Music therapy in palliative setting
Dieter Korczak 1Monika Wastian 2
Michael Schneider 3
1 GP Forschungsgruppe, Institut für Grundlagen- und Programmforschung, München, Germany
2 Institut für Organisationspsychologie, München, Germany
3 Ludwig-Maximilians-Universität, Institut für Soziologie, München, Germany
Abstract
The expectations on the care of humans with an incurable disease are to console, to relieve pain and to take away somebody’s fears. Therefore, palliative care tries to support terminally ill persons during the last stage of life and to ameliorate the living conditions. The question is how far music therapy can increase the quality of life. Until now, there is only small evidence for that, because there are too few applicable studies.
Keywords
end-of-life care, hospices, music, therapy, palliative care, terminal care
Summary
Health political background
For some time there is a discussion in Germany that the focus on clinical-curative and on medical equipment dominated care of the last days does not match with the claim of holistic care of dying persons. A movement against this development is the spread of hospices in Germany since the sixties of the last century. In palliative stations and hospices it is tried to provide care and support which respond appropriately on dignity, quality of life and autonomy of terminally ill persons in their last days. The use of music therapy is one way.
Scientific background
Patients with severe diseases without chance of healing need professional pallative care. In contrast to curative medicine palliative medicine sets the focus on the improvement of the quality of life and not on life prolongation in the last days of patients.
There are some scientific references that music therapy on palliative stations and hospices can give comfort in the last days, can improve the quality of life and reduce the emotional strain (e.g. depression, anxiety, pain) of care givers and the medical professionals. These references are basically supported by studies with small samples and a methodological weak study design and derive by a reasonable part from master theses.
Research questions
The medical research questions try to clarify which effectivity music therapeutic intervention has in the palliative setting on the improvement of quality of life, on pain reduction, on anxiety reduction, on the improvement of physiological parameters, on relaxation and on the development of a positive mood.
The economic research question deals with the evaluation of the cost-benefit-effectiveness of music therapy.
From an ethical and social point of view it is analysed whether music therapy supports a stately and self-determined dying process and considers personal value orientations and spiritual need in an appropriate manner.
Methods
The electronic literature research covered publications in German and English in 34 international data bases (e.g. EMBASE, PsycINFO, MEDLINE, Cochrane). Studies published between 2007 and July 2012 were included. The studies were judged independently by two researchers. The final selection was based on the full scripts using pre-defined inclusion and exclusion criteria.
Medical results
Five studies were finally included, one review, one randomised controlled study (RCT) and three pre-post-studies. The studies were undertaken in Australia, USA, Canada and Taiwan.
The efficiency of music therapy on the quality of life of palliative patients was examined in several studies. A weak to medium effect size could be observed. The results for the reduction of pain were inconsistent. Anxiety of palliative patients is not significantly reduced by music therapy. Weak physiological effects are found by one study using theta-waves in combination with fantasy journeys.
Occasionally it is reported that music therapy in comparison with standard therapy achieves better relaxation and a more positive mood.
Economic results
Only one study analyses cost-benefit aspects of music therapy. The study shows that music therapy is cost neutral in comparison to standard therapy as music therapy saves cost for medication and care. It has to be noticed that the study results are based on only 16 cases in a private hospice.
Ethical and social results
The studies deliver no empirical results on spiritual needs of the palliative patients. There are only some references that the spirituality of palliative patients can be improved by music therapy.
Discussion
The number of studies which evaluate the efficacy of music therapy is extremely limited. The studies are of low quality, the risk of bias is very high. Most of the studies have small samples; often the randomiation is not clear. The music intervention takes 20 to 60 minutes and usually it is not controlled. The measurement of the efficacy is done immediately after the intervention and in the majority of the cases limited on patient-self-assessment and single items. Follow-up measurement does not exist for longer time periods. There is great doubt about the validity of the results.
Conclusion
The quality of the included studies is too low for an evidence-based recommendation. The scientifically discussed efficacy of music therapy can not be found in a sufficient manner in the studies.
There is a need for additional high quality studies to provide an evidence-based recommendation for or against the use of music therapy in palliative medicine.
Notes
Competing interests
The authors declare that they have no competing interests.
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