AM-I-FCR was developed successfully. The pilot-RCT including 60 patients (30 per group), with 28 valid cases per group, revealed significantly lower FCR severity (95% CI, 0.606 ~ 2. 994, p \u003C 0. 001), anxiety (95% CI, − 2.888 ~ − 0 . 712, p \u003C 0. 05), depression (95% CI − 3.587 to − 1 . 147, p \u003C 0. 05), and illness perceptions (95% CI, 0.079 ~ 4. 654, p \u003C 0. 001), along with improved confrontation (95% CI, − 3.908 ~ − 1 .425, p \u003C 0. 001) and emotional quality of life (QOL) (95% CI, − 2.674 ~ − 0 . 859, p \u003C 0. 001) in the intervention group. No significant differences were noted in avoidance or other QOL dimensions (p>0. 05) . The intervention was feasible, with no adverse events. The interviews emphasized emotional release and self-exploration, demonstrating high fidelity.  \nConclusions This study successfully developed the AM-I-FCR, which showed encouraging feasibility and acceptability and preliminarily reduced FCR severity, anxiety, and depression while improving confrontation, illness perceptions, and emotional well-being.  \nTrial registration ChiCTR2300069395 . Registered on 15 March 2023.  \n†Jialing Lin and Zhixuan Kang contributed equally to this work.  \n*Correspondence: Feifei Huang [pt860315@163.com](pt860315@163.com)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitte","cbCaif17hwhyR64j","https://ap.wps.com/l/cbCaif17hwhyR64j","pdf",2356588,22,"English","# Background\n## Fear of cancer recurrence (FCR) and its burden\n## Prevalence and psychological consequences in lung cancer survivors\n# Methods\n## Program development via intervention mapping (March–December 2023)\n## Pilot-randomized controlled trial design (August–December 2023)\n## Data collection and analysis\n## Feasibility and fidelity assessments\n# Results\n## Development outcome and pilot-RCT sample description\n## Effects on FCR severity, anxiety, depression, and illness perceptions\n## Effects on confrontation and emotional quality of life\n## Safety and qualitative findings\n# Conclusions\n# Trial registration and contributions","[{\"question\":\"What is AM-I-FCR and what problem does it target?\",\"answer\":\"AM-I-FCR is an art-making program developed to manage fear of cancer recurrence (FCR). It targets FCR-related psychological burden in lung cancer patients.\"},{\"question\":\"How was the AM-I-FCR program developed?\",\"answer\":\"The program was developed using intervention mapping steps, including needs assessment through qualitative interviews, objective setting with translation and matrix creation, program design with theory and a systematic review, and program production with expert meetings and patient feedback.\"},{\"question\":\"What did the pilot randomized controlled trial find?\",\"answer\":\"In the pilot RCT, the intervention group showed significantly lower FCR severity and reduced anxiety and depression, with improved illness perceptions, confrontation, and emotional quality of life. No adverse events were reported.\"}]","Feasibility and preliminary efficacy of an art-making program to manage fear of cancer recurrence (AM-I-FCR) in lung cancer patients - a randomized controlled pilot study | PDF",1790149421,55]