Improving the Mood of Palliative Patients by Using of a Single Session Music Therapy - Research Paper Example

Introduction Regardless of the type of settings, hospice care is purposely given to patients who are terminally ill and are at the last stage of their lives. Since hospice care is more focused on caring for the terminally ill patients, the main purpose of hospice nurses is to provide the terminally ill patients with a comfortable life as often as possible (Fayed, 2005). Chronic pain is considered as the major contributor of degraded quality of life, reduced well-being, and physical disability among the terminally patients. Pain which lasts for more than six months could negatively affect five dimensions in the life of the terminally ill patients which include: (1) physical; (2) psychological; (3) emotional; (4) social; and (5) spiritual wellness of the patient. In general, failure of the health care professionals to provide the palliative patients with effective pain management could result to compromising the ability of the hospice patients to perform activities of daily living (ADLs), health and appetite, and sleep. Therefore, chronic pain management should be one of the main responsibilities of the hospice nurses. Music therapy is one of the techniques used in managing chronic pain among the terminally ill patients. To enable the readers to have a better understanding of the subject matter, the definition of related medical terms will be provided in the study. Eventually, a literature review will be conducted to examine the impact of music therapy on pain management among the hospice patients. In the process of going through the literature review, the summary of each article related to the research methods used and results will be thoroughly discussed. Based on the gathered information, whether or not the use of music therapy should be considered as a strategy for pain management among the hospice patients will be tackled. Definition of Terms Contemporary Therapy – alternative therapies used in managing the symptoms of terminally ill patients. (Hemming & Maher, 2005) Hospice Care – especial care which aims to increase the quality of life and comfort among the terminally ill patients. (Fayed, 2005) Music Therapy – “the use of music and/or musical elements (sound, rhythm, melody, and harmony) by a qualified music therapist” (Vink, Birks, Bruinsma, & Scholten, 2004, p. 2). Pain Management – the process of providing medical care in order to alleviate and reduce the pain being experienced by a terminally ill patient. Palliative Care – “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illnesses, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain among others. (World Health Organization, 2009) Literature Review It is common among the terminally ill patients to experience negative emotions related to anger, anxiety and depression since chronic pain related to their illnesses. These negative feelings could hinder their ability not only to perform the activities of daily living but also their social functioning and the overall quality of living. Today, music therapy is considered one of the most inexpensive and effective way of managing the not only pain but also anxiety and depression among the terminally ill patients. Music Therapy Enables the Patients to Feel More Relax and Calm The controlled research method used by Stefano et al. (2004) is more scientific as compared to other research studies. To determine the key factors that makes the listeners more relaxed and calm, the researchers examined the difference in the levels of cytokines, peripheral blood mononuclear cells and polymorphonuclear cells – the blood plasma signaling molecules between the pre- and post music listeners. Using a high pressure liquid chromatography, electrochemical detection, and nano electrospray ionization double quadrupole orthogonal acceleration time of flight-mass spectrometry, the researchers determined the exact opiate alkaloid levels between the two groups. Based on the research findings of Stefano et al. (2004), a significant increase in the mononuclear cells was observed when the research participants were listening to the music. On the contrary, a decreased in the levels of plasma morphine was significant after the research participants listened to music. Basically, the changes in the music listeners’ physiologic reaction to music enables them to feel more relaxed. Therefore, they show signs of lowered blood pressure as compared to those who were not listening to music. Similar to the research findings of Stefano et al. (2004), other related research studies also concluded that the use of music therapy can provide a lot of health benefits to the patients who are experiencing critical illness (Rose & Weis, 2008; Stubbs, 2005; Nilsson, Unosson, & Rawal, 2005). As part of conducting a pilot study using a single-group pre-post study on patients who received at least 4 sessions of music therapy during a time span of 3 weeks as a way to evaluate the impact of receptive music therapy performed in an oncological rehabilitation hospital, a bipolar mood and quality of life questionnaire was distributed to each of the research participants before and after each session of music therapy (Rose & Weis, 2008). Upon measuring the quantitative data using ANOVA, the researchers revealed that the the patients’ mood became more balanced, less nervous, and less exhausted after attending music therapy session for some time whereas 75.6% of the patients experience positive body sensation like the feeling of warmth and heaviness of the limbs after receiving music therapy (Rose & Weis, 2008). After allowing the patients to receive music therapy on two different occasions for a time span of 30 minutes per day, Stubbs (2005) asked the research participants to participate in the unstructured interview. Based on the research survey results, Stubbs (2005) concluded that the patients who received music therapy are capable of recalling the experience of listening to music even when they are sedated and/or ventilated. Therefore, patients can experience a longer time being relaxed as compared to those patients who failed to receive music therapy. In the case of and Nilsson, Unosson, and Rawal (2005), the researchers conducted a randomized controlled trial to examine the impact of calming music on stress reduction and immune response during and after anesthesia was given to patients before and after undergoing an operation. The researchers divided a total of 75 aptients into three major groups: (1) intra-operative music; (2) post-operative music; and (3) silence or the controlled group. To avoid discripancy in the research findings, the administration of anesthesia and post-operative anesthesia was standardized. The researchers determined the patients’ individual plasma cortisol and blood glucose levels together with the patients’post-operative pain, anxietty, blood pressure (BP), heart rate (HR), and oxygen saturation were recorded as a way of testing the patients’ stress response whereas the patients’ indivdiual immunoglobulin A (IgA) was evaluated in order to test the immune response (Nilsson, Unosson, & Rawal, 2005). Based on the research findings, patients who participated in the post-operative music group showed a signficant decrease in the level of cortisol (2066 mmol L-1) as compared to the controlled group (72 mmol L-1) two hours after being admitted in the post anesthesia care unit (Nilsson, Unosson, & Rawal, 2005). This is the primary reason why the post-operative music group were able to experience less anxiety and pain as compared to the controlled group. Likewise, it was also noted that the intra-operative music group experienced less pain one hour after being transferred to the anesthesia care unit. The research study made by Nilsson, Unosson, and Rawal (2005) revealed that there was no significant difference found in the patients’ IgA, blood glucose, BP, HR, and oxygen saturation among the three groups. However, the research study of Myskja and Lindbaek (2000a) provided evidences that the use of music therapy could signficantly influence the physiological variables in the human body such as the blood pressure, heart rate, respiration, EEG measurements, body temperature, and galvanic skin response since music could influence the normal functioning of our immune and endocrine system. Although there is not much study conducted on what type of music should be included in the music therapy, the fact that music could significantly affect the functioning of the immune and endocrine system are among the few basic factors that makes music therapy effective in terms of minimizing pain, anxiety, nausea, fatigue, and depression among the terminally ill patients. Importance of Music Therapy in Alleviating Anxiety and Depression among the Patients The use of pharmacological intervention for pain management among the chronic cancer patients could cause side-effects related to the increase in anxiety and depression which could adversely affect the hospice patients’ quality of life. Although the research study that was conducted by Kwekkeboom (2003) revealed that the use of music therapy and simple distaction methods are the same in terms of controlling medical procedural pain and anxiety, several research studies suggest that music therapy is an effective method in terms of alleviating the patients’ feeling of depression (Maratos et al., 2008; Iqawa-Silva, Wu, & Harriqan, 2007). In general, the standard of care for patients who are manic depressive includes psychological and/or pharmacological therapies. Upon examining the effectiveness of music therapy in alleviating depression among the patients, Maratos et al. (2008) studied the use of standard care procedures combined with music therapy in comparision with the standard care procedure without the application of music. Based on the research findings, music therapy is widely accepted by people who are depressed since music can help them improve their mood. However, there are still a small number of research studies that do not consider the use of music therapy to be effective in alleviating depression. To test the impact of music therapy on pain management control for cancer patients, Iqawa-Silva, Wu, and Harriqan (2007) conducted a systematic evaluation of the information gathered from a literature review related to the music therapy and management of pain control. Upon concluding that the use of music therapy is effective in terms of alleviating the pain felt by the chronic cancer patients, Iqawa-Silva, Wu, and Harriqan (2007) explained that “music therapy during invasive cancer procedures and chemotherapy demonstrated the role that attention states play in distracting patients from, and therefore minimizing their experience of, the pain associated with such treatments”. Since chronically ill patients can easily be distracted from the pain and physical discomfort they feel, music therapy can be considered as one method to minimize the chances that the hospice patients would feel depress. Significance of Music Therapy in Minimizing Acute and Chronic Pain in Terminally Ill Patients Seventy-five percent of the cancer patients experience chronic pain. (Management of cancer pain with complementary therapies, 2007) According to Maquill-Levreault (1993), music therapy in pain and symptom management of terminally ill patients is an effective non-pharmacological approach to pain and suffering. Upon using a multi-modal pain management control, Simcock et al. (2008) conducted a controlled clinical trial to test whether or not the use of music therapy can reduce the patients’ perceived postoperative pain right after receiving a total knee arthroplasty (TKA). After allowing 15 out of the 30 research participants to select their own prefered music, the reseachers found out that the group who were given the privilege to listen to their own preferred music experienced less pain as compared to the group who were not able to listen to music. For this reason, the researchers concluded that the use of music therapy can be considered as one of the most less expensive non-pharmacological treatment in managing postoperative pain. Similar to postoperative pain, patients who are suffering from burn cases are also experiencing excessive pain. Given that burn cases can significantly affect the victims’ physiological and psychological well-being, Prensner et al. (2001) conducted a clinical experiment to determine the impact of music therapy on top of cognitive, behavioral, and pharmacological intervention in burn cases. Based on the experimental findings, the researchers revealed that the use of music intervention is useful not only managing the patients’ pain and anxiety but also in enabling the patients to be able to easily cope with the environment. It is given that a lot of nursing homes are using music as a therapeutic therapy especially among the terminally ill patients. Basically, the use of music therapy can alleviate symptoms related to agitation, anxiety, depression, and sensomotor symptoms related to nerodegenerative diseases. Upon reviewing some of the existing meta-analyses and systematic review articles concerning the application of music and music therapy in the care for geriatrics, Myskja (2005) made a comparison between the gathered literature review related to the impact of music therapy, music medicine, and individualized music over the patients who are at the late stages of life. The study revealed that Myskja (2005) found out that although the use of music therapy could contribute in the delivery of palliative care at the end-of-life stage, it remains a fact that the evidence-based study concerning the use of music therapy in nursing homes is still insufficient up to the present time. Aside from the fact that ost of the research studies avialable has its own limitations when it comes to the research method used, most of the research studies also lack sufficient information concerning how to use music as therapy. Impact of Music Therapy on the Improvements in the Quality of Life of People who are Terminally Ill Given that most of the research studies suggest the use of music therapy can result to positive effects in terms of alleviating the hospice patients’ pain, anxiety, physical discomfort, and depression; Iqawa-Silva, Wu, and Harriqan (2007) concluded that the use of music therapy on hospice patients can signficantly improve the cancer patients’ quality of life. Similar to the research findings of Iqawa-Silva, Wu, and Harriqan (2007), Hillard (2003) also concluded that the quality fo life of palliative patients was higher for those individuals who managed to receive more sessions of music therapy regardless of gender and age. Basically, Hillard (2003) evaluated the effects of music therapy on the quality of life, length of life under palliative care, physical status, and relationship of death occurrence of terminally ill patients who were receiving hospice care inside the comfort of their own home by conducting experimental and controlled group research study. Similar to the research method used by Rose and Weis (2008), Hillard (2003) also applied ANOVA in measuring the gathered data. A year after, Hillard (2004) conducted another research study entitled “A post-hoc analysis of music therapy services for residents in nursing homes receiving hospice care”. Basically, the main purpose of the research study is to analyze the use of music therapy among the residents in nursing homes who are receiving hospice care. Using an ex-post facto design, the researcher evaluated the length of life under a hospice program, the time of death in relation to the last encounter with the music therapist and social worker, and the 80 patients’ individual care plan. Although the research findings revealed that female lived longer than the male patients, significant differences was noted in the length of life of hospice patients who managed to receive music therapy (Hillard, 2004). Basically, no significant difference was observed on the time of death in relation to the time the hospice care professionals had visited the patient. Running, Shreffler-Grant, and Andrews (2008) conducted a research survey concerning the use of complementary therapy on hospices. Based on the descriptive research survey findings, the use of complementary therapies could significantly increase ease, relieve pain, and improve the quality of life among the patients with chronic illnesses during the last stage of the patients’ lives. Likewise, the researchers revealed the they found no significant difference between the rural and urban hospices (Running, Shreffler-Grant, & Andrews). Significance of Music Therapy over Dying Patients and Family Members Terminally ill patients such as those who are in the advance stage of cancer are often experiencing emotional and spiritual struggles due to the possible losses not only on the part of the dying patient but also the family members. For this reason, palliative care provides relief not only for the suffering of the terminally ill patients but also their family members by providing them with physical symptom control, psychosocial support, and spiritual needs (Maqill & Berenson, 2008; Renz, Schutt, & Cerny, 2005; McClain, Rosenfeld, & Breitbart, 2003). Upon examining the importance of spirituality in coping with terminal illness, McClain, Rosenfeld, and Breitbart (2003) interviewed a total of 160 palliative patients with life expectancy of only 3 months or less regarding the importance of spiritual therapy and the patients’ desire to hastened their death, hopelessness, and suicidal ideation. The researcher found that the provision of spiritual therapy among the hospice patients can be considered as one of the best method to protect the patients from having a desire for an untimely death. Basically, the use of music therapy can address the major concerns in the provision of palliative care for terminally ill patients since the use of music can facilitate communication between the health care professionals, the patients, and their family members. (Maqill & Berenson, 2008) By open communication among these group of people, health care professionals can have a better opportunity to provide the patients and their family members a more peaceful dying experience. Similar to the research findings of Maquill & Berenson (2008), the study of Krout (2003) also acknowledged that hospice care team can effectively deal with the dying patients and their family members with the use of music therapy. Since the family members of the dying patients may find it difficult to communicate their thoughts, feelings, and last wishes, hospice care professionals can use music as a way to establish communication with the patients and their family members before providing them with comfort and empathy. Types of Music Used in the Provision of Music Therapy for Palliative Patients Music thanatology includes the use of harp and/or voice. Recently, Freeman et al. (2006) examined the impact of music thanatology on palliative care for dying patients in terms of providing them with comfort. Using observation method on 65 patients who participated in the research study, the researchers noticed a significant change in the patients’ physiologic changes such as their breathing pattern and vital signs of patients before and after listening to harp music for at least 24 to 95 minutes per session. Based on the research findings, the researchers concluded that patients who managed to listen to harp music experience lesser agitation and wakefulness given that listening to harp music makes their breathing slow and deep. Likewise, most of the patients did not experience difficulty in breathing (Freeman et al.). The Best Approach in the Application of Music Therapy on Terminally Ill Patients Upon trying to determine the best approach when applying music therapy on patients who are experiencing chronic pain, Krout (2001) examined the effects of single-session music therapy as an intervention for pain control, physical comfort, and relaxation among the hospice patients. As part of gathering data, the research study used both behavioral observation and self-report before and after receiving music therapy which is composed of either the use of live active music or passive music. After conducting a three-month or 90 session per day music therapy on a total of 80 terminally ill patients in Hospice of Palm Beach County in Florida, Krout (2001) concluded that the use of a single-session music therapy intervention is effective in terms of increasing the patients’ pain control, physical comfort, and relaxation. Considering that the physical pain felt by hospice patients who are at the advanced stage cancer is multifaceted and complex, the health care professionals should be aware that the pain felt by a terminally ill patient is not focused only on the physiological aspect but also psychological, social, and spiritual (Maqill & Berenson, 2008; Maqill, 2001). Aside from the importance of selecting the type of music that are ‘uplifting’, ‘transporting’, and ‘bringing of peace’ which can enable the hospice patients to find time to reflect and renew themselves spiritually (Maqill, 2001); health care professionals should take into consideration the benefits of integrating the use of music therapy with other forms of contemporary therapy as a way to improve the hospice patients’ physical and emotional comfort, peace of mind, and the overall quality of life. For instance: Maqill and Berenson (2008) revealed that combining the use of music theraphy and reflexology is better in terms of increasing the physical comfort of the terminally ill patient as compared to the application of music therapy alone. Therefore, hospice patients can enjoy the benefits of experiencing reduced anxiety, pain, and isolation. Upon investigating the impact of psychotherapy, emphatic therapy, and music therapy in palliative care for cancer patients; Renz, Schutt, and Cerny (2005) concluded that the combination of the three types of therapy is more effective than the application of music therapy alone. The proposed method is realistic since the hospice patients’ spiritual experiences have a significant impact over their physical and emotional well-being. In other words, hospice patients are expected to experience not only lesser pain but also the release in anxiety and despair aside from increasing the feeling of serenity and wholeness which are important component in facilitating the needs of a dying patient. Research Method Using search engines like ‘Yahoo’ and ‘Google’, the researcher gathered some academic journals from databases like: PubMed, CINAHL, and Healthsource. Among the keywords used in the search for related literature includes: ‘music therapy palliative’, ‘music therapy hospice care’, ‘music therapy pain hospice care’, ‘music therapy chronic pain terminally ill patient’, etc. Scope and Delimitations The literature review tackled the latest research findings available concerning the impact of music therapy on pain management for hospice patients including its importance of alleviating the patients’ anxiety and depression, significance of music therapy over dying patients and family members, and the best approach when applying music therapy on hospice care. Since the available peer-reviewed journals concerning the subject matter is limited, the researcher managed to gather academic journals that were published between the years 2000 – 2009. The gathered literature review will provide the readers with idea related to the type of research method used and the research finding results upon evaluating the impact of music therapy on managing chronic pain. However, the literature review is limited in informing the readers about the type of music the hospice care professionals should use. Aside from the research study of the Freeman et al. (2006), Read (2000), and another journal entitled “Live music can be comfort to the terminally ill” which was published under Patient-Focused Care and Satisfaction back in 1999; not much research study was found to enable the researcher to determine the best type of music to use on palliative patients. Likewise, the literature review presented in this study is also limited in determining the impact of music therapy over the palliative caregivers’ emotional and physical burden including how music can enhance their overall wellness. Discussion A lot of research studies were conducted to test the impact of music therapy in the different field of medical practice. In the past, research studies were conducted to test the significance of music therapy in alleviating pain, anxiety, depression, and improvement in the overall functioning of the patients’ body. Since the use of music therapy does not only contribute to the health and wellness of the palliative patients but also addresses the improvements within the social environment and spiritual needs of the patients and their family members, the application of music therapy an effective method in enabling the palliative care professionals need the holistic needs of the patients (O'Kelly & Koffman, 2007). Most of the research articles applied in testing the effectiveness of music therapy are either experimental and/or descriptive research related to physiological measures, behavioral observation, the use of computer devices, and self-reports. According to Gregory (2000), roughly 83% of 183 research studies were experimental or descriptive and 50% of 183 research studies adopted the use of test instruments. Likewise, Hilliard (2005) also reviewed a total of 11 empirical studies to examine the impact of music therapy in hospice and palliative care. Hillard (2005) reported that six out of the 11 empirical studies show a positive sign that the use of music therapy could significantly improve the terminally ill patients’ lives by minimizing their physical pain. As a result of being able to successfully lessen the pain, terminally ill patients were able to experienced an increase in physical comfort and relaxation which enabled them to have a better mood and physical energy. Even though not much research study was made to inform us about the type of music, how, and when these music should be applied within the hospital or clinical settings, Myskja and Lindbaek (2000b) suggested that the combination of the music with guided imagery and deep relaxation should be observed in order to provide the patient with a better pain and anxiety reduction as the health care professionals try their best in improving the well-being of patients who are experiencing chronic pain related to cancer and/or rheumatic origin. Likewise, several studies also recommended the need to combine music therapy with other complementary therapies in order to maximize the patients’ health and overall benefits. Depending on the desired end-result of the hospice care professionals, the use of music theraphy can be combined with reflexology in order to increase the physical comfort of the terminally ill patient (Maquill & Berenson, 2008). It is also possible for palliative care team to combine psychotherapy, emphatic therapy, and music therapy in case the hospice patient is having physical and emotional problems (Renz, Schutt, & Cerny, 2005) or the use of harp music in case the patient is experiencing high blood pressure (Freeman et al., 2006). Conclusion Since the application of music within the medical practice is inexpensive and effective in minimizing the chronic pain, levels of anxiety, and depression being experienced by the patients; the role of music therapy in medicine has been considered not only supportive but also palliative especially when rendering care for terminally ill patients. Although the use of a single session music therapy can be effective in terms of improving the mood of palliative patients, the continuous provision of music therapy session is necessary to ensure that the terminally ill patient will be able to maximize living the last few days of their lives. Considering that the physiological needs of each terminally ill patient varies from one another, the palliative care nurses should be able to design new care plan depending on the specific needs of each patient. For instance: Hospice care team may include in the patient’s care plan the use of harp music for patients who are experiencing high blood pressure and anxiety. Basically, the use of this type of music could help in calming down the patient thereby lowering his/her blood pressure at the end of the music therapy session. On the contrary, terminally ill patients who feel physically weak should be given live music as part of their music therapy. To provide the palliative patients with a maximum health benefit, the palliative care team may consider combining the music therapy with complementary therapies like reflexology and aromatherapy or other commonly used therapies like psychotherapy and emphatic therapy. *** End *** References: Fayed, L. (2005, June 6). 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