Music Therapy In Palliative Care Research Articles

Fostering Pre-Professionals and Learning Experiences in End-of-Life Care Contexts: Music Therapy Internship Supervision.

Certified music therapists use music within therapeutic relationships to address human needs, health, and well-being with a variety of populations. Palliative care and music therapy are holistic and diverse fields, adapting to unique issues within end-of-life contexts. Palliative care music therapy has been formally practiced since the late 1970s and affords a variety of benefits, including pain and anxiety reduction, enhancement of quality of life, emotional expression, and relationship completion. The training of music therapists varies around the globe, but clinical supervisors play a key role in skill acquisition. Clinical supervisors support pre-professionals as they realize the application of their training, foundational competencies, and authentic therapeutic approaches in end-of-life care, while navigating the challenges and rewards of this work. This article is a narrative review which offers background information on palliative care music therapy, and reports the authors' viewpoints and reflections on supervision strategies and models employed with music therapy interns in palliative care settings based on their experiences. Approaches are shared on supporting pre-professionals as they begin working in palliative care contexts, as well as implications for supervision practices.

Relationship completion in palliative care music therapy (Clements-Cortés & Yip, Eds.)

This is a review of the book "Relationship completion in palliative care music therapy" edited by Amy Clements-Cortés & Joyce Yip Title: Relationship completion in palliative care music therapy Editors: Amy Clements-Cortés & Joyce Yip Publication year: 2021 Publisher: Barcelona Publishers Pages: 236 ISBN: 9781945411656

“Song of Life”: A Comprehensive Evaluation of Biographical Music Therapy in Palliative Care by the EMW-TOPSIS Method

The “Song of Life (SOL)” is a kind of music therapy in palliative care for addressing emotional and existential needs in terminally ill patients nearing the end of life. Few previous studies focus on objective data analysis methods to validate the effectiveness of psychotherapy therapy for patients’ overall state. This article combines the entropy weighting method (EWM) and the technique for order preference by similarity to the ideal solution (TOPSIS) method to evaluate the effectiveness of SOL music therapy and the treatment satisfaction of the patients and family members. Firstly, the collaborative filtering algorithm (CFA) machine learning algorithm is used to predict the missing ratings a patient might have given to a variable. Secondly, the EWM determines the weights of quality of life, spiritual well-being, ego-integrity, overall quality of life, and momentary distress. Thirdly, the EWM method is applied for the TOPSIS evaluation model to evaluate the patient’s state pre- and post-intervention. Finally, we obtain the state change in patients and recognition based on the feedback questionnaire. The multiple criteria decision making (MCDM) comprehensive evaluation method objectively validated the overall effectiveness of SOL music therapy. Based on MCDM method, we provide a new approach for judging the overall effect of psychological intervention and accurately recommend psychotherapy that fits the symptoms of psychological disorders.

Relationship completion in palliative care music therapy. Editors: Amy Clements-Cortes & Joyce Yip

Relationship completion is a relatively new area of focus in palliative care that is of growing interest and championed by Dr. Amy Clements-Cortes. This book includes a collaboration of music therapists whose work is inclusive of various models of palliative care, in settings around the world. It is a strong read not only clinicians, but for students, researchers, and others in allied health professions.

Use of Palliative Care Music Therapy in a Hospital Setting during COVID-19.

As many hospitals scaled back integrative therapies during the COVID-19 pandemic, we instead turned to the multifaceted qualities of music to bridge physical and social divides. In this report, we describe palliative care music therapists as frontline providers utilizing evidence-based approaches to support healing and recovery for patients in the intensive care unit, patient and family care at end of life, and staff wellness. We provide examples of music therapy (MT) to promote successful weaning from mechanical ventilation, create bedside rituals and legacy gifts for dying patients and their families, and provide real-time support for overwhelmed staff. Despite barriers brought on by the pandemic, the sensory and emotional immediacy of music bridged social distances at critical moments and addressed "suffering beyond words" among patients, families and health care workers. Our experience reinforced the need for MT as standard of interdisciplinary care during the pandemic and beyond.

“Song of Life”: Results of a multicenter randomized trial on the effects of biographical music therapy in palliative care

Background: Awareness for the importance of psychological and spiritual needs in patients with terminal diseases has increased in recent years, but randomized trials on the effects of psychosocial interventions are still rare. Aim: To investigate the efficacy of the “Song of Life” music therapy intervention regarding the emotional and psycho-spiritual dimensions of quality of life. Design: Patients were randomly assigned to either “Song of Life” or a relaxation intervention. “Song of Life” is a novel three-session music therapy intervention working with a biographically meaningful song. Primary outcome was the improvement in psychological quality of life. Secondary outcomes included spiritual well-being, ego-integrity, momentary distress, and global quality of life and the explorative assessment of treatment satisfaction (patient and family member version). Intention-to-treat analysis was conducted including adjustment for multiple testing in secondary outcomes. Setting/participants: Between December 2018 and August 2020, 104 patients receiving specialized palliative care were recruited from two palliative care wards. Results: No significant differences were found regarding psychological and global quality of life, but “Song of Life” participants reported significantly higher spiritual well-being (p = 0.04) and ego-integrity (p < 0.01), as well as lower distress (p = 0.05) than patients in the control group. Both patients’ and family members’ treatment satisfaction was higher after “Song of Life” with large between-group effect sizes on items asking for meaningfulness (d = 0.96) and importance (d = 1.00). Conclusions: Our findings provide evidence that “Song of Life” is an effective and meaningful biographical music therapy intervention to facilitate psycho-spiritual integration in terminally ill patients. Trial Registration: German Clinical Trials Register (DRKS)—DRKS00015308 (date of registration: September 7th 2018).

Adapting to change, welcoming otherness

Adapting to change, welcoming otherness

Virtual Reality-Based Music Therapy in Palliative Care: A Pilot Implementation Trial.

Background: Music therapy (MT) and virtual reality (VR) have shown favorable patient-reported outcomes during serious illness. Objectives: To evaluate implementation measures of feasibility, usability, and acceptability of a VR-based MT intervention. Design: A pilot implementation study of a two-day VR-MT intervention using mixed methods. Patients created a personalized soundtrack with a music therapist, and then paired the soundtrack with a 360° VR environment. Setting/Subjects: Hospitalized patients with palliative care needs. Results: Of 23 patients (ages 20-74 years, 52% women), 17 completed the intervention, including 39% during an intensive care unit stay. Participants scored usability above average. For satisfaction, 53% chose the highest rating. Most participants spoke favorably of VR-MT, describing pleasant emotional and physical responses. Participants provided feedback on length, frequency of use, VR options, and timing of delivery. Conclusion: This VR-MT intervention was feasible, usable, and acceptable for hospitalized palliative care patients. Further study will test VR-MT outcomes.

Development and Evaluation of a Hospice and Palliative Care Music Therapy Education Program.

This study was conducted to develop a hospice music therapist training program and to evaluate its effects. The educational program consisted of training on the theory of hospice and the theory and practice of hospice music therapy. The course lasted for 4 weeks, with 8 hours of training per week, and 33 music therapists completed the course. In order to assess the effectiveness of the course, participants' knowledge and confidence regarding hospice music therapy and readiness for hospice music therapy before and after education were measured. The statistical analysis was done using SPSS version 18.0 and the paired t-test was used to assess the effectiveness of the program. The trainees showed significant improvements in knowledge (P<0.001) and confidence (P<0.001) in all areas of this course, as well as in readiness for hospice music therapy (P<0.001). Participants' satisfaction with the lectures was assessed using a 5-point Likert scale. The average score for all lecture areas exceeded 4 (yes), and the satisfaction level was mostly high. Students were most satisfied with the lectures on music therapy theory, followed in order by those on music therapy practice and hospice theory. This hospice music therapist training program is considered to be suitable because of its positive educational effects and the high satisfaction of participants with the lectures. In order to provide high-quality music therapy services to patients and their families, this training course should be regularly offered to cultivate competent music therapists, and the content of the education should be standardized and applied in various clinical settings.

A synopsis of the MusiQual feasibility study into the effectiveness of music therapy in palliative care inpatient settings

The research team involved in conducting the MusiQual study – carried out in Belfast, Northern Ireland by Queen’s University Belfast, Every Day Harmony Music Therapy, and Marie Curie Northern Ireland – aimed to ascertain the feasibility of carrying out a larger multicentre trial into the effectiveness of music therapy in improving the quality of life of palliative care inpatients. This synoptic paper summarises a number of publications which resulted from developing and implementing the MusiQual study. Those publications include the main findings paper (Porter et al., 2018) and a number of supplementary publications: a systematic review of the literature (McConnell et al., 2016a), a realist review of the literature (McConnell &amp; Porter, 2016), a critical realist evaluation (Porter et al., 2017a), an outline of the theoretical model which resulted from the realist review of the literature (McConnell &amp; Porter, 2016), and the treatment manual for music therapy in palliative care drafted for use in the potential multicentre trial and recently published (Kirkwood et al., 2019). The purpose of this synopsis is to consolidate information in one single, accessible place in order to advance knowledge in this area of work and support the evidence-informed practice of music therapists and others in this field.

\u201cSong of Life (SOL)\u201d study protocol: a multicenter, randomized trial on the emotional, spiritual, and psychobiological effects of music therapy in palliative care

BackgroundAlthough patients in palliative care commonly report high emotional and spiritual needs, effective psychosocial treatments based on high quality studies are rare. First research provides evidence for benefits of psychosocial interventions in advanced cancer care. To specifically address end-of-life care requirements, life review techniques and creative-arts based therapies offer a promising potential. Therefore, the present study protocol presents a randomized controlled trial on the effectiveness of a newly developed music therapy technique that is based on a biographically meaningful song (“Song of Life”; SOL).MethodsIn a design with two parallel arms, 104 patients at two palliative care units will be randomly assigned to three sessions of either SOL (experimental group) or relaxation exercises (control group). Improvements in the psychological domain of quality of life will be the primary endpoint, while secondary outcomes encompass spiritual well-being, ego-integrity, overall quality of life, and distress. Additionally, caregivers will be asked to provide feedback about the treatment. Assessment of biopsychological stress markers and qualitative analysis of perceived strengths and weaknesses will complement data collection.DiscussionBased on the results of a previous pilot study, we dedicated considerable efforts to optimizing the intervention and selecting appropriate outcomes for the present trial. We are confident to have designed a methodologically rigorous study that will contribute to the evidence-base and help to develop the potential of psychosocial interventions in palliative care.Trial registrationGerman Clinical Trials Register (DRKS) – DRKS00015308 (date of registration: September 07th 2018).

Relationship Completion in Palliative Care Music Therapy: Clinical Case Research Overview and Results-Part 2

Part I 1 of this paper presented the clinical case of Bill: a participant in the research study investigating the role of relationships completion in palliative care music therapy. Part II presents a brief overview of the research study, and the results of Bill’s case (one of the four primary participants). The study sought to answer the primary question: What is the experience of a dying person engaged in a specific music therapy treatment program intended to facilitate relationship completion? The investigation was a phenomenological qualitative inquiry that included multiple data sources analysed through a process coding of the data and identifying themes.

Patient\u2019s and health care provider\u2019s perspectives on music therapy in palliative care \u2013 an integrative review

BackgroundThe use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy’s potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users’ and providers’ perspectives on music therapy in palliative care within one research article.MethodsA systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy’s impact in palliative care to forward a comprehensive understanding of it’s effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data.ResultsTwelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy.ConclusionsBoth quantitative as well as qualitative research showed positive changes in psycho-physiological well-being. The integration of the users´ and providers´ perspectives within future research applicable for example in mixed-methods designs is recommended.

Comfort, Connection and Music: Experiences of Music Therapy and Inter-Active Listening on a Palliative Care Unit

Music therapy in palliative care aims to provide psychosocial support, assistance with pain and symptom management and opportunities for life review and legacy work. Although there have been a variety of studies conducted on the effects of music therapy in palliative care facilities, there is a gap in research examining the experience and feasibility of music therapy on acute palliative care units within cancer care settings. This qualitative study explored the lived experience of inter-active listening (IAL), an individualized music therapy in which the therapist plays music or sings while the patient engages through listening, for nine inpatients on a palliative care unit. The study found that a receptive music therapy referred to as IAL was associated, in cancer patients in an acute palliative care unit, with increased emotional and spiritual well-being and a greater sense of connection to self and others. Further research into specific effects of various music therapy intervention styles is warranted.

The effectiveness of receptive music therapy in palliative care: results of a randomized, controlled trial

Background: Music therapy has been used as a complementary treatment in palliative care for more than 35 years. Despite some promising findings regarding the improvement of quality of life and pain, empirical evidence is still rare.Objective: The goal of the present study was to examine the effects of a standardized, live music therapy relaxation intervention for terminally ill patients.Methods: A total of 84 patients were randomly assigned to either two sessions of music therapy or a control intervention. Primary outcomes were self-ratings of relaxation, well-being, and acute pain. Heart rate variability (HRV) and blood volume pulse amplitude (BVP-A) were assessed as secondary outcomes.Results: The music therapy group showed significantly greater improvements regarding relaxation and well-being. No significant differences were observed for acute pain. Examination of physiological data revealed a significant increase in HRV and a marginally significant increase in BVP-A.Discussion/Conclusions: Results ind...

Trajectories of Terminally Ill Patients' Cardiovascular Response to Receptive Music Therapy in Palliative Care

ContextRelaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms. ObjectivesThe present analysis aimed at examining the psychophysiological pathways of terminally ill patients' cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise. MethodsEighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants' gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors. ResultsBoth VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals' trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow. ConclusionHigher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients' physiological response and need to be taken into account in clinical practice and future theory building.

Music Therapy in Palliative Care

Music therapy has been used successfully for over 30 years as part of palliative care programs for severely ill patients. There is nonetheless a lack of high-quality studies that would enable an evidence-based evaluation of its psychological and physiological effects. In a randomized controlled trial, 84 hospitalized patients in palliative care were assigned to one of two treatment arms--music therapy and control. The music therapy intervention consisted of two sessions of live music-based relaxation exercises; the patients in the control group listened to a verbal relaxation exercise. The primary endpoints were self-ratings of relaxation, well-being, and acute pain, assessed using visual analog scales. Heart rate variability and health-related quality of life were considered as secondary outcomes. The primary data analysis was performed according to the intention-to-treat principle. Analyses of covariance revealed that music therapy was more effective than the control treatment at promoting relaxation (F = 13.7; p <0.001) and well-being (F = 6.41; p = 0.01). This effect was supported by a significantly greater increase in high-frequency oscillations of the heart rate (F = 8.13; p = 0.01). Music therapy did not differ from control treatment with respect to pain reduction (F = 0.4; p = 0.53), but it led to a significantly greater reduction in the fatigue score on the quality-of-life scale (F = 4.74; p = 0.03). Music therapy is an effective treatment with a low dropout rate for the promotion of relaxation and well-being in terminally ill persons undergoing palliative care.

Development and efficacy of music therapy techniques within palliative care

Music therapy is increasingly becoming an intervention used in palliative care settings around the globe. While the specialty of palliative care music therapy is relatively young having emerged in the late 1980s, there is a strong and growing body of evidence demonstrating its efficacy in assisting a variety of issues common at end-of-life. There are multiple music therapy techniques that are implemented with clients in palliative care and they can be categorized in four broad areas: receptive, creative, recreative and combined. These techniques will be presented with respect to their development by clinicians as supported by the descriptive and research literature. Information is also provided on the use of music therapy in facilitating the grieving and bereavement process.

Methodological challenges for music therapy controlled clinical trials in palliative care

Since the late 1970s, music therapy has been an important part of multidisciplinary palliative care programs. Despite its wide application and high acceptance by patients, caregivers and staff members, recent systematic reviews and reports point to a lack of research, and the need for controlled clinical trials. The present article reviews the methodological quality of controlled clinical trials on the effects of music therapy in palliative care and addresses issues regarding the implementation of such designs. We identified eight studies (both published and unpublished), conducted between 2003 and 2013, through a systematic search of the scientific literature. We present major challenges according to the PICOS taxonomy and provide recommendations for future research using controlled clinical trial designs.

Musiktherapie in der palliativmedizinischen Versorgung: Gegenwärtiger Stand und aktuelle Entwicklungen

For more than 30 years, music therapy has been part of multi-disciplinary palliative care programs for terminally ill patients. Music therapists use active and receptive treatments such as relaxation/ imagery, songs and improvisation techniques to maintain or enhance the patient's quality of life on a psychological, physical, social and spiritual dimension. Despite positive clinical experiences in the field, there is still a lack of empirical evidence on the indication and effectiveness of music therapy in palliative care. Some recent studies examined the effects of music therapy on outcomes such as quality of life, pain, anxiety and spiritual well-being of palliative patients. This article describes the interventions, outcome criteria, and the current state of research on music therapy in the palliative setting.