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The contents of this blog contain topics relevant to end of life care written by our own hospice clinical pharmacists. Continue to check this site regularly for the newest post or subscribe to the RSS feed below.
Jessica Horsley, PharmD

Music Therapy in Hospice and Palliative Care

Music Therapy (MT) is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. It is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Although note-worthy and possibly soothing in nature, activities like bedside and lobby performances, background music and providing media players/headphones are NOT considered clinical music therapy.

Board Certified Music Therapists (MT-BC) work in a variety of settings including schools, nursing facilities, hospitals, and hospices. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words.1

MT has shown benefit for many conditions relevant to the care of a hospice patient. In dementia, including Alzheimer’s, MT can reduce behaviors like agitation,2 improve speech and attention,3 even make shower/bath times easier for patients and caregivers.4 Incorporating MT into Parkinson’s therapy improves gait,5, 6 speech and mood.7 Of particular interest to the hospice population, MT can treat anxiety,8 dyspnea9 and pain.10 MT is not only appropriate for adult hospice patients; it also proven exceptionally useful in the pediatric population,11 including those with Autism spectrum disorders.12

Benefits of MT extend beyond relieving patient symptoms. It can oftentimes be associated with a reduction in stress, as reported amongst both family13 and professional caregivers. Beyond the physical/emotional benefits of MT to patients, families and caregivers, it may even offer benefit to hospices seeking cost-saving strategies. A growing body of evidence supports that MT can decrease medication and care costs (by decreasing nursing visits) for patients, offsetting the cost of MT.14

 

Aside from cost-savings, MT offers another benefit over medications – it has only one true contraindication: patient preference. A recent survey of U.S. hospices estimated that MT is provided as a discretionary service by over half of the hospices nationwide. Further, hospices that offer MT report that it is more often preferred by patients than any other complementary treatment method.9 If MT is not currently offered by your hospice, patients can be referred to an independent MT-BC by a prescriber. According to the American Music Therapy Association, about 20% of MT-BC receive third party reimbursement. These payers include Medicare and private insurance. Additional funding sources may include state departments of mental health and/or developmental disabilities, private auto insurance, worker’s compensation, foundations and grants.15

Although many MT-BCs work in institutional settings, home-based music therapy (HBMT) is a growing field relevant to home hospice providers. These programs can include home visits by a MT-BC and/or instruction of spouses, family members and other caregivers in selected MT techniques, which can offer lasting effectiveness and cost-savings.16 Like many growing fields, more research into the provision and implementation, as well as efficacy and cost-benefits of this innovative service are needed, but the current body of literature suggests MT is a strong addition to a hospice and/or palliative care service’s complementary and alternative treatment offering.

How to find a Board Certified Music Therapist:
Certification Board for Music Therapists
http://www.cbmt.org/certificant_search
This email address is being protected from spambots. You need JavaScript enabled to view it.

American Music Therapy Association  
http://www.musictherapy.org/about/find/
This email address is being protected from spambots. You need JavaScript enabled to view it. 


REFERENCES:

1 Definition and Quotes about Music Therapy. American Music Therapy Association web site. http://www.musictherapy.org/about/quotes/. Accessed June 20, 2015.
2 McDermott O, Crellin N, Ridder HM, Orrell M. Music therapy in dementia: a narrative synthesis systematic review. Int J Geriatr Psychiatry. 2013;28:781–794
3 Ceccato E, Vigato G, Bonetto C, et al. STAM protocol in dementia: a multicenter, single-blind, randomized, and controlled trial. Am J Alzheimers Dis Other Demen. 2012;27:301-310.
4 Ray KD, Fitzsimmons S. Music-assisted bathing: making shower time easier for people with dementia. J Geront Nurs. 2014;40:9-13.
5 Bella SD, Benoit CE, Farrugia N, Schwartze M, Kotz SA. Effects of musically cued gait training in Parkinson’s disease. Ann N Y Acad Sci. 2015;1336:77-85
6 de Dreu MJ, van der Wilk AS, Poppe E, Kwakkel G. Rehabilitation, exercise therapy and music in patients with Parkinson’s disease: a meta-analysis of the effects of muscle-based movement therapy on walking ability, balance and quality of life. Parkinsonism Relat Disord. 2012;18:S114-119.
7 Haneishi E. Effects of a music therapy voice protocol on speech intelligibility, vocal acoustic measures, and mood in Parkinson’s disease. J Music Ther. 2001;38:273-290.
8 Horne-Thompson A, Grocke D. The effect of music therapy on anxiety in patients who are terminally ill. J Pall Med. 2008;11:582-590.
9 Burns DS, Perkins SM, Tong Y, Hilliard RE, Cripe LD. Music therapy is associated with family perception of more spiritual support and decreased breathing problems in cancer patients receiving hospice care. J Pain Symptom Manage. 2015. In press.
10 Krout RE. The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. Am J Hosp Palliat Care. 2001;18:383-390.
11 Lindenfelser KJ, Hense C, McFerran K. Music therapy in pediatric palliative care: family-centered care to enhance quality of life. Am J Hosp Palliat Care. 2012;29:219-226.
12 Simpson K, Keen D. Music interventions for children with autism: a narrative review of the literature. J Autism Dev Disord. 2011;41:1507-1514.
13 Choi YK. The effect of music and progressive muscle relaxation on anxiety, fatigue, and quality of life in family caregivers of hospice patients. J Music Ther. 2010;47:53-69.
14 Romo R, Gifford L. A cost-benefit analysis of music therapy in a home hospice. Nurs Econ. 2007;25:353-358.
15 How to find a music therapist. American Music Therapy Association web site. http://www.musictherapy.org/about/find/. Accessed June 20, 2015. 16 Schmid W, Ostermann. Home-based music therapy – a systematic overview of settings and conditions for an innovative service in healthcare. BMC Health Serv Res. 2010;10:291.

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