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Integrative hospice and palliative care are a holistic way of treatment that considers a person as a whole, instead of multiple interrelated systems[1]. Nurses and therapists are in a unique position to work together to provide holistic care, such as music therapy. In the hands of a skilled music therapist, music has proven to be an incredible tool for enhancing one’s quality of life[2].
Throughout history, music and medicine have been interrelated, as exemplified by African, ancient Greek, and Indigenous communities in the Americas. In more recent history, music therapists have brought music into medicine[3]. The use of music as therapy in multi-disciplinary end-of-life care dates to the 1970s and is currently one of the most frequently used complementary therapies in in-patient palliative care[4]. Furthermore, it has been widely implemented internationally within the last few decades.
In music therapy, the patients and therapist engage actively in singing, song writing, improvisation, as well as listening to music, according to a person’s musical preferences. Music therapy applies a wide range of elaborated approaches, enjoys high acceptance by patients and has few side effects.
Music therapy techniques in palliative care can be categorized into one of four categories: receptive, creative, recreative, or combined[5]. Receptive methods include music listening, song choice, and lyric analysis. This method is common during end-of-life as the patient typically has lower energy levels and involves more passive responses from the patient. Creative methods include song writing, lyric composition, and improvisation. Recreative approaches include performing pre-composed music, while combined approaches combine modalities, such as art, movement, or drama.
Research has shown that music therapy is well suited to hospice as it addresses the four domains of palliative care: physiological, emotional, social, and spiritual care. Both quantitative and qualitative research has shown positive changes in psycho-physiological well-being. Furthermore, it was found that patients themselves associated music therapy with positive expression as well as increased well-being[4].
Music therapy can be used throughout the entire care process, from diagnosis and treatment, through palliation, during hospice, when the patient is actively dying, and during bereavement[6]. It can assist the patient in dealing with bodily symptoms, emotional impacts, social challenges, and spiritual concerns. Physical symptoms such as shortness of breath, nausea, tension, and pain have been proven to be helped by music therapy[7].
Although there have been many advancements in this practice, implementing music therapy as a core service in hospice comes with many challenges that limit successful collaboration with nurses as members of the interdisciplinary treatment team. Part-time or volunteer music therapists are often not invited to engage in treatment team meetings and planning with nurse case managers and social workers, in comparison to full-time employees, who typically participate in the treatment planning. In order to develop co-treatment opportunities, music therapists must have the space to communicate with all team members to coordinate care plans, which will provide patients and caregivers greater access to comprehensive holistic care.
Despite challenges, the use of music therapy has benefits that go beyond alleviating the patient’s pain, anxiety, depression, and quality of life. Music can be used to bridge communication barriers and foster a sense of unity. It is an individualized approach to improving the quality of remaining life by incorporating music that matches a person’s interests, spiritual beliefs, and cultural background.
[1] Potvin, N., Hicks, M., & Kronk, R. (2021). Music therapy and nursing cotreatment in integrative hospice and palliative care. Journal of Hospice and Palliative Nursing, 23(4), 309.
[2] Munro, S., & Mount, B. (1978). Music therapy in palliative care. Canadian Medical Association Journal, 119(9), 1029.
[3] Babikian, T., Zeltzer, L., Tachdjian, V., Henry, L., Javanfard, E., Tucci, L., … & Tachdjian, R. (2013). Music as medicine: a review and historical perspective. Alternative and Complementary Therapies, 19(5), 251-254.
[4] Schmid, W., Rosland, J. H., von Hofacker, S., Hunskår, I., & Bruvik, F. (2018). Patient’s and health care provider’s perspectives on music therapy in palliative care–an integrative review. BMC palliative care, 17(1), 1-9.
[5] Clements-Cortés, A. (2016). Development and efficacy of music therapy techniques within palliative care. Complementary therapies in clinical practice, 23, 125-129.
[6] Porter, S., McConnell, T., Clarke, M., Kirkwood, J., Hughes, N., Graham-Wisener, L., … & Reid, J. (2017). A critical realist evaluation of a music therapy intervention in palliative care. BMC palliative care, 16(1), 1-12.
[7] Bradt, J., & Dileo, C. (2010). Music therapy for end‐of‐life care. Cochrane Database of Systematic Reviews, (1).
