The EFECT of Poetry: A Novel Framework for Cancer Survivor Engagement Through Independent Literary Expression
- PJO
- Jun 14
- 14 min read
Updated: Oct 6
Original Article
The EFECT of Poetry: A Novel Framework for Cancer Survivor Engagement Through Independent Literary Expression
1 Cancer Care Center, ManilaMed – Medical Center Manila, 850 United Nations Ave, Paco, City of Manila, Metro Manila
2 Better Days Well Being Center, White Plains, Quezon City
Corresponding author: Susano B. Tanael; tanaelsusano@gmail.com
ABSTRACT
Objectives: This pilot project evaluated an internet-based poetry program for cancer survivors using independent engagement. Through the EFECT model (engage, feel, explore, connect, and transfer), the study examined purpose-setting, emotional responses, self-exploration, connection-building, and practical application of insights.
Methods: Using a single-case design, the study centered on Maya Angelou's "Still I Rise," selected for its thematic resonance with cancer survivorship. Following informed consent, the participant independently engaged with online materials and completed an EFECT-based questionnaire. Written responses were analyzed for engagement levels, emotional reactions, personal connections, and practical implications.
Results: The breast cancer survivor demonstrated strong identification with "Still I Rise," particularly its themes of resilience and self-empowerment. Poetry engagement facilitated identity exploration and purpose redefinition. Notably, empowerment themes triggered complex emotional responses, highlighting the need for careful intervention design. The participant's interest in advocacy suggests poetry's potential role in activism. These findings indicate meaningful engagement through online poetry programs.
Conclusion: This preliminary study supports the viability of internet-based poetry programs for cancer survivors, aligning with established poetry therapy principles. While the program shows promise in supporting patient resilience through creative expression, its unexpected potential for fostering creative advocacy merits further investigation. These findings support integrating poetry into comprehensive cancer care, though larger-scale validation studies are needed.
Keywords: Cancer survivors, poetry reading and expression, EFECT model, online intervention, creative advocacy
INTRODUCTION:
Cancer survivors often face emotional and psychological challenges despite effective treatments, emphasizing the need for alternative therapies. Poetry reading and expression hold promise as therapeutic tools. Yet, research highlights gaps in understanding how patients engage with poetry.(1) Exploring these connections is vital to realizing its therapeutic potential.
Close reading meticulously examines a poem’s structure and language to uncover deeper meanings, fostering appreciation and understanding.(2,3) In contrast, literary criticism evaluates themes, cultural contexts, and significance, offering a broader poem analysis.(4) Critical appraisal complements these methods, assessing a poem’s quality, structure, and literary devices to deepen literary discourse.(5)
Reflective reading, however, provides a personal, contemplative approach, encouraging readers to explore their emotions and memories. This method positions poetry as a healing tool by fostering self-awareness and emotional growth.(6) Among these strategies, reflective reading is especially valuable for clinicians assisting cancer survivors. It emphasizes emotional reactions, facilitating conversations that connect poetic themes with patients’ experiences to nurture validation and understanding.
Effective strategies enhance reflective reading.(7) These include setting goals, connecting ideas within the text, pausing for reflection, leveraging prior knowledge, maintaining focus, and using native language translations.
These strategies align with Alfey’s EFECT model, which outlines engaging, feeling, exploring, connecting, and transferring as mechanisms of poetry therapy.(8) This model promotes emotional reflection, skill-building, and connection, helping readers validate feelings and improve communication. However, gaps remain, such as integrating goal-setting, refocusing, and translation into the framework. Could a self-guided poetry reading approach based on the EFECT model bridge these gaps?
A pilot study explored this idea with a single participant, addressing missing practices. It assessed engagement, emotional responses, self-reflection, connections to poetry, and application of insights to daily life while gathering feedback on well-being and self-awareness.
METHODS
Poem Selection
The poem Still I Rise by Maya Angelou was chosen for its themes of hope, resilience, and coping with challenges. Its selection was guided by a close reading and critical appraisal, aligning with the participant’s cancer journey.(9)
Participant Selection
The participant was selected based on a cancer journey that resonated with the poem's themes of resilience and hope. Consent was obtained for independent reading and task completion. The participant demonstrated interest in emotional exploration and introspection, along with the ability to express insights and feelings evoked by the poem. Eligibility criteria included being 18 or older, fluent in English, with internet access, and willingness to participate in tasks after reading the poem.
Delivery Method
The poem was delivered electronically, ensuring convenience and eliminating the need for traditional group settings or facilitators.
Questionnaire Development
To ensure alignment with Alfey’s EFECT model, the questionnaire was designed to evaluate each task’s theoretical foundation. Multiple questions were crafted to capture the objectives of engaging, feeling, exploring, connecting, and transferring. Psychology and literature experts reviewed the initial questions for clarity and adherence to the model. A pilot study assessed their applicability, ensuring they mirrored tasks in conventional poetry therapy (see Supplementary Material S1). After reading the poem, the participant completed the questionnaire to evaluate the effectiveness of independent poetry reading and expression.
Participant’s Tasks
Engaging: The participant read the poem independently, focusing on its ideas and themes. Questions assessed attentiveness and engagement during reading.
Feeling: Emotional responses to the poem were explored, with participants describing how the poem impacted them and explaining the reasons behind these emotions.
Exploring: Participants connected the poem’s themes—resilience, hope, and overcoming challenges—to personal experiences. Reflections on the poem's relevance to their journey were elicited.
Connecting: The participant related the poem’s themes to personal values, cultural contexts, and societal beliefs. Questions probed how the poem aligned with their identity and sense of belonging.
Transferring: Participants considered how the poem’s messages could influence their goals and personal growth. Inspired by themes of resilience and empowerment, they identified ways to apply these lessons to their lives.
Data Collection
A single participant completed a questionnaire designed to gather insights into poetry reading tasks. Responses were recorded and analyzed to uncover relevant patterns and study-related findings.
Data Analysis
Responses from the open-ended questionnaire underwent qualitative thematic analysis. Recurring themes and patterns were identified, focusing on emotional reactions, personal connections, and the application of lessons to daily life. The analysis explored how the participant engaged with the poem and its potential therapeutic impact.
Participant Inclusion and Ethical Considerations
The participant was credited as a co-author to highlight their unique perspective and ensure accurate representation of their experience. Informed consent was obtained after a detailed explanation of the study, including their dual role and the implications for anonymity. To uphold ethical standards and minimize bias, the participant was excluded from analyzing their responses or interpreting data. Their role was limited to manuscript review, ensuring consistency with their experience without influencing the study’s findings or conclusions.
Leveraging Generative AI for Task Completion and Enhanced Writing
This research focused on clearly defining AI tasks by providing relevant background information, specifying desired output formats and content, and including necessary constraints as special instructions. Each AI-generated concept was cross-validated across multiple platforms (ChatGPT, Claude, Perplexity, Gemini). Responses were carefully reviewed and adjusted to ensure effective AI utilization based on principles of clarity, conciseness, relevance, consistency, and engagement. Analysis-related sections were prioritized while removing irrelevant information to maintain focus.
In writing the manuscript, AI tools like ChatGPT and Gemini were employed to reword text, rearrange sentences, restructure phrases, and suggest more appropriate vocabulary. Additionally, Grammarly was utilized to correct grammatical and spelling errors.
RESULTS
A single poem, Still I Rise by Maya Angelou, curated for its themes of hope and resilience, was selected. The participant reflected on their experience through a questionnaire assessing engagement, emotions, and connections.
Participant Profile
The participant, a 57-year-old woman living with Stage 4 metastatic breast cancer for eight years, volunteered for the study. Fluent in English, she accessed the poem Still I Rise via email. Her interest in introspection and emotional expression made her an ideal participant.
Engagement with the Poem
During her reading of Still I Rise, the participant visualized "sunrise," "a fist of triumph," "chain that was broken," "diamonds," and "gold in the furnace." These images evoked feelings of confidence, courage, joy, honor, hope, and resilience. She interpreted the poem as a reminder to endure challenges and find empowerment in adversity.
The participant expressed a strong connection to the lines "You might shoot me with your words," "Up from a past that was rooted in pain," and "Shoulders falling down like teardrops." These phrases prompted deep reflections on her personal journey, particularly overcoming Stage 4 breast cancer in 2016. She found solace and motivation in the poem’s themes of resilience and triumph over hardship.
Emotional Responses
The participant’s reading of Still I Rise by Maya Angelou evoked profound physical sensations and emotional reactions, highlighting the poem’s impact on her psyche.
Physically, the poem elicited goosebumps during lines like "You may shoot me with your words / You may cut me with your eyes." She described a tingling warmth as the reading progressed, especially during passages emphasizing overcoming adversity. The rhythmic assertiveness of lines such as "Out of the huts of history's shame / I rise" increased her heart rate, reflecting the poem's intensity.
Emotionally, the poem sparked inspiration, resilience, self-confidence, and triumph over hardship. She felt pride, motivation, and a deep sense of empowerment, occasionally shedding tears of hope. The poem unearthed fresh emotions while revisiting past memories, resonating with her courage and dignity in facing life’s struggles.
Her engagement with the poem also shaped her perspective. The qualities of fortitude, strength, and hope echoed her own journey through adversity. These traits not only inspired her but also strengthened her ability to support others, fostering a cycle of empowerment and resilience.
Exploration of Themes
The participant, a cancer survivor, deeply resonated with Maya Angelou's Still I Rise, finding it a reflection of her resilience, strength, and defiance against a life-threatening illness. The poem empowered her to reclaim agency, celebrate survival, and approach the future with dignity.
The poem’s defiance mirrored her refusal to be subdued by her cancer experience. She described reclaiming her liberty and resolving to live free from the constraints of illness or societal expectations. Its empowering message affirmed her self-worth and encouraged her to challenge the stigma often associated with cancer survivors.
While acknowledging the despair of cancer, the poem inspired her to hope for a brighter future. It urged her to celebrate survival and envision a fulfilling life beyond her diagnosis.
The participant also connected with the poem's call to follow her path, embracing her experiences and intuition. It highlighted her inner strength and resilience to face adversity. Still I Rise reinforced her sense of empowerment, boosting her confidence and determination to overcome challenges.
Lastly, the poem reminded her of being part of a larger narrative of generational resilience. This connection gave her a sense of solidarity and strength, helping her realize she was not alone in her journey.
Connection to Identity and Beliefs
Engaging with Maya Angelou's Still I Rise prompted a profound journey of self-discovery for the participant, encouraging reflection on her past challenges and present aspirations. Facing cancer with resilience and courage, she embraced uncertainty while reevaluating her values and life goals.
The poem inspired her to reconsider her purpose and legacy, reshaping her priorities. As her cancer journey progressed, she contemplated life’s meaning and the mysteries of death. Despite fear and anxiety, she cultivated gratitude and sought to live each day purposefully.
Amid uncertainty, the participant affirmed her independence, aligning her actions with her values. She found strength in navigating difficult decisions and unknown outcomes, which deepened her self-awareness and spiritual transformation. Overcoming cancer became a testament to her inner strength.
The participant's journey and the poem’s influence offer inspiration to others. Through public speaking, social media, or support groups, she can share her story, raise awareness of survivorship, and motivate others to persevere and thrive.
Transfer of Insights
The participant, a cancer survivor and coach, deeply connected with Still I Rise. Its themes of defiance and empowerment inspired her to support others on their healing journeys. Drawing strength from the poem, she envisioned building a community centered on courage, hope, and determination.
The poem’s message encouraged her to express her reflections creatively. She considered painting vibrant imagery of resilience, writing about the survivor experience with emotive language, or capturing moments of strength and recovery through photography. These creative outlets symbolized her journey from adversity to triumph.
The idea of a phoenix rising from the ashes resonated deeply, representing transformation and renewal. This metaphor inspired her work as both a cancer survivor and an advocate for resilience.
She also envisioned creating a tangible artifact or organizing workshops based on her poetry reading and insights. These initiatives would offer tools and perspectives to help others find growth and rejuvenation in the face of hardship.
DISCUSSION
This study piloted an online, self-guided poetry reading program with task-oriented questions instead of traditional face-to-face sessions. Using the EFECT paradigm, the questionnaire evaluated whether the program provided enough tools to enhance engagement with the poem.
One methodological focus was selecting a poetry exploration objective. Participants received an email asking them to read the poem and reflect on their cancer experiences. Questions explored imagery, emotions evoked, connections to life events, and the poem's overarching message.
To address concentration gaps, the study used a two-pronged approach. Participants could pause reading and complete the questionnaire at a "convenient time," allowing breaks to maintain focus. Additionally, the questionnaire was divided into sections with targeted questions, creating natural pauses for refocusing. An online discussion with the researcher concluded the study, clarifying comments and encouraging deeper reflection on the poem.
These strategies ensured focus and comprehension, removing the need for native language (L1) translation. English fluency was a requirement for participation, ensuring understanding. Participants wrote down their interpretations and selected key messages from a list. Feedback confirmed no problematic terms or phrases, demonstrating sufficient comprehension without translation.
Maya Angelou's "Still I Rise" deeply resonated with cancer survivors' emotional journeys and self-reflection. The participant, both a survivor and advocate, found profound meaning in the poem's defiant spirit and themes of overcoming adversity. Poetry therapy can indeed empower cancer patients, as Greer et al. noted.(10)
The participant's personal connection to the poem emerged through its themes of resilience, validating their own journey through cancer. This aligns with Sweeney's (11) emphasis on validation in poetry therapy. The emotional impact transcended mere understanding, stirring feelings of inspiration and determination that echo Richards & Sawyers'(12) research on poetry's ability to deepen patient connections.
This engagement sparked meaningful self-discovery and identity exploration, supporting Baikie & McGuire's(13) findings about poetry therapy's role in patient reflection. The experience ultimately inspired creative expression and advocacy work, though research on creative expression in cancer advocacy remains limited.(14)
The participant's encounter with "Still I Rise" revealed a nuanced emotional landscape where empowerment coexisted with vulnerability. Despite its inspiring message, the poem stirred complex feelings of sadness and anger during reflection.
This paradoxical response likely stems from the poem's dual nature - its triumphant themes alongside references to past struggles that may trigger difficult memories. The depth of emotional response underscores the need for careful facilitation in poetry reading sessions, ensuring participants feel supported when unexpected feelings surface.
In examining how this poem affected a cancer survivor, the study revealed poetry's potential for psychological healing. The findings align with multiple theoretical frameworks: story therapy's focus on rewriting hardship narratives(15), client-centered treatment's emphasis on validation16, and psychodynamic theory's perspective on emotional processing.(17) These insights support integrating individual poetry reading into cancer care programs, building on established research about poetry's therapeutic benefits.(9)
Independent poetry reading can foster self-reflection and resilience, particularly when themes resonate deeply with participants.(9,12) Creating safe spaces for emotional expression proves especially valuable for cancer survivors.(10)
The study introduces a novel approach to trauma-related creative therapies13, notably through the participant's motivation for advocacy. This suggests promising directions for research into creative advocacy programs, such as specialized writing workshops for sharing cancer experiences.
The EFECT model (engaging, feeling, exploring, connecting, transferring) provides a framework for innovative healthcare strategies. The findings support integrating poetry reading into cancer care programs, as it facilitates self-discovery and motivates advocacy efforts.
Several key limitations warrant careful consideration in this study. Primarily, the single participant design significantly limits generalizability of findings,(18) while the absence of a control group makes it challenging to attribute outcomes specifically to the poetry therapy intervention.(19) Additionally, the limited expert review process may have introduced potential bias into the study design.(20) Furthermore, the single time-point assessment provides only a snapshot view, constraining our understanding of long-term effects.(21) The exclusive reliance on self-reported questionnaire data raises concerns about response bias,(22) and finally, the implementation of a newly developed questionnaire without established psychometric properties necessitates further validation before broader application.(23)
To rigorously evaluate the EFECT framework, future research should include RCTs comparing it to controls. This will assess its impact on mental, social, and physical health. Alternatively, large-scale qualitative studies can explore diverse survivor experiences through interviews, focus groups, and observations. A mixed-methods approach combining these methods can provide a more comprehensive understanding of the program's impact.
CONCLUSION
This pilot study explored an online, self-guided poetry program's impact on cancer survivors through "Still I Rise." Despite complex emotional responses, findings support incorporating poetry reading into cancer care to enhance self-discovery and emotional validation. Future research should examine tailoring sessions for creative advocacy.
DATA AVAILABILITY STATEMENTS
Not publicly available
ETHICS STATEMENT
This pilot study, involving a co-author as a respondent, was conducted in adherence to fundamental ethical principles. The participant provided informed consent with full disclosure of the dual role implications, and participation was entirely voluntary. While anonymity was impossible for the co-author/respondent, her data was treated with the same confidentiality as other anonymous participants. Measures were implemented to avoid coercion, ensuring the co-author/respondent felt no pressure to participate or provide specific responses due to their research team role. To maintain data integrity, the co-author/respondent was excluded from analyzing her own responses or participating in study writing aspects where the dual role could introduce bias. The methodology section explicitly states the co-author's dual role as a respondent, ensuring full transparency. Through these measures, we have maintained the ethical integrity of the research while addressing the unique circumstance of a respondent also being a co-author.
AUTHORS CONTRIBUTION
SBTJ, original draft, writing of the manuscript; CJM, review and editing
FUNDING
This research received no external funding.
CONFLICT OF INTEREST
The authors declare no conflicts of interest related to commercial or financial relationships.
PUBLISHER’S NOTE
This article reflects the views and findings of the authors alone and does not necessarily represent the official position of the author's affiliated organizations, the publisher, editors, or reviewers. We encourage readers to remember that the content presented here does not constitute endorsement or approval by any of the entities above.
Similarly, any products or services mentioned within this article are for informational purposes only. The publisher recommends that readers conduct independent evaluations before making any decisions, as the publisher does not guarantee or endorse any products or services mentioned.
DECLARATION OF USE OF GENERATIVE ARTIFICIAL INTELLIGENCE
In the preparation of this manuscript, Gemini 1.5 Flash and Grammarly were utilized to refine grammatical structure and phrasing. The authors have thoroughly reviewed, edited, and verified all content generated by AI, taking full responsibility for the accuracy, integrity, and originality of the final published work. The use of AI did not extend to data analysis, interpretation of results, or the drawing of scientific conclusions. All scientific content, intellectual contributions, and research findings presented herein are solely those of the authors.
In addition, generative AI tools—including ChatGPT, Claude, Perplexity, and Gemini—were intentionally employed to support the development of the two structured question sets and the classification scheme presented in the supplementary materials. These tools were used to generate prompts, refine question clarity, organize thematic categories, and propose preliminary classification criteria grounded in literary, clinical, and pastoral-spiritual dimensions.
The purpose of employing AI in this context was to initiate a systematic approach to critically appraising poems that may be of therapeutic value to patients, particularly in settings of accompaniment, reflection, and meaning-making. The question sets and classification framework are exploratory and provisional, serving as a conceptual foundation for future work. The authors acknowledge that further development, field testing, and formal validation are necessary to ensure their reliability and applicability in diverse clinical and spiritual care contexts.
All AI-assisted outputs were critically reviewed, revised, and contextualized by the authors. Final editorial and scholarly responsibility lies entirely with the human authors, who affirm the ethical, intellectual, and clinical integrity of the work.
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Received: 2024 May 15 Received in revised form: 2024 June 05 Accepted: 2024 Jul 07
CITATION
Tanael SB. A multifaceted appraisal of Maya Angelou's Still I Rise as a supportive resource in
the accompaniment of cancer patients. Philipp J Oncol [Internet]. 2025 [cited 2025 Jun
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