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Music therapy with imminently dying hospice patients and their families: Facilitating release near the time of death

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Abstract

Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient's impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed.
Abstract
Hospice care seeks to address the
diverse needs of terminally ill patients
in a number of physical, psychosocial,
and spiritual areas. Family members
of the patient often are included in the
care and services provided by the hos-
pice team, and hospice clinicians face
a special challenge when working
with families of patients who are
imminently dying. When loved ones
are anticipating the patients impend-
ing death, they may find it difficult to
express feelings, thoughts, and last
wishes. Music therapy is a service
modality that can help to facilitate
such communication between the fam-
ily and the patient who is actively
dying, while also providing a comfort-
ing presence. Music therapy as a way
to ease communication and sharing
between dying patients and their loved
ones is discussed in this article. The
ways in which music therapy can
facilitate a means of release for both
patients and family members in an
acute care unit of a large US hospice
organization are specifically described.
Case descriptions illustrate how
music therapy functioned to allow five
patients and their families to both
come together and let go near the time
of death. Elements to consider when
providing such services to imminently
dying patients and their families are
discussed.
Background
Music therapy is a complementary
treatment modality which increasing-
ly is being recognized as an important
adjunct service within hospice and
palliative care organizations.1-8 A
number of patient and family needs can
be addressed simultaneously through
music therapy as a creative holistic
service within hospice care.9When
these needs are addressed, the patient
and family can express and share feel-
ings, as well as continue to communi-
cate and interact in a meaningful man-
ner, even as the patient declines and
ultimately dies.10-13
A critical and often difficult period
for families and loved ones is the time
immediately before the patient’s death.
Although patients receiving hospice
care have a life expectancy of six
months or less, should a disease
process follow its anticipated course,
determining exactly when a patient
will die is impossible for doctors and
other hospice care team members.14
However, terms such as “imminent
death,” “approaching death,” “impend-
ing death,” and “actively dying” are
used to describe patients whose vital
signs are rapidly declining towards
expiration.15-20 Some signs and symp-
toms of approaching death include a
cooling of the extremities, coloring or
mottling of the skin, slow and/or irreg-
ular breathing, an increase in sleeping,
a buildup of fluids and secretions in
the lungs and throat, apparent confu-
sion, and restlessness and agitation.5
Various rating scales may be used to
describe the patient’s status as he or
she declines toward death. The Kar-
nofsky Performance Scale, which is
used at the Hospice of Palm Beach
County in West Palm Beach, Florida,
rates a patient whose fatal processes
are rapidly progressing as being mori-
bund, with a score of 10 out of a possi-
ble 100. A score of zero indicates that
the patient has died.21
When imminent or impending
death is noted in a patient’s care plan,
family members are often informed
129American Journal of Hospice & Palliative Care
Volume 20, Number 2, March/April 2003
Music therapy with imminently dying
hospice patients and their families:
Facilitating release near the time of death
Robert E. Krout, EdD, MT-BC, RMTh
Robert E. Krout, EdD, MT-BC, RMTh, Music
Therapy Programme Leader, Conservatorium of
Music, Massey University, Mt. Cook, Wellington,
New Zealand; formerly Music Therapy Manager,
Hospice of Palm Beach County, West Palm
Beach, Florida.
that they may wish to plan their last
visits with the patient as soon as possi-
ble. During this last period of the
patient’s life, family members often
are faced with the challenge of
expressing their feelings without the
patient being able to overtly commu-
nicate in response to them. Family
members may feel frustrated when the
patient cannot look at or speak with
them, or even hold or squeeze their
hands. The patient’s appearance may
also be disturbing to the family, as it
may have drastically changed or dete-
riorated since a previous visit. For
example, apnea, sounds of congested
breathing, or observed restlessness
and agitation may be troubling to visi-
tors. For loved ones, even being able
to determine the exact time at which
the patient dies can be difficult. As
Kastenbaum noted, the perceptible
moment at which life ends is not
always clear to the observer, as vital
signs may slowly diminish and fade
almost imperceptibly at the actual
moment of death.22 Visitors may not
realize that the patient has expired
until a physician or nurse has checked
vital signs and pronounced the patient
to have died.
Music as therapy
Active expression of feelings of
grief and anguish by loved ones dur-
ing this time is considered to be both
normal and healthy, and the entire
hospice interdisciplinary care team
helps to facilitate this process.23 The
team can include a wide variety of
professionals, including the physician,
nurse, nursing aide, social worker,
pastoral counselor, dietician, physical
therapist, music therapist, a volunteer,
and additional clinicians such as an art
therapist, massage therapist, acupunc-
turist, movement therapist, Reiki
practitioner, and others. When family
members and other loved ones visit
shortly before an anticipated death,
the hospice music therapist has a
unique opportunity to engage them
and create a meaningful experience
for them with the patient.
As each patient’s and family’s situ-
ation and needs are unique, music
therapists provide individualized in-
terventions based on these needs at the
time of the session. The music used
during a session with patient and
loved ones can include original, folk,
contemporary or popular, jazz, classi-
cal, spiritual, and many other styles.
The music can function in a number of
ways during the therapeutic process.
The first consideration is maintaining
the physical comfort of the patient.
Music therapy with imminently dying
patients may include techniques to
facilitate pain control, help provide
physical and emotional comfort, assist
in relaxation, and reduce anxiety.
Music therapy may also involve pas-
sive or active participation by the fam-
ily. As one example, the selecting,
singing, or listening to familiar or
favorite songs of the patient and fami-
ly may stimulate discussion relating to
life memories, reminiscence, and life
review. Family members may request
a specific song, listen to or sing with
the therapist, and then reflect on the
significance of that song to them and
the patient. The music may elicit an
emotional response that can then
allow for the sharing of feelings and
emotions. These feelings can then be
validated, normalized, and explored
by the therapist. Teahan24 used the
acronym VINE to describe the work
of the hospice team in facilitating the
Validation, Identification, Normali-
zation, and Expression of feelings of
anticipatory mourning on the part of
the patient’s loved ones, a process that
contributes to a healthy grieving
process. For families with a strong
religious base, hymns or other sacred
songs may result in sharing feelings of
spiritual strength with the patient and
one another. Each session is unique,
and the music therapist must be flexi-
ble about the needs of the family and
patient at the time of the session.
Following are five single-session
case descriptions, vignettes that are
designed to illustrate how music ther-
apy enabled a joining of the patient
with family members shortly before
the patient’s death. Music therapy
offers release in different ways. The
actual clinical death may be a consid-
ered a physical release for the patient
at the end of her or his life. The death
may also provide a release for the
family and loved ones, in their know-
ing that the patient is no longer ill or in
discomfort. While this release is a clo-
sure of sorts, it is also just one event in
the grief journey of a family member
or other loved one.
Case examples
The following sessions all took
place at the C.W. Gerstenberg Hospice
Center at Hospice of Palm Beach
County, Florida, an organization that
serves approximately 650 patients per
day. The Gerstenberg Center houses
an acute care unit. Some patients
admitted for skilled care physically
decline as a result of their disease
process, and then further decline
toward eventual and imminent death.
Family and friends of patients are free
to visit 24 hours a day, seven days a
week. Each private room has convert-
ible sofas and chairs for sleeping. It is
not uncommon for family members to
remain continuously at a patient’s
bedside during the final days and
hours, including the time of death.
While none of the patients were overt-
ly responsive at the time of these ses-
sions, the patients’ caregivers were all
present. The caregivers gave their
consent for a brief description of the
session to be shared in an article to be
used for educational purposes, with the
understanding that no actual patient or
family names or specific identifying
information would be used. As such,
the names or initials of the following
patients have been changed, with the
130 American Journal of Hospice & Palliative Care
Volume 20, Number 2, March/April 2003
exception of Ms. T, whose first name
was Rose. The sessions are described
in the first person from the author’s
perspective as the clinician.
Case one: Ms. P
Ms. P was a 37-year-old woman
with ovarian cancer. Immediately be-
fore meeting with Ms. P and her fami-
ly, I had been visiting with another
patient in the common area of an inpa-
tient unit. As I provided live songs as
comfort and support for the other
patient, Ms. P’s aunt and brother
walked through and stopped to listen.
They entered Ms. P’s room, and
remained there while I finished my
visit in the common area. After con-
cluding the first visit, I entered Ms. P’s
room to offer music therapy services.
Ms. P was reclining in bed with her
head leaning to her left on her pillow.
Her eyes were partly open, and her
breathing sounded shallow and dry.
Ms. P seemed to be minimally respon-
sive and not able to communicate with
her family members. Impending death
was noted on Ms. P’s care plan.
I asked Ms. P’s aunt and brother if I
could share some music with Ms. P
and them to provide comfort. Ms. P’s
brother replied. “She can’t hear us,
she’s almost gone.” I told them that
Ms. P might be able to hear even
though she could not speak. I ad-
dressed Ms. P directly, telling her “My
name is Robert. I’m a music therapist,
and you are with us here at hospice.
You are very safe, and your family is
here with you. We will keep you com-
fortable. I am going to sing some songs
to help you relax. Just listen to the music.
It is a gift from your family to you, and it
is a privilege to visit with you.
I then asked Ms. P’s aunt and broth-
er what type of music she enjoyed.
Both replied “hymns and gospel.” Ms.
P’s aunt asked to hear “Amazing
Grace” and “anything else you like.” I
began with “Amazing Grace,” and
then continued to play a medley of
spiritual songs, including “Michael,
Row the Boat Ashore,” “He’s Got the
Whole World in His Hands,” “This
Little Light of Mine,” and “Kum-
baya.” During the music, Ms. P’s aunt
sang with me (I had provided copies
of the words), and Ms. P’s brother sat
next to the patient with his hand on her
left shoulder. I began the songs at a
moderate tempo and then slowed the
pace and lowered the volume through
the final verse. “Kumbaya” was thus
sung in a gentle and tender manner.
The final words of the song were “Oh
Lord, come by here,” the translation
of the song title from Angolan to
English. Both Ms. P’s aunt and broth-
er appeared to appropriately express
feelings and emotions during the ses-
sion, crying lightly at several points.
After concluding the music, I
stayed with the patient and family to
provide support and to thank them for
traveling across the country to visit. I
also explored their support system
with them and validated their feelings
of impending loss. Ms. P’s aunt and
brother thanked me several times for
visiting, saying that the music helped
them interact with Ms. P in a meaning-
ful manner. Ms. P died later that night.
In summary, Ms. P’s aunt and
brother had offered a cue that music
was meaningful to them by stopping
in the unit to listen as I provided music
for another patient. In the room, their
interaction with the patient shifted
from passive (“She can’t hear us”) to
active. Both family members told me
that the music helped them say good-
bye to their loved one.
Case two: Ms. G
Ms. G was a 78-year-old woman
with a terminal diagnosis of dementia.
I had provided some music for her and
several of her adult children the previ-
ous day, and the family requested that
I return again. During the first visit,
Ms. G presented as minimally respon-
sive, as she did on this visit.
When I entered the room, Ms. G
was lying in bed with her eyes closed.
She appeared to be comfortable and
relaxed. Six family members, includ-
ing adult children and some of their
spouses, were present. During the pre-
vious visit, the family had asked for
spiritual songs from the Roman
Catholic faith. These had included
“On Eagle’s Wings” and “Be Not
Afraid.” During the current visit, a
daughter asked me to play and sing
“Wind Beneath My Wings.” We
briefly spoke about the meaning of the
song, and she shared that “Beaches”
had been a favorite movie of the
patient. She also shared that the pa-
tient had “always been there” for the
family. I validated and reinforced this
sentiment for the family, noting that
this was a time that the family was
able to “be there” for their loved one.
We briefly explored the theme of the
song and movie (support of a loved
one during a long terminal illness),
with the support metaphor being “the
wind beneath the wings.” I also
addressed the patient directly, saying,
“This is a song of love and support
from your family. It is a gift they
would like to share with you now.”
During the singing, family mem-
bers focused their eyes and attention
on the patient. Two daughters, one on
each side of Ms. G’s bed, held her
hands. Several family members grasped
tissues and dabbed their eyes. The
patient appeared comfortable through-
out but did not appear to respond to
the music in an overt manner. After
the song ended, a wonderful stillness
was present in the room. No one spoke
for 30 seconds. This silence was not
uncomfortable for me, nor did it
appear uncomfortable to the family
members. It was nothing that can be
measured quantitatively, but the still-
ness felt like it was comforting for all
persons in the room. I waited until a
family member spoke before I spoke,
to avoid intruding upon the family’s
moment. A son then expressed sincere
131American Journal of Hospice & Palliative Care
Volume 20, Number 2, March/April 2003
appreciation for the song. I shared that
this was a special time, and that hav-
ing the family together in such a sup-
portive manner made the music much
more powerful than if I had been visit-
ing with the patient alone. The work of
hospice is best realized when we
allow families to come together and
share meaningful moments during the
end-of-life transition. The family then
requested several spiritual songs,
including “On Eagle’s Wings” and the
“Prayer of St. Francis.” Again, there
was a comfortable feeling in the room
both during and after the music. The
family thanked me several times for
the visit, and Ms. G died within one
hour of that visit.
With Ms. G’s physical comfort
needs met, the family was able to
come together to say goodbye to her
and share on a psychosocial and spiri-
tual level through the music. The spe-
cific choices of songs and hymns
appeared to enhance the support that
the family provided to the patient and
to each other. The music also appeared
to connect all in the room—therapist,
patient, and family—in a concrete
way through the vibrations of the gui-
tar and voice, and the eye contact
between us. The music also stimulated
the family to touch and hold the
patient’s hands during the music.
Case three: Ms. T
Ms. T was an 85-year-old woman
with a history of breast cancer. I had
visited her room once during the pre-
vious week. The patient was minimal-
ly responsive at that time and had just
that day been admitted into the hos-
pice center. The family at that time
accepted my support and appeared
appreciative of the offer of music, but
declined, stating that the patient was
still “getting settled.” However, the
family had requested music therapy
today, and I was paged overhead.
Upon arrival, I observed Ms. T
reclined in bed with her eyes partly
open, appearing to be minimally
responsive. Ms. T’s nurse described
her as “actively dying,” and the
patient’s breathing sounded congest-
ed. A number of family members were
present in the room, including the
patient’s husband, children, and adult
grandchildren. One of the patient’s
daughters served as spokesperson for
the group, saying, “Ma’s close now,
and we thought music might be a good
thing.” I validated that statement, say-
ing, “Yes, she appears peaceful and
comfortable. Thanks to all of you for
being with her and for asking for me.”
The daughter related that the patient’s
favorite song was “The Rose” from
the movie of the same name. She said
that since her mother’s name was
Rose, this song had been special to her
for many years. I briefly touched on
some of the images and symbolism in
the song lyrics, focusing on the final
two lines of the song: “Just remember
in the winter far beneath the bitter
snows, lies the seed that with the sun’s
love in the spring becomes the rose.”
The family members shared that they
related to this image. The patient and
her husband had lived in New York
City during many cold winters and
then had relocated to South Florida in
the late 1990s. We also discussed, at
the family’s initiation, the metaphor of
the newly growing rose emerging
from the snow, signifying the release
of Ms. T’s soul to heaven after her
impending death.
During the song, family members
comforted each other and the patient.
Several cried lightly and hugged each
other. Following the song, I continued
to allow family members to share
memories of the patient’s life as well
as tell stories that involved the patient.
Several times these stories involved
humorous situations. At one point a
grandchild said, “I don’t know
whether to laugh or cry.” I told her
gently that both are okay and can hap-
pen at almost the same time. The fam-
ily did not want any other live music,
but chose to simply visit with each
other and the patient. Ms. T died later
that afternoon with the family present.
The use of a meaningful song
allowed for the family of Ms. T to
communicate on a number of different
levels. While listening to a recorded
version of the song also may have
been comforting for the patient and
loved ones, the exploration of the
imbedded meaning in the song
appeared to be especially meaningful
for the family.
Case four: Mr. J
Mr. J was an 83-year-old man with
congestive heart failure, renal failure,
and Alzheimer’s disease. The social
worker had said that the patient was
actively dying. When I entered the
room, Mr. J was lying in bed with his
eyes closed, seeming to be comfort-
able. Mr. J appeared to be struggling
with apnea, and I observed pauses of
20 to 30 seconds between noticeable
breaths. Seated at his bedside were his
wife and his sister-in-law. I introduced
myself and provided some supportive
and comforting words, telling them
what I could offer as a music therapist.
Mr. J’s wife asked if I knew the hymn
“Beulah Land,” explaining that the
hymn was a significant one for her
husband and herself. I asked to be
excused for a moment to get the music
from my office. Upon re-entering the
room, I observed Mr. J’s wife standing
and holding his hand. Mrs. J appeared
to be crying lightly, with her sister
physically comforting and supporting
her. I stood quietly for a minute, want-
ing to support the family without
intruding on their private and intimate
moment. Mrs. J turned to me and
asked if I would play “Beulah Land.” I
began the hymn, with the family sup-
porting each other and listening. As I
sang the beginning of the chorus, Mrs.
J began to sing with me. She sang
along with each verse and continued
to hold her husband’s hand. After the
132 American Journal of Hospice & Palliative Care
Volume 20, Number 2, March/April 2003
hymn, I told Mrs. J that I was honored
to be able to play a hymn that was so
meaningful for the patient and family.
Mrs. J related that hearing the words
of the hymn reinforced her belief that
her husband was going “to a better
place, Beulah Land.” We briefly dis-
cussed this image and conviction as
related to the family’s spiritual back-
ground. I thanked the family and then
left the patient’s room. Mr. J died one
and a half hours after my visit.
Music therapy appeared to help the
patient’s wife and sister-in-law actively
express their belief that their loved one
was leaving his physical body to go to
“a better place.” The singing and shar-
ing of that hymn at that time appeared
to help them with a release of their feel-
ing, and may have helped the patient
experience release as he died.
Case five: Mr. Y
Mr. Y was a 77-year-old man with
cancer of the pancreas. While check-
ing with a unit nurse regarding new
patients, I learned that Mr. Y was min-
imally responsive and that his wife
was keeping a vigil by the bedside.
Upon entering the room, I observed
Mr. Y lying in bed with his eyes open
but with his gaze fixed and his eyes
appearing to be cloudy. His wife was
sitting by his side, gently massaging
his forehead. Upon seeing the guitar
around my neck, she exclaimed “Oh
how wonderful, music for you” (say-
ing the patient’s first name). I intro-
duced myself, and Mr. Y’s wife began
sharing about her husband and their
relationship of over 40 years. When I
asked about their family, Mrs. Y
described their adult children and
grandchildren and where each family
lived. Although none lived locally, she
told me that many had been to visit the
patient at home during the past several
months “while he was good.”
Mrs. Y then turned to her husband
and said, “It’s okay to let go, we’re
going to have some music.” Turning
my attention again to Mr. Y, I
observed that his breathing appeared
quite shallow, with a pause of 10-15
seconds between each breath. I asked
if there was a special song that I could
sing to provide comfort. Mrs. Y said,
“I have a spiritual song that I wrote for
my husband. Can you follow me?”
She then began to sing, and I found
chords on the guitar that supported her
melody. The words related to her
belief that God would take her hus-
band from her when He was ready for
him. The words also said, “I will see
you again in the arms of the Lord.”
Mrs. Y sang the words several times,
and I observed Mr. Y’s breathing
appear to quicken. Mrs. Y indicated
after the song that she wanted to be
alone with her husband. I left the room
very quietly, not wanting to break the
wonderful stillness and love that I felt
in that room. Mr. Y died that night.
Hearing her original spiritual song
appeared to have specific meaning
and significance for the patient’s wife.
Getting to sing that special song to her
husband one last time seemed to be
especially important for her. It may
have been a stimulus for Mr. Y to be
able to let go as well.
Conclusions
In each of the above sessions,
music therapy played an important
role by helping family members to be
actively involved in the last hours of
the lives of their loved ones. The
music therapist did not set a specific
agenda or plan for each session.
Rather, each session unfolded based
on the presenting needs of the patient
and family at that moment. The time
immediately before the death of a per-
son can be especially difficult for the
family. Within the context of the inter-
disciplinary care team, music therapy
can help to bring comfort to patient
and family alike.
It is important for the music thera-
pist and other care team members to
remember that the final days and
hours of a patient’s life are times for
helping loved ones to visit and say
goodbye in their own ways and styles.
There are times when family members
do not want others, including staff
members, to intrude on that private
time. In other cases, loved ones look
to the hospice clinicians for help and
support in finding ways to visit and
say goodbye. It is during these times
that we as members of the hospice
team can provide support and facili-
tate meaningful release for both the
patients and those who love them.
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134 American Journal of Hospice & Palliative Care
Volume 20, Number 2, March/April 2003
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... It is estimated that up to 8 out of 10 individuals who die have needs that would benefit from the provision of palliative care [1]. A key aim of palliative and end of life care is to ensure holistic care and support is aligned to the needs and preferences of the dying person, their families and carers [2]. ...
... Playlist for Life is based on the idea that sharing personalised musical experiences can promote communication and enrich the bond between the person receiving care and their loved ones [10,11]. Although the origins are in dementia care, Playlist for Life has been introduced within inpatient hospice and hospital settings to support people at the end of life and to support patients and their families at the end of life, as well as help relieve anxiety, distress, pain and other physical symptoms [2,12,13]. ...
... Listening to these can help to coordinate neural activity [14]. The synthesis of music, emotion and autobiographical memories within the pre-frontal cortex appears to improve mood, promote awareness and support memory retrieval and personhood [2,13]. Indeed it is suggested, in dementia, the brain continues to interpret and understand musical input when other areas of functional ability have deteriorated [15]. ...
Article
Full-text available
Background Playlist for Life is a brief, inexpensive music listening intervention which originated in dementia care, but is increasingly being used for people at the end of life. However, there is a lack of robust empirical research on its application in the hospice setting. Our patient and public involvement group originated the idea for this study. The aim of this feasibility study was to inform the design of a larger effectiveness study on the use of Playlist for Life in the hospice setting. Method This study was a mixed-methods feasibility study involving adults at the end of life, family members and hospice staff from one in-patient hospice in Scotland. Eligible patient/family member dyads were approached by hospice staff and if interested, recruited by the researcher. All included participants received the intervention, which involved the provision of an MP3 player and assistance to set up a playlist. Participants were asked to listen to the playlist daily during the intervention period (7 days). Data were collected through patient reported outcome measures and on days 1, 3 and 7 of the intervention period and through participant observation session. Patient/family member dyads and hospice staff also took part in qualitative interviews (Appendix 1) post-intervention, which were audio-recorded, transcribed and analysed thematically. Semi-structured interviews at the end of the intervention period were used to evaluate feasibility and acceptability. An advisory group including patients, family members and staff gave helpful feedback on the qualitative interview questions. Interview questions were the same for all participants and all the questions were asked to all participants. Results N = 15 participants were recruited (n = 5 patients, n = 5 family, n = 5 staff. The intervention was appraised positively, particularly regarding its beneficial effect on patient/family relationships. The study design was deemed feasible and acceptable. Conclusion The findings of this study will inform the development of a future randomised cluster trial designed to assess the usability and effectiveness of the Playlist for Life personalised music intervention. Trial registration This study was not registered as this was a small feasibility study, conducted prior to a pilot study not testing for effectiveness. In addition, the study was non-randomised. The study is registered with NHS ethics and the hospice research and governance team
... The literature points to music therapy's ability to promote relaxation, reduce anxiety, stress, depression and fear, and provide non-intrusive opportunities for people to connect with and express their feelings [5][6][7][8][9]. Additionally, through skillful use it can facilitate communication with family and loved ones [10][11][12]. Music can evoke emotions, both perceived and experienced [13][14][15] and thoughts, leading to recognition of needs and desires. Music therapy may contribute to each patient and families being able to explore opportunities to enjoy time together or in solitude, to review life and to achieve a sense of completion in relationships and life itself. ...
... Music therapy enables validation of feelings and is a safe appropriate vehicle for releasing them. It enables the communication of important messages by a population with a strong need to convey wishes and desires before the final transition [10][11][12][13][14][15][16][17][18][19]. ...
... Faced with the fact of death's approach, many people value the process of structured life completion and closure. On the other hand, although not measured specifically, the authors wish to emphasize that they did indeed observed the great comfort and satisfaction that music therapy also provided for family members, that was demonstrated in other studies [11,42] Some patients requested that we compile a personalized recording of songs that assisted in identifying, expressing and communicating their thoughts and feelings to their love ones. Songs written with the music therapists or pre-composed recorded songs we often left as a legacy for family members. ...
Article
Context Eighty-seven patients newly diagnosed with lung, breast, or gastrointestinal cancer and undergoing chemotherapy in the infusion suite of a large urban hospital in New York City. Objective Patients were enrolled in this study of music therapy's impact on resilience in coping with the impact of symptoms inclusive of symptom clustering. Methods Patients were randomly assigned to three arms: clinical instrumental improvisation or clinical vocal improvisation 43 subjects to instrumental improvisation or vocal improvisation and 44 subjects to control. All subjects received a Medical Music Psychotherapy Assessment including psychosocial information and music preferences, pre-/post-Resilience Scale, Hospital Anxiety and Depression Scale, Visual Analogue Scale/Faces Scale, and a pain—Color Analysis Scale. Interventions included 20-minute music therapy (MT) and two additional sessions. Results Significant increases in Resilience Scale in MT groups after treatment with instrumental and vocal MT interventions equally potent-reflect average changes of 3.4 and 4.83 (P = 0.625), respectively. Although Hospital Anxiety and Depression Scale scores showed little impact of MT on perceived anxiety/depression, a strong correlation is seen between vocal intervention and lower depression scores through Visual Analogue Scale–rendered postsessions. This yielded a significant decrease in pain levels immediately after MT, with the final session showing the most significant change in pain level. Resilience in enduring procedures is a necessary component of combating potential negative illness perception. Conclusion Our study shows MT's facility to propel resilience in patients newly diagnosed with cancer, particularly when promoting and pairing adaptation toward coping through the expression of perceived negative effects of emotional and physiological symptoms.
... The literature points to music therapy's ability to promote relaxation, reduce anxiety, stress, depression and fear, and provide non-intrusive opportunities for people to connect with and express their feelings [5][6][7][8][9]. Additionally, through skillful use it can facilitate communication with family and loved ones [10][11][12]. Music can evoke emotions, both perceived and experienced [13][14][15] and thoughts, leading to recognition of needs and desires. Music therapy may contribute to each patient and families being able to explore opportunities to enjoy time together or in solitude, to review life and to achieve a sense of completion in relationships and life itself. ...
... Music therapy enables validation of feelings and is a safe appropriate vehicle for releasing them. It enables the communication of important messages by a population with a strong need to convey wishes and desires before the final transition [10][11][12][13][14][15][16][17][18][19]. ...
... Faced with the fact of death's approach, many people value the process of structured life completion and closure. On the other hand, although not measured specifically, the authors wish to emphasize that they did indeed observed the great comfort and satisfaction that music therapy also provided for family members, that was demonstrated in other studies [11,42] Some patients requested that we compile a personalized recording of songs that assisted in identifying, expressing and communicating their thoughts and feelings to their love ones. Songs written with the music therapists or pre-composed recorded songs we often left as a legacy for family members. ...
... Music therapists are Board Certified (MT-BC) by the Certification Board for Music Therapists (CBMT) [54], and offer tailored interventions using music to facilitate communication, and to provide physical, spiritual and emotional well-being to patients (55,56). They employ a wide variety of methods, including improvisation, evoking memory, enhancement of life review, creation of audio recordings, relaxation techniques, guided imagery or instrument playing (41,54). ...
... Sometimes a patient may request a specific piece that has a unique meaning, while at other times the aim may be to access a memory or emotion associated with a particular song, as a resource or tool for healing. This can then be facilitated by the music therapist, whose aim is to create a safe space where reflection and communication is supported in a non-judgmental way, and where feelings can be validated [55,57] . The abstract nature of music enables conveying complex emotions that can be difficult for the patient to verbalize or express otherwise, and the choice of a particular piece can help with the expression of a deep feeling that may be too daunting or complex to convey in any other way [58]. ...
Article
Dying from a terminal illness involves a period of transition throughout which the person deals with multiple losses, including the loss of one’s own life. The awareness of death makes the individual confront spiritual questions that touch the very nature of existence, and music can help intensify that spiritual experience bringing new meaning to the end of life. The reasons why spirituality, religion and music can facilitate the existential quest for meaning and provide an overall improvement of the quality of life at the end of life will be explored, aiming to suggest that a humanist approach to end-of-life care in which alleviation of suffering and consideration of the specific needsof the patient including spiritual care and therapy with music would be desirable to help patients during the dying process.
... Music is of great importance to people and holds significance in connection with death and farewell ceremonies as part of human experience, in particular, when conducted for a close relative (Krout, 2003). But there has been little attention in research into the importance of music choice at funerals and farewells when it comes to the grieving process for close relatives. ...
... In a study conducted with a hospice in the United States, Krout (2003) claims that it can be difficult to talk to relatives about their feeling and final wishes before death. He believed that music therapy with relatives can open up a space for conversation and a moment to be present with one another at the end of life. ...
Article
Full-text available
In this study we examined a case where twelve participants conducted farewell ceremonies for their deceased relatives. Taking a qualitative approach, we used interviews and questionnaires to focus on life stories that involve grieving. Specifically, we asked about experiences of the grief process as related to choice of music. Our results indicate that the role of music in farewell rituals is important for the grieving process in several ways. Firstly, music was associated with positive memories of the loved one and gave rise to experiences of recognition. Secondly, music facilitated active participation in the grieving process through choosing farewell music together with a relative. Thirdly, selecting music for the funeral in advance, together with their loved ones, was also experienced as hopeful, comforting and consoling before, during and after the bereavement.
... Communication with family, staff, and oneself can often be impacted when approaching the end-of-life. Music therapy may be used as a tool to facilitate communication in palliative care (Clements-Cortés, 2004;Krout, 2003). Song-writing is another music therapy intervention that could lead to elucidating emotions, creating legacies, and facilitating communication at the endof-life (Heath & Lings, 2012;O'Callaghan, 1996a). ...
... However, music therapy can often facilitate positive social experiences for caregivers, family, friends, and the person receiving palliative care. Receptive music listening and interactive listening can be effective in linking people near end-of-life and their families in profound ways (Black, 2014;Krout, 2003;Lachaal, 2014). Music therapy has been shown to have the ability to create positive bonding experiences for caregivers and their loved one through active participation and patient-self connections, in which aspects of the person's self are brought forward in sessions, allowing family to re-connect (Magill, 2009a). ...
... In recent years, music has been increasingly used as a therapeutic tool in the treatment of different diseases and in intensive care medicine. [2][3][4][5][6] Research today has shown that repeatedly practicing the association of motor actions with a specific sound and visual patterns (musical notation), while receiving continuous multisensory feedback will strengthen connections between auditory and motor regions (e.g., arcuate fasciculus) as well as multimodal integration regions. Furthermore, the plasticity of this system as a result of long-term and intense interventions suggest the potential for music making activities (e.g., forms of singing) as an intervention for neurological and developmental disorders to learn and relearn associations between auditory and motor functions such as vocal motor functions. ...
Article
Full-text available
Introduction: The role of music in medicine, and specifically, Intensive care medicine is still unclear; however, its role in affecting vital parameters is well known. Thus, in recent years, music has been increasingly used as a therapeutic tool in the treatment of different diseases and in intensive care medicine. Neural plasticity has been believed to explain some of the sensorimotor and cognitive enhancements that have been associated with music therapy. Thus, a study was conducted to see if it can serve as complementary method for treating perioperative stress and for acute and chronic pain management in a critical care setting. Aim and Objectives: The aim is to evaluate the effect of music therapy on clinical parameters in critically ill patients, its role in causation of biochemical parameters, and its effect on the overall outcome in critical care patients. Materials and Methods: The study was a cross‑sectional study conducted in the intensive care unit (ICU) of the medicine department, AVBRH, Sawangi, from September 2018 to February 2019. The study involved 120 adult patients aged 18–85 years categorized into 60 cases and 60 controls. Reasons for hospitalizations primarily included sepsis, congestive cardiac failure, acute respiratory distress syndrome, cerebrovascular episodes with complications, and chronic kidney disease with concurrent complications. Cases were administered music therapy in the form of classical piano pieces composed by Mozart, played for 20 min in the morning, afternoon, and evening, while controls received only protocol‑based management. Data were entered in Microsoft Office Excel 2010 and analyzed using the IBM SPSS software version 22.0 (Chicago, Illinois, USA). Results: Case category patients were found to have a statistically significant reduction in Glasgow Coma Scale, heart rate, blood pressure, and Hamilton anxiety scale rating on day 1 versus day 5 and in comparison to the control group as well. Case patients were also noted to have a lesser duration of hospital stay and lesser mean morbidity in the ICU compared to controls. Conclusion: Thus, authors believe that music therapy can be a crucial adjuvant to protocol‑based management that already exists across critical care settings, and strongly feel that further studies, including a greater number of patients and follow‑up evaluations, are needed to confirm promising results observed in this study.
Article
Assessment is a critical aspect of treatment planning, and while there exist standards for facilitating music therapy assessments in a variety of clinical settings, no such standards exist for music therapists in hospice and palliative care. This gap in knowledge, which limits music therapists’ ability to provide patients and caregivers best practices promoting supported movement through the dying process, becomes particularly problematic when assessing patients who are imminently dying with a 24–72 hour prognosis. To further develop and define assessment and clinical decision-making processes used by music therapists in hospice and palliative care, the authors used a constructivist grounded theory and situational analysis methodology to analyze interviews of 15 hospice music therapists. The resulting theoretical model describes an ongoing process of assessment and clinical decision-making shaped by participants’ individual epistemologies. Epistemologies were comprised of 5 ways of knowing, which were termed experiential, personal, musical, ethical, and integral, and provided participants critical foundations for their practice. The results support a development of a model for reflective practice as well as continued research on epistemological foundations of clinical practice.
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Traditional music is gaining more and more attention in higher education in China. As a Chinese music culture, traditional folk music is also a powerful means to strengthen the construction of socialist spiritual civilization, subtly improve students ’aesthetic standards, cultivate sentiment, and promote the development of physical and mental health, and also help to improve the soft power of home country. This article takes the folk music club of Jinzhou Medical University as an example, and discusses its development, construction, management, function, and achievements. A few relevant events are analysis and reviewed. The folk music club was established in 2013, and a total of more than 100 members performed large-scale performances on and off campus. In addition to active campus life and enriching students 'own cultural accomplishments, we believe that medical students' specialty in playing musical instruments will also benefit their future careers. In accordance with the content of the professional courses, we have introduced concepts of context in music therapy and special lectures on music and neuroscience for our students. We hope that the student music club, while inheriting the traditional Chinese music culture, will also enhance its medical practice ability and achieve the goal of comprehensive development and education.
Article
Full-text available
A partnership between The Cleveland Clinic Foundation and The Cleveland Music School Settlement has resulted in music therapy becoming a standard part of the care in our palliative medicine inpatient unit. This paper describes a music therapy program and its impact on patients, their families, and staff. A service delivery model is suggested for implementation and integration of music therapy within palliative medicine. Specific music therapy interventions, evaluation and documentation techniques are also mentioned. A description of patient and family responses to music therapy, staff satisfaction, and effectiveness of interventions is presented.
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This article is about healing in the context of the oncology hospital setting. It suggests the benefits of collaborative medicine and its enhancement through music therapy. An empowerment perspective guides its emphasis on the necessity of meeting the psychosocial needs of patients, encouraging participation in treatment, and facilitating a psychologically positive hospital experience through the application of music. A review of the literature and an outline of the specific physical and psychological benefits of music in oncology treatment are provided. The authors argue that psychological symptoms, such as depression and anxiety, which are commonly experienced by long-term hospital patients, can be prevented when oncology care teams follow a philosophy of healing the whole person rather than merely treating an illness. They suggest that researchers and care teams further explore the development of creative arts programs in hospital settings.
Article
In a time when the nation's health care system is still unrefined, dying persons and their families are forced to confront numerous problems; among the worst are huge medical bills, isolation, fear, and little to no coordination among the services and care provided. As more and more people suffer from chronic illnesses that prolong the dying process, the need for an effective code of treatment for terminally ill and dying patients grows substantially. This sourcebook attempts to fill that need. It provides professionals who care for dying persons an extensive yet user-friendly guide on how to render the best possible treatment. It is complete with bar graphs, pie charts, an annotated bibliography, and lists of other resources. Overview chapters focus on the epidemiology of dying, patterns of treatment and service, the experience of dying persons, family roles, health care systems, and financing. Other chapters discuss dying of specific diseases, socio-cultural factors that influence how we die, and differences in dying by age. Care for the Dying concludes with an important discussion of future directions and a useful appendix that includes methods for measuring quality in health care. Undoubtedly, this book is a necessity for all who pursue the best care possible for people in their last stages of life.
Article
The purpose of this article is to describe the hospice concept and to illustrate how music therapy activities can be incorporated into the concept. Included are suggestions for specific music activities plus supplementary activities which can be utilized with the aging patient. The final portion of this article is a set of case studies which very clearly indicate the validity of using music therapy with the terminally ill.
Article
This article is about healing in the context of the oncology hospital setting. It suggests the benefits of collaborative medicine and its enhancement through music therapy. An empowerment perspective guides its emphasis on the necessity of meeting the psychosocial needs of patients, encouraging participation in treatment, and facilitating a psychologically positive hospital experience through the application of music. A review of the literature and an outline of the specific physical and psychological benefits of music in oncology treatment are provided. The authors argue that psychological symptoms, such as depression and anxiety, which are commonly experienced by long-term hospital patients, can be prevented when oncology care teams follow a philosophy of healing the whole person rather than merely treating an illness. They suggest that researchers and care teams further explore the development of creative arts programs in hospital settings.
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Hospice music therapy requires of the therapist a firm foundation in the psychological aspects of dying and grief. This paper focuses on issues frequently faced by the dying adult in hospice. The author creates a theoretical framework which supports assessment and treatment by tracking the patient's efforts to move through phases and tasks of dying. Grief issues and spiritual aspects of this work are explored. Goals and roles for the music therapist and for the music are suggested with particular attention to the changing needs presented as the patient moves closer to death. Case examples illustrate therapist interventions and music used to support improved quality of life and the psychological and spiritual progress of the dying patient toward a peaceful death.
Article
Initial observations regarding the use of music therapy at one hospital in the palliative care of patients with advanced malignant disease are presented. In the hands of a trained music therapist, music has proven to be a potent tool for improving the quality of life. The diversity of its potential is particularly suited to the deversity of the challenges - physical, psychosocial and spiritual - that these patients present.
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The reactions of terminally ill patients are sometimes difficult to understand. The nursing staff in palliative care units say that they are confused by what they call "denial," thereby using, in a general sense, a word that has a very precise meaning in psychoanalysis. It seems necessary to put this concept in its true perspective in relation to the various defence mechanisms that can come into play each time a normal subject is confronted with the reality of death, his own or that of someone close to him. This will, I hope, help nursing staffs to adjust their attitude towards terminally ill patients.