Assessing the Unique Needs of Hospice Patients: A Tool for Music Therapists

Abstract

ABSTRACT: The needs of the hospice patient are wide-ranging and include physical, emotional, social, and spiritual challenges. This article explores the role of assessment in hospice music therapy and presents a tool that integrates standards for assessment developed by the profession. The purpose of the assessment tool is to assist music therapists in achieving a clear and detailed portrayal of the current level of functioning of adult hospice patients and in obtaining relevant information to be used in formulating an appropriate plan of care. A detailed description of the tool is provided along with procedures for its administration. As the presence of music therapists in the hospice field grows, it is important to develop and share a framework for clinical practice. Today, there are over 100 music therapists in the United States who identify hospice as a setting in which they work (American Music Therapy Association [AMTA], 2004a). One important area that has received little attention for this population is the music therapy assessment. A valuable assessment must generate a clear understanding of client functioning in multiple domains relating to the formulation of an appropriate plan of care. It must also facilitate the therapist in gaining specific and detailed understanding of client behavior unique to the modality used in therapy. Hospice Care Hospice eligibility requires that a patient be diagnosed by a physician as having a life-limiting illness. Reimbursement for hospice services is most often provided to those patients who have a projected prognosis of six months or less (National Hospice and Palliative Care Organization, 2002). In addition to support, education, and comfort, patients receive a level of care that is palliative rather than curative. That is, members of a palliative care team aim to alleviate symptoms and focus on maintaining the best possible quality of life. Patients with terminal illnesses are often both physically and emotionally delicate and may have little energy for active involvement in interventions (West, 1994). Therefore, assessment is focused on evaluating current levels of functioning, determining strengths and weaknesses, and identifying coping skills, support systems, and expressive abilities. Therapeutic intervention occurring in hospice care is determined by the multi-faceted needs of patients challenged with life-limiting illnesses. These needs are addressed through a team approach, which may include pastoral counseling, social work, bereavement counseling, complementary therapies, and music therapy in addition to standard palliative care from medical doctors, pharmacists, nurses, and certified nurses assistants. At the beginning of treatment, each professional conducts an assessment specifically designed to contribute to a complete understanding of patient needs. These may include nursing assessments; pain assessments, such as a visual analog pain scale and the Checklist of Nonverbal Rain Indicators (Feldt, 2000); cognitive functioning assessments, such as the Karnofsky Rating Scale (Karnofsy, Abelmann, & Graver as cited in Krout, 2000) and the Functional Assessment Staging Measures (Reisberg, 1988); as well as a social work assessment, spiritual needs assessment, quality of life index (Byock, 2003), and music therapy assessment. In conducting a thorough music therapy assessment, music therapists benefit from considering the needs upon which treatment will be focused. Milliard (2003), Krout (2001), Starr (1999), West (1994), and Curtis (1986) identified possible treatment goals for music therapy in hospice care. These include (a) decreasing anxiety and perception of pain, (b) developing coping skills, (c) gaining spiritual support, (d) identifying and expressing emotions, (e) engaging in life review, (f) improving communication skills, (g) improving relaxation skills, (h) decreasing restlessness and agitation, and (i) orienting to reality. …