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.     

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 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.     

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.     

Bringing music to life: a study of music therapy and palliative care experiences in a cancer hospital

A music therapy research study aimed at understanding patients', visitors' and staff members' experiences of a music therapy program in a cancer hospital over a three-month period is described. Respondents' answers to brief open-ended questions, as well as the music therapist researcher's interpretations of the program's relevance, were examined using thematic analysis based on grounded theory. ATLAS.ti software supported data management and analysis. Themes encapsulating 128 patients' reflections about music therapy were delineated and substantiate how music therapy can support palliative care aims throughout the cancer illness trajectory.     

A project investigating music therapy referral trends within palliative care: an Australian perspective

The purpose of this project is to analyze music therapy (MT) referral trends from palliative care team members across nine Australian inpatient and community-based palliative care settings. For each referral 6 items were collected: referral source, reason and type; time from Palliative Care Program (PCP) admission to MT referral; time from MT referral to death/discharge; and profile of referred patient. Participants (196 female, 158 male) were referred ranging in age from 4-98 years and most were diagnosed with cancer (91%, n = 323). Nurses (47%, n = 167) referred most frequently to music therapy. The mean average time in days for all referrals from PCP admission to MT referral was 11.47 and then 5.19 days to time of death. Differences in length of time to referral ranged from 8.19 days (allied health staff) to 43.75 days (families). Forty-eight percent of referrals (48.5%, n = 172) were completed when the patient was rated at an Eastern Cooperative Oncology Group Performance (ECOG) of three. Sixty-nine percent (n = 244) were living with others at the time of referral and most were Australian born. Thirty-six percent (36.7%, n = 130) were referred for symptom-based reasons, and 24.5% (n = 87) for support and coping. Implications for service delivery of music therapy practice, interdisciplinary care and benchmarking of music therapy services shall be discussed.     

The use of music therapy in meeting the multidimensional needs of hospice patients and families

This article presents four case studies which demonstrate the use of music therapy in assisting palliative care patients and families cope with grief and loss, pain and anxiety, disorientation and dementia, lack of meaning, and hopelessness. Music therapy techniques are illustrated and patient-related goals are defined within the case studies. A review of the literature supports the use of music therapy in palliative care, and a variety of qualitative and quantitative studies are reported in the article.     

Developing narrative research in supportive and palliative care: the focus on illness narratives

The phenomenon of the 'illness narrative' is well-documented, in the last 25 years, of increasing interest to researchers in health and social sciences. Personal stories about the experience of facing the end of life also have an established history of particular relevance for palliative care clinicians. In this article, we review and describe a range of narrative analysis approaches that may be of use in palliative care. In particular, we distinguish between qualitative analysis applied to narratives and narrative analysis as a method. We discuss the potential benefits and challenges in the use of narrative research methods as a means to deepen our understanding of patient, carer and health professionals' experience, and to support improvements in end of life care policy and practice.     

Integrated, collaborative palliative care in heart failure: the St. George Heart Failure Service experience 1999-2002

BACKGROUND: Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues. AIM: To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program. METHOD: A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002. FINDINGS: Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting. CONCLUSIONS: In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.     

A study of family carers of people with a life-threatening illness. 2: Implications of the needs assessment

This is the second of two articles that consider the findings of a Carers' Assessment of Difficulties Index (CADI) (Nolan et al, 1998) delivered in a palliative care context. It analyses the implications of these findings for practitioners concerned with the delivery of palliative care to such carers and their families. The development of support strategies and services addressing their needs are also presented against a backdrop of transactional stress theory. For people new to caring, recommendations for the local service include early intervention through informational support and validation of their emotional responses to caring; for longer-term carers they include assistance with cognitive reappraisal of the stressfulness of caring and regular 'respite' and socializing opportunities. These are taking place in a political climate that finally recognizes the contribution and value of carers (Department of Health, 1999). The research behind these carer identity and recognition initiatives aims to apply the spirit of public recognition and practical wisdom of palliative care expertise by responding sensitively to the specific needs of carers of people with a life-threatening illness.     

Palliative home care: improving co-operation between the specialist team and the family doctor

The aim of this study is to ascertain family doctors' opinions of the home care services dispensed by a specialist palliative care team. Fifty-six doctors responded to the questionnaire they had been sent. Ninety-four per cent of them were satisfied with the team's intervention. The highest satisfaction ratings were those for the provision of specialist medical equipment, technical competence and medical support. The lowest ratings were for information coming from the team and for recognition of the practitioner as the primary carer. Among these items, information, regard for the doctor's role and medical support are closely correlated to the practitioners' overall index of satisfaction. The palliative care team answered a mirror questionnaire. It found its availability, its speed of intervention, its technical competence, and its regard for the doctor's role very satisfactory. It was less satisfied with the information, medical support and psychosocial support it provided. Its centres of interest also differed, with the team clearly attributing greater importance to psychosocial support than to technical competence, regard for the role, and information to the practitioner. In conclusion, a survey of this type is a useful and easy way of identifying the aspects that need to be improved on by the palliative care team so as to improve its co-operation with the family physician. But it is of interest only if it forms part of an overall approach whereby, having taken the survey results on board, the team uses them to modify its intervention procedures.     

Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data

Although music therapy is an established allied health professionand is used with increasing frequency in the treatment of thosewith a terminal illness, there is a real dearth of empiricalresearch literature supporting the use of music therapy in end-of-lifecare. This article reviews the empirical studies found in theliterature and documents the emergence of an evidenced-basedapproach to the use of music therapy in hospice and palliativecare. A total of 11 studies are reviewed; of these, six showsignificant differences supporting the use of music therapyin this area. Dependent variables positively affected by musictherapy include pain, physical comfort, fatigue and energy,anxiety and relaxation, time and duration of treatment, mood,spirituality and quality of life. Guidelines for future researchare considered, and variables that need to be controlled arepresented. The need to create an evidence-based approach tohospice and palliative care music therapy is articulated, andfuture researchers are empowered to continue to conduct investigationsamong this population.     

A scale to measure satisfaction of bereaved family receiving inpatient palliative care

Although satisfaction is an important outcome of medical care, there are no validated tools to quantify family satisfaction with hospital-based palliative care. In this nationwide postal survey, an instrument to measure informal carer satisfaction with an inpatient palliative care service was validated. A 60-item questionnaire was mailed to 1344 bereaved people who had lost their family members at 50 palliative care units in Japan, and 850 responses were analysed (response rate = 64%). The reliability, construct validity, and convergent validity of the scale were examined after the responses were randomly divided into two groups: a training set used in the development phase (n = 500) and a testing set used in the validation phase (n = 350). The number of scale items was reduced from 50 to 34 through psychometric techniques in the development phase. In the testing sample, the overall Cronbach's coefficient alpha for the final 34-item scale was 0.98. A factor analysis revealed that the scale consisted of seven subcategories: Nursing Care, Facility, Information, Availability, Family Care, Cost, and Symptom Palliation. The total score of the scale was significantly correlated with the degree of global satisfaction of the bereaved (Spearman's rho = 0.78). In conclusion, this 34-item scale, the Satisfaction Scale for Family Members Receiving Inpatient Palliative Care (Sat-Fam-IPC), has acceptable psychometric properties and would be a useful tool to measure carer satisfaction with an inpatient palliative care service.     

Music therapy as psychospiritual process in palliative care

This paper proposes a theoretical framework for understanding how music therapy elicits and supports depth experiences in palliative care. The author explores music therapy as a containing or sacred space in which ventures into the realm of psychospiritual awareness may safely occur. The ultimate goal is to facilitate the process of connecting to that which is psychologically and spiritually significant for the patient, thereby transforming experiences of suffering into those of meaning.     

Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial

ContextTreatment of pain in palliative care patients is challenging. Adjunctive methods of pain management are desirable. Music therapy offers a nonpharmacologic and safe alternative.ObjectivesTo determine the efficacy of a single music therapy session to reduce pain in palliative care patients.MethodsTwo hundred inpatients at University Hospitals Case Medical Center were enrolled in the study from 2009 to 2011. Patients were randomly assigned to one of two groups: standard care alone (medical and nursing care that included scheduled analgesics) or standard care with music therapy. A clinical nurse specialist administered pre- and post-tests to assess the level of pain using a numeric rating scale as the primary outcome, and the Face, Legs, Activity, Cry, Consolability Scale and the Functional Pain Scale as secondary outcomes. The intervention incorporated music therapist-guided autogenic relaxation and live music.ResultsA significantly greater decrease in numeric rating scale pain scores was seen in the music therapy group (difference in means [95% CI] ?1.4 [?2.0, ?0.8]; P < 0.0001). Mean changes in Face, Legs, Activity, Cry, Consolability scores did not differ between study groups (mean difference ?0.3, [95% CI] ?0.8, 0.1; P > 0.05). Mean change in Functional Pain Scale scores was significantly greater in the music therapy group (difference in means ?0.5 ([95% CI] ?0.8, 0.3; P < 0.0001).ConclusionA single music therapy intervention incorporating therapist-guided autogenic relaxation and live music was effective in lowering pain in palliative care patients.     

The risk assessment of bereavement in a palliative care setting

An effective bereavement risk assessment document used in a palliative care setting was identified which could ensure bereavement support for those in need, be it a family or carer group. The nursing team were used as assessors with a system to indicate carers' and relatives' immediate need following the death of a patient. The aim of this bereavement risk assessment system was to lessen the possible long-term effects of unresolved grief for family and carers of patients who died within a hospice setting. The assessment document is a useful education tool for nurses, allied support professionals and bereavement support volunteers in their work with grief and loss.