Patient’s and health care provider’s perspectives on music therapy in palliative care – an integrative review

Abstract

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

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition

“…Music/art therapy: However, there was moderatequality evidence from three reviews 51,69,94 demonstrating the positive impact of music/art therapy on a The GRADE category is based on identified systematic reviews published between 2013 and February 2018. We used the following reasons for downgrading confidence in the evidence (downgraded by 1 or 2): Study limitation (observational studies start with a low GRADE value), Inconsistency (individual studies do not come to the same conclusions or there is only one study so inconsistency cannot be evaluated), Imprecision (there is no effect estimate, there is no measure of dispersion, or the CI is very broad); we used the systematic review authors' evaluation for other GRADE criteria if there was a formal quality of evidence assessment (see text).…”

“…Three reviews reported anxiety outcomes for music/art therapies. 51,69,94 One review reported that creative art therapies significantly reduced anxiety (SMD 0.28; CI 0.11e0.44; 25 RCTs) and depression (SMD 0.23; CI 0.05e0.40; 11 RCTs) compared to controls after intervention. 94 Another review found four studies (one RCTand three pre-post) demonstrating positive effects of music therapy on anxiety and three studies (one RCT and two pre-post) demonstrating reduced depression.…”

“…94 Another review found four studies (one RCTand three pre-post) demonstrating positive effects of music therapy on anxiety and three studies (one RCT and two pre-post) demonstrating reduced depression. 51 A third review found two studies demonstrating significant reductions in anxiety associated with music therapy. 51 There was moderate-quality evidence that cannabinoids did not have an impact on depression compared to placebo 52 and very low-quality evidence indicating that nonpharmacological cognitive interventions such as relaxation, imagery, hypnosis, psychosocial interventions, and psychospiritual interventions can improve depressive symptoms.…”

Effectiveness and Interventions of the Music Therapy in Patients in Palliative Care

“…It is a medicine that is person-centered, holistic, and not just in disease as it was in the case of the biomedical technique, which fragments the individual according to the pathology, aiming only for healing and not for comfort. 6,7,13 Patients in palliative care often have too much pain that does not stop well with medication, but adjunctive therapies such as music therapy can more effectively alleviate some symptoms, such as fatigue, depression, and relatively common problems in this population. to evoke memories of pleasure and joy associated with the songs that make up the therapeutic arsenal.…”

Does Hospice Need a Musical Therapy?

“…Опрос, проведенный Британской ассоциацией музыкальных терапевтов среди ее членов в 2017 г., показал, что более половины специалистов ассоциации на постоянной основе задействованы для оказания паллиативной помощи в хосписах [49]. Мета-анализ применения МТ в паллиативной помощи, выполненный в 2018 г. учеными университета в Бергене (Норвегия), и основанный на 67 рандомизированных контролируемых исследованиях (РКИ) с участием в общей сложности более 800 пациентов, продемонстрировал широчайшую область применения метода в паллиативной медицине и выявил непрерывный рост востребованности МТ со стороны пациентов, а также увеличение разнообразия методик, предлагаемых музыкальными терапевтами [50]. Ежегодное увеличение количества исследований МТ в паллиативной медицине, направленных на повышение ее эффективности в облегчении страданий неизлечимых пациентов, дает основания для уверенности в дальнейшем развитии и совершенствовании метода.…”