Multidisciplinary perspectives of music therapy in adult palliative care

BACKGROUND: Music therapy aims to provide holistic support to individuals through the sensitive use of music by trained clinicians. A recent growth in music therapy posts in UK palliative care units has occurred despite a paucity of rigorous research. Study aim: To explore the role of music therapy within multidisciplinary palliative care teams, and guide the future development of the discipline. DESIGN: In-depth qualitative interviews with 20 multidisciplinary colleagues of music therapists, based in five UK hospices. RESULTS: Analysis of interview material revealed a number of themes relevant to the study aims. Music therapy was valued by most interviewees; however there exists some lack of understanding of the role of the music therapist, particularly amongst nurses. Emotional, physical, social, environmental, creative and spiritual benefits of music therapy were described, with some benefits perceived as synergistic, arising from collaborations with other disciplines. Interviewees found experiencing or witnessing music therapy is effective in developing an understanding of the discipline. CONCLUSION: Music therapy is an appropriate therapeutic intervention for meeting the holistic needs of palliative care service users. More understanding and integration of music therapy could be encouraged with collaborative work, educational workshops, and the utilization of environmentally focused techniques. The study merits further research to explore and develop these findings.     

Music therapy research and applications in pediatric oncology treatment

Music therapy is a profession which meets multiple physical, social, and psychological needs. Music therapists can facilitate health objectives by reducing the intensity or duration of pain, allevlating anxiety, and decreasing the amount of analgesic medication needed. Rehabilitative objectives can include activities which incorporate exercise, range of motion therapy, or gait training. Reduction of fear, anxiety, stress, or grief are common psychological objectives. Music therapy is particularly effective in promoting social objectives such as increased interaction, verbalization, independence, and cooperation; enhanced relationships with health care personnel and family members; and increased stimulation during long-term hospitalization or isolation. Counseling techniques are often paired with music to achieve emotional objectives such as expression, adjustment, stability, or locus of control. The purpose of this article is to synthesize the extant music/medical research literature and clarify how music therapy can provide a quintessential combination of physical, social, and psychological benefits to enhance the health care of pediatric oncology patients.     

Music Therapy in Palliative Care: a State of the Art

Music as a healing symbol and source has been known since the days of David and Saul, but awareness of music therapy and its benefits to palliative care patients is only just starting to emerge within the current debate about broadening palliative care services. In recognition of its creative and holistic ability to reduce physical, emotional, social and spiritual distress, music therapy services are increasingly being incorporated into palliative care programmes throughout the world. The purpose of this paper is to outline the definition and indications for music therapy in palliative care, and to briefly illustrate the various music therapy techniques adopted to relieve suffering and facilitate change and self-transformation within the dying process.     

State of the science of music interventions. Critical care and perioperative practice

Music therapy is an easy to administer, relatively inexpensive, noninvasive intervention that can reduce anxiety and pain in critical care and perioperative patients. Libraries of relaxing music selections need to be compiled, reflecting diverse musical tastes. Providing patients with the opportunity to partake in music therapy sessions, selecting their own music, and providing them with quiet, uninterrupted time to listen to the music provides patients with a sense of control and separation from the multiple environmental stressors they are experiencing. Although there is now an extensive empirical base for the therapeutic usefulness of music therapy, particularly with the myocardial infarction population, few hospitals have adopted music therapy programs. Patient satisfaction and outcomes clearly have improved after music therapy sessions have been implemented. Further study with more diverse samples with a wider variety of medical conditions is indicated. Most of these studies used only one or two music sessions. It is not known whether effectiveness of music therapy sessions improves with repeated exposures. Further, there are little data with respect to optimal time for implementation of music therapy, length of music therapy sessions, or types of music to use. The effects of cultural diversity have not been addressed. Music therapy can improve the quality of care that critical care and perioperative nurses deliver to their patients.     

Music’s relevance for adolescents and young adults with cancer: a constructivist research approach

Purpose  

Music is one of the most widely used activities amongst young people, significant in personal and group identity, motivation, physical release, and emotional support. Adolescents and young adults with cancer (AYA) require specialized care because of intensified challenges related to developmental vulnerability, treatment toxicity effects, and slower improvements in survival rates compared to other age groups. To advance effective supportive care for AYA, understanding their thoughts about music is necessary. This study examines AYAs’ perspectives about music’s role in their lives.     

Cognitive,emotional, and neural benefits of musical leisure activities in aging and neurological rehabilitation: A critical review

Music has the capacity to engage auditory, cognitive, motor, and emotional functions across cortical and subcortical brain regions and is relatively preserved in aging and dementia. Thus, music is a promising tool in the rehabilitation of aging-related neurological illnesses, such as stroke and Alzheimer disease. As the population ages and the incidence and prevalence of these illnesses rapidly increases, music-based interventions that are enjoyable and effective in the everyday care of the patients are needed. In addition to formal music therapy, musical leisure activities, such as music listening and singing, which patients can do on their own or with a caregiver, are a promising way to support psychological well-being during aging and in neurological rehabilitation. This review article provides an overview of current evidence on the cognitive, emotional, and neural effects of musical leisure activities both during normal aging and in the rehabilitation and care of stroke patients and people with dementia.     

Music therapy and child care

Music therapy was shown many years ago to have positive effects in various age groups of patients in the Western world. Music can produce physiological and psychological effects, including changes in the vital signs, reductions in anxiety, improvements in the immune system, decreases in cortisol levels, the reduction of stress and the promotion of well-being. Music therapy is an inexpensive and effective intervention for nurses to apply to patients. The application of such therapy to children, however, is different from that to adults due to their limited cognitive and language development. In Taiwan, nurses' knowledge of music therapy is limited, and it is rarely used in child care. This article introduces music therapy and its effects in child care, such as in premature infants, children in emergency care, handicapped children, and children receiving surgery. Music therapy is often used as an assisted intervention for patient care in clinical settings. Health care professionals can perform some of the music therapy activities for patients appropriately even if they have not been trained in music. This article aims to improve nurses' knowledge of music therapy and to provide a useful reference for those involved in child care.     

Music therapy in palliative care: current perspectives

As the music therapy profession has developed internationally over the last 25 years, so has its role in palliative care. Music is a highly versatile and dynamic therapeutic modality, lending itself to a variety of music therapy techniques used to benefit both those living with life-threatening illnesses and their family members and caregivers. This article will give a broad overview of the historical roots of music therapy and introduce the techniques that are employed in current practice. By combining a review of mainstream music therapy practice involving musical improvisation, song-writing and receptive/recreational techniques with case material from my own experience, this article aims to highlight the potential music therapy holds as an effective holistic practice for palliative care, whatever the care setting.     

The use of music therapy to address the suffering in advanced cancer pain

Pain associated with advanced cancer is multifaceted and complex, and is influenced by physiological, psychological, social, and spiritual phenomena. Suffering may be identified in patients when pain is associated with impending loss, increased dependency, and an altered understanding of one's existential purpose. Comprehensive pain management aims to address problematic symptoms in order to improve comfort, peace of mind, and quality of life. Music therapy is a treatment modality of great diversity that can offer a range of benefits to patients with advanced cancer pain and symptoms of suffering. Music therapists perform comprehensive assessments that include reviews of social, cultural, and medical history; current medical status; and the ways in which emotions are affecting the pain. A variety of music therapy techniques may be used, including vocal techniques, listening, and instrumental techniques. These techniques provide opportunities for exploration of the feelings and issues compounding the pain experience. Case examples are presented to demonstrate the "lifting", "transporting", and "bringing of peace" qualities of music that offer patients moments of release, reflection, and renewal.     

An overview of music therapy research

There is a broad literature covering the application of music therapy, but a general absence of valid clinical research material from which substantive conclusions can be drawn. Group creative music therapy in psychiatric hospitals reflects the acceptance of the creative arts therapies themselves in such settings. Receptive taped music, used as an anxiolytic for individual patients, has found favour particularly in coronary care units and in cancer pain care. Music therapy with adults and children is seen as part of a necessary creative arts environment within hospital settings for the management of the mentally handicapped of varying ages. Music therapy is accepted as a valid therapeutic treatment for children.Observations in the realm of psychotherepy highlight a critical feature of music therapy research; well intentioned, and often rigorous work, is spoiled by a lack of research methodology. Music therapy clinical research needs to develop a common methodology such that standard research tools and methods of clinical assessment be developed which can be replicated, which are appropriate to music therapy itself and develop a link with other forms of clinical practice. The research which has been produced is notably lacking in follow-up data, without which it is difficult to make valid statements about clinical value.     

Music therapy in the context of palliative care in Tanzania

There has been much written to support music therapy as an adjunct in managing pain and anxiety in palliative care patients in Western societies, but little written on its use in developing countries. In light of increasing numbers of terminally ill patients in Tanzania owing to HIV/AIDS and cancer, limited access to opioids, and a growing interest in palliative care support, this study looks at the application of music in this context. The study reviews the history and principles of therapeutic music and outlines its role in palliative care. A qualitative study was conducted by questionnaire of 17 professionals involved in home-based palliative care in Tanzania. Findings include beliefs about the power of music, how music is being used to bring comfort to the dying patient, and the most important aspects of helpful music to many Tanzanian palliative care patients. Music can powerfully affect body, mind and spirit. It is vocal music, which is an accepted therapeutic music tool used to bring comfort to the palliative care patient and their family members. Finally, music is an active and participatory activity in Tanzanian culture, even for the dying.     

Application of music therapy for managing agitated behavior in older people with dementia

Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia.     

Music therapy for the neonate

Surviviors of extreme prematurity (less than 26 weeks gestational age) may have long-term impairment, including developmental disabilities and neurological deficits that become evident as the child matures. Music has been used as an intervention purported to facilitate development in young, at-risk children in infant stimulation and early intervention programs. Over the past decade, music has been introduced into the neonatal intensive care unit as a therapy designed to enhance treatment and facilitate growth and development of premature infants. This report summarizes extant research on music therapy in the neonatal intensive care unit. Copyright © 2001 by W.B. Saunders Company     

Developing and using a computerized database for music therapy in palliative medicine

The purpose of this paper is to describe the music therapy program at the Harry R. Horvitz Center for Palliative Medicine, to present different music therapy interventions that are used with individuals who have terminal illnesses, and to introduce initial findings from a pilot study of the effects of music therapy on an inpatient palliative medicine unit. For the first time, a computerized database has been designed to evaluate clinical practice by tracking music therapy intervention effectiveness on common symptoms. Measurement techniques included visual analogue scales and behavioural observation. Music therapy was shown to have a significant effect on common symptoms in advanced cancer patients, suggesting that it should be included in palliative medicine programs as an adjunct to symptom treatment.     

Active music engagement with emotional-approach coping to improve well-being in liver and kidney transplant recipients

Liver and kidney transplant recipients report elevated psychological distress following transplant in comparison to other types of organ transplant recipients. Negative affective states can lead to immune dysregulation and adverse health behaviors, and therefore may contribute to disease. In contrast, positive affective states can broaden individuals' thoughts and actions to promote the accumulation of coping resources. Coping strategies have traditionally been conceived of as being either problem-focused or emotion-focused in nature, while contemporary theory and research supports a different division: approach-oriented strategies versus avoidance-oriented strategies. Emotional expression and processing may function as an approach-oriented coping strategy. Emotional-approach coping relates to the use of emotional expression, awareness and understanding to facilitate coping with significant life stressors. The current study evaluated the impact of music therapy with and without a specific emphasis on emotional-approach coping. This randomized, controlled trial aimed to use Active Music Engagement with Emotional-Approach Coping to improve well-being in post-operative liver and kidney transplant recipients (N = 29). Results indicated that music therapy using Emotional-Approach Coping led to significant increases in positive affect, music therapy using Active Music Engagement led to significant decreases in pain, and both conditions led to significant decreases in negative affect, an indicator of perceived stress/anxiety.     

The structural neuroanatomy of music emotion recognition: evidence from frontotemporal lobar degeneration

Despite growing clinical and neurobiological interest in the brain mechanisms that process emotion in music, these mechanisms remain incompletely understood. Patients with frontotemporal lobar degeneration (FTLD) frequently exhibit clinical syndromes that illustrate the effects of breakdown in emotional and social functioning. Here we investigated the neuroanatomical substrate for recognition of musical emotion in a cohort of 26 patients with FTLD (16 with behavioural variant frontotemporal dementia, bvFTD, 10 with semantic dementia, SemD) using voxel-based morphometry. On neuropsychological evaluation, patients with FTLD showed deficient recognition of canonical emotions (happiness, sadness, anger and fear) from music as well as faces and voices compared with healthy control subjects. Impaired recognition of emotions from music was specifically associated with grey matter loss in a distributed cerebral network including insula, orbitofrontal cortex, anterior cingulate and medial prefrontal cortex, anterior temporal and more posterior temporal and parietal cortices, amygdala and the subcortical mesolimbic system. This network constitutes an essential brain substrate for recognition of musical emotion that overlaps with brain regions previously implicated in coding emotional value, behavioural context, conceptual knowledge and theory of mind. Musical emotion recognition may probe the interface of these processes, delineating a profile of brain damage that is essential for the abstraction of complex social emotions.     

Music therapy as a nursing intervention for patients supported by mechanical ventilation

Music therapy is a nonpharmacologic nursing intervention that can be used as a complementary adjunct in the care of patients supported by mechanical ventilation. This article details the theoretical basis of music therapy for relaxation and anxiety reduction, highlights the research testing the intervention in such patients, and discusses areas of needed research to extend further the implementation of music therapy in critical care nursing practice in an effort to promote a healing environment for patients.     

Relaxing to the beat: music therapy in perioperative nursing.

1. Music therapy is a research-based nursing intervention that can be used in perioperative nursing to reduce anxiety and prevent postoperative complications. 2. Music therapy provides patients with some degree of control and the opportunity to participate in their own care. 3. The use of headphones allows the patient to listen to the music without the distraction of other sounds.     

音乐疗法对慢性精神分裂症患者社会功能的影响

目的:探讨慢性精神分裂症患者辅以音乐治疗对其社会功能的改善。方法:选取62例符合CCMD-2-R关于精神分裂症诊断标准的患者,按入院顺序随机分为实验组(抗精神病药物辅以音乐治疗)和对照组(单用抗精神病药物治疗及传统护理),实验组32例,对照组30例。采用住院病人护士观察量表,在实验前后分别进行观察评分,并进行相关因素的比较。结果:两组在治疗后,NOSIE评分减分值有显著差异,实验组明显优于对照组(P<0.01)。音乐治疗的干预对慢性精神分裂症患者的社会功能产生了其它护理方法不可替代的积极作用。结论:在传统护理方法的基础上,辅以音乐治疗的方法更能有效地改善慢性精神分裂症患者的社会功能,明显提高慢性精神分裂症患者的生存质量。     

Effects of music therapy on health-related outcomes in cardiac rehabilitation: a randomized controlled trial

This study tested effectiveness of music therapy in improving health-related outcomes of cardiac rehabilitation patients. Using a randomized, controlled trial with follow-up, the study was conducted in an outpatient cardiac rehabilitation program in Ohio. Sixty-eight of 103 recruited patients, 30 to 80 years of age, completed the protocol through posttreatment. Physiological and psychological outcomes were measured. Cardiac rehabilitation patients were randomly assigned to cardiac rehabilitation only or to music therapy plus cardiac rehabilitation. Music therapy included musical experiences, counseling, and Music-Assisted Relaxation and Imagery. The null hypothesis of no differences in health-related outcomes between cardiac rehabilitation patients who experienced cardiac rehabilitation with and without music therapy was rejected due to changes in systolic blood pressure pre to post-treatment. Interpretation of changes at 4 months posttreatment in anxiety, general health, and social functioning are limited, due to small sample sizes at follow-up. Pre to post-music therapy session improvements were also reported. Findings suggest that some health-related outcomes may be affected positively by participation in music therapy in addition to cardiac rehabilitation. Attrition contributed to limitations in statistical power.