Developing a platform for research to inform music therapy practice with hospitalised children

Abstract

This thesis poses three questions about the work of the music therapist and the possibilities for future research in a children's hospital context. These questions are addressed through the practical implementation of clinical studies, the soliciting of opinion of expert colleagues and a review of relevant clinical and research literature from music therapy and wider publications. Key issues relating to clinical research including the philosophical foundation of inquiry and ethical aspects of research with children are considered throughout the thesis in discussion, critical debate and practical application. Music therapy with hospitalised children is at a development stage in Australia. This thesis proposes and demonstrates ways by which the development of research may be undertaken. The three main questions guiding the thesis, and the consideration provided are: 1. What are the parameters of the existing research in paediatric music therapy? A critical overview of current music therapy research in paediatrics is presented to answer this question. A small number of experimental studies have been documented. Outcomes of these studies provide support for music therapy's role in meeting clinical goals; either at the bedside, in private sessions or during treatment procedures with hospitalised children. These studies have shown efficacy in the use of music therapy to assist in relaxation, increasing coping and reducing anxiety for paediatric patients. 2. What is the philosophical basis for further research endeavours in paediatric music therapy? The discussion and outcomes of the thesis argue that the post-positivist philosophical frame is the most congruent with the music therapy research and practice writings reviewed. Music therapy research with children in hospital, whether undertaken using a quantitative or qualitative method, has reflected the post-positivistic paradigm characteristics of use of natural setting, the attainment of outcomes that can be generalised, and the use of either experimental research or qualitative methods. Demands for efficacy and accountability within the medical context are likely to remain key directives for the types of research activity supported and the types of research information valued. 3. What are the main considerations in developing future research projects in paediatric music therapy? Three studies are presented in response to this question. In the first study, a Delphi method investigation synthesises the opinion of experts in the field of music therapy in Australia as well as the fields of medicine and allied health at The University of Queensland. The top five items of importance for the total group of expert respondents in the Delphi reported in the thesis are that ethical procedures are followed, children1s responses are included, results obtained are valid and reliable, the research methods are suitable and qualitative methods are used. Considerations arising from the responses of these experts are then used to inform and support the development of two further research studies undertake n at a paediatric hospital. A pilot study of the effects of music therapy with children newly diagnosed with cancer, and a further grounded theory study with children following car accidents receiving music therapy in the Statewide Paediatric Rehabilitation Service (SPRS) at the hospital, are presented. The findings of the oncology study showed that the measures used were appropriate, the research was minimally intrusive and the patients and their families were able to follow the protocol. Some further attention to staff participation is needed for the continuation of the study beyond pilot stage. The qualitative study in the SPRS uncovered eight techniques used consistently by the therapist in her sessions with the children. These techniques are cueing, synchrony, choice, orientation, preparation, feedback, incorporation and humour. As music therapy practice in the children's hospital context develops and expands further, it is intended the findings of this thesis serve as a platform for research endeavours to further refine knowledge about this field.