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Palliative Care

Music Therapy and Palliative Care

When we are working with persons for whom a medical cure is no longer possible, music therapy can improve the quality of life by addressing the emotional, spiritual and physical needs that may arise during this time.

Music experiences utilized in palliative care may include music listening, discussion of specially chosen lyrics, songwriting, improvisation, singing and playing instruments. A person's musical, cultural and religious background may be incorporated into the session, providing a personalized approach. In all instances, respect for the patient’s needs and preferences is of primary importance.

For terminally ill persons, music therapy can serve as a catalyst to establish both verbal and non-verbal communication. The skilled use of music can facilitate emotional self-expression and provide a supportive and non-threatening environment with opportunities to confront fears and discuss present concerns. Musical associations can facilitate life review and assist in resolving significant personal issues.

Music therapy can help to lessen feelings of isolation and loneliness by providing opportunities for social interaction and the sharing of personal experiences with others. The use of religious music can provide spiritual comfort, and reassurance and support the individual's faith. Music therapy can also be used to help family members throughout the grieving process by providing comfort, continuity and opportunities to express feelings of loss.

Music has been found to have a significant impact on reducing the perception of physical pain and the length and severity of chemotherapy-induced nausea and vomiting. Carefully selected music can facilitate relaxation and alleviate anxiety, agitation and insomnia or it can provide motivation for physical activation and enhance feelings of well-being. Music therapy can also assist the individual in maintaining a sense of independence and in retaining a sense of control of his or her life by providing opportunities for choice and decision-making. Instruments and materials can be adapted to encourage as much participation as possible within the session.

Music therapy sessions can be offered individually or in a group setting with family, friends or other patients. Sessions can also be provided at the bedside with portable instruments and sound equipment. Both live and recorded music can be used during treatment sessions depending upon the needs and preferences of the patient and the techniques being used.

In palliative care, music therapy can:

Help to alleviate fears and anxieties

Music therapy can promote and facilitate self-expression, thus assisting in alleviating fears and anxieties associated with terminal illness. The ability to confront and begin to deal with some of the intense feelings that may be present can be encouraged in a verbal or non-verbal manner. The music therapist may present music with specially chosen lyrics to provide a springboard for discussion of personal issues that have previously been difficult to express. Music can also, be used to represent thoughts and feelings that may be difficult to express verbally. Here instrumental improvisation can offer the patient an outlet-for self-expression, while the patient can feel supported by accompanying music provided by the music therapist. Songwriting provides an alternative way in which thoughts can be expressed in a manner that is pleasurable, sensitive, and meaningful and that is supported throughout its creation by the associated music. The use of songs has been found to provide a framework for tension release, integration -and pleasure, promoting contact, awareness and resolution (Bailey, 1983). Live music has been found to have a significantly better effect in reducing tension and anxiety, and in alleviating physical discomfort and negative affect, than recorded music (Bailey, 1983), emphasizing the importance of the therapist/music relationship.

Reinforce identity and self-concept and decrease feelings of isolation

Each person has a unique musical past. Through encouraging participation within such experiences as listening to favourite music, playing favourite instruments, and songwriting and through providing opportunities to share these musical experiences with others a sense of normality can be maintained and self-concept and identity reinforced. Music therapy can also promote social interaction and facilitate discussion among a group of patients, allowing them to share common experiences and derive support from one another. Within a group, music becomes a shared experience that encourages group cohesiveness, sharing and trust. Many of the activities used in individual sessions can be incorporated into group situations including songwriting, instrumental improvisation, singing, sharing songs of inspiration and hope, and discussion of lyrics.

Encourage participation in physical activity and exercise to promote feelings of vitality and well-being

The use of music with physical activity can provide increased motivation for participation. The person can benefit from increased feelings of vitality and well-being associated with the benefits of exercise. Through varying the musical styles, tempi, and timbres, music can be used to match and facilitate movement. The use of live music is often beneficial so that individual creativity and spontaneity can be encouraged. By encouraging the individual to remain active, independence and the sense of control can be maintained.

Promote relaxation and alleviate insomnia

Through the combination of music and relaxation exercises, which encourage self-expression and promote positive affect, music therapy has been successful in helping to increase states of relaxation and alleviate insomnia (Bailey, 1986; Cook, 1985; Cook, 1986). Both active and passive relaxation exercises can be used depending upon the intensity of the patient's pain, fatigue and anxiety. ' Music can accompany the act of tensing and releasing muscles, providing a framework for the intensity, duration and frequency of the exercise. Music can also promote slow, deep breathing exercises by rhythmically matching, reflecting, and guiding the breathing toward desired results. The use of music as diversion may help to eliminate intrusive thoughts that. may hinder the onset of sleep. Music-mediated imagery may assist in providing this diversion and in creating a positive state of mind which may help to facilitate sleep. Music listening is the primary experience involved in these techniques and the knowledge and careful use of specifically chosen music is of great importance toward achieving these goals.

Help to initiate communication with family members, serving as a source of comfort throughout the grieving process

The use of music can help to bridge communication barriers, providing a common means through which communication can be fostered. Music that families shared together can be utilized to initiate communication and foster reminiscence of shared memories. The music therapist can offer support, comfort and continuity, assisting the family throughout the grieving process. The music used, created and shared by a loved one can become an integral part of that person's legacy and provide a source of comfort to the family.

Decrease the perception of pain and the length and severity of the side effects of chemotherapy

It has been theorized that listening to some types, of music- can produce endorphines that can reduce the amount of pain we feel (MacLelland, 1979). Music listening can serve as a source of diversion from the experience of pain and help to induce relaxed states and provide a positive change in affect, thereby facilitating pain relief (Zimmerman, Pozehl, & Duncan, 1986). Music-mediated imagery has also been widely used for this purpose. Music-mediated imagery primarily involves the experience of listening to carefully chosen musical selections that will promote desired visual images and thoughts for the individual. Studies have found that significant positive results have been achieved using this technique for both pain reduction (Rider, 1985) and in reducing the perceived severity and length of chemotherapy-induced side effects (Frank, 1985). The music therapist may also choose to use live instrumental improvisation to reduce the experience of pain. Here, the music can match and reflect the intensity of the patient's experience of pain through the use of thick textures, dissonant harmonies and evocative rhythms. A gradual change can then be made by slowly implementing slower tempi; steadier rhythms; consonant, pleasurable harmonies; and longer phrase and harmonic structures. Additional benefits of music therapy may include the decreased need for assistive medications and increased ease of care during difficult nursing procedures.

Aid in the process of life review

Through putting together a collection of music memories, and associating these memories with significant events that occurred during an individual's life, the process of life review can be facilitated and enhanced. Discussion of these associations can lessen feelings of desolation, and help to provide the individual with a sense of contentment and satisfaction with life.

Provide opportunities to express emotions in a non-threatening and accepting environment

The use of music provides a non-threatening atmosphere, an accepting environment, which encourages the expression of emotions. Because a person may feel more comfortable in this type of environment, the therapeutic process may be accelerated when time is of importance. Through using music that matches a person's preferences, spiritual beliefs and/or cultural background, music therapy offers an individualized approach which can enhance the quality of remaining life.

Music therapy in palliative care: a selected bibliography

Bailey, L.M. (1983). The effects of live music versus tape recorded music on hospitalized cancer patients. Music Therapy, 3(l), 17-28.

Compared the effects of live and tape recorded music in reducing tension and anxiety in hospitalized cancer patients. Live music was significantly more successful in reducing tension and anxiety, and in alleviating physical discomfort and negative affect.

Bailey, L.M. (1984). The use of songs in music therapy with cancer patients and their families. Music Therapy, 4(l), 5-17.

Describes the beneficial qualities of the use of songs in providing support, acting as a tool for change and in reducing the suffering often involved in cancer. Presents the characteristics of songs and their use in providing a framework for tension release, integration and pleasure, promoting contact, awareness and resolution.

Bailey, L.M. (1986). Music therapy in pain management. Journal of Pain and Symptom Management, l(l), ri25-28.

Discusses the uses of music therapy to facilitate emotional expression promoting relaxation, alteration in affect, sense of control and self expression.

Cook, J.D. (1985). The therapeutic use of music in the oncology setting (meeting abstract). Oncological Nursing Forum, 12(2 supplement), 86.

Describes the numerous uses of music as an adjunct to traditional methods of treatment in the oncology setting, including pain control, insomnia relief, and reduction of anxiety. Provides an overview of the concept of music therapy and the effectiveness of music based on physiological action. Discusses examples of music therapy research with specific implications for oncology.

Cook, J.D. (1986). Music as an intervention in the oncology setting. Cancer Nursing, 9(l), 23-28.

Describes the use of music therapy in alleviating the perception of pain and relieving insomnia and the effectiveness of music as a universal language in opening the lines of communication and serving as an outlet for emotions.

Fagen, T.S. (1982). Music therapy in the treatment of anxiety and fear interminal pediatric patients. Music Therapy, 2(l), 13-23.

Presents excerpts and analyses of case studies of terminal cancer pediatric patients. Discusses the use of music therapy techniques and their benefits in dealing with the confrontation of death, pain, withdrawal, apathy, promoting communication within the family and facilitating understanding and coping with the fears associated with terminal illnesses.

Frank, J.M. (1985). The effects of music therapy and guided visual imagery on chemotherapy induced nausea and vomiting. Oncological Nursing Forum,12(5), 47-52.

Studies the effects of music therapy and guided visual imagery on the perceived degree and length of nausea and vomiting resulting from chemotherapy treatment. Results indicate that state anxiety, length of nausea and vomiting, and perceived severity of vomiting were all significantly reduced.

Gilbert, J.P. (1977). Music Therapy perspectives on death and dying. Journal of Music Therapy, 14(4),165-171.

MacClelland, D. (1979). Music in the operating room. Association of Operating Room Nurses, 29(2), 252-260.

Monro, S. (1984). Music therapy in palliative /hospice care. St. Louis MO 63132. Magnamusic-Baton.

Pfaff, V.K (1986). Music therapy in the interdisciplinary care of children with cancer. San Francisco, Ca.: Paper presented at the Conference of the Association for the Care of Children's Health.

Describes and supports the use of music therapy in alleviating anxiety, coping with hospitalization, reducing stress, facilitating verbal and nonverbal self-expression, and increasing self-esteem through the musical media of singing, improvisation, songwriting, etc. Describes the special implications of music therapy with children.

Rider, M. (1985). Entrainment mechanisms are involved in pain reduction, muscle relaxation and music mediated imagery. Journal of Music Therapy, 22(4), 182-192.

Examines the effects of music mediated imagery on pain relief and muscle relaxation. Results indicate significant treatment effects for both pain and E.M.G. reduction with the entrainiment condition being most effective.

Zimmerman, L., Pozehl, B., & Duncan, K. (1986). The effects of music therapy on oncologic patients' with chronic pain (meeting abstract). Oncological Nursing Forum, 13(2 supplement), 74.

Examines the effects of music therapy on oncology patients experiencing chronic pain. Results indicate that after 30 minutes of preferential music listening, the experimental group had significantly lower pain scores than the control group which did not receive any music.