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How Music Therapy Helps Terminally Ill Patients

Discussion in 'Oncology' started by Ghada Ali youssef, Feb 1, 2017.

  1. Ghada Ali youssef

    Ghada Ali youssef Golden Member

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    What would you want to listen to in your final days and moments?

    One cancer patient, a woman in her 40s, chose Frank Sinatra as her life ebbed in a New Jersey hospice. In the woman’s waning days, hospice staffers and volunteers wore out the CD player in her room, activating Sinatra standards like “Strangers in the Night,” “The Way You Look Tonight” and “That’s Life,” says Bob Orozovich, a volunteer at Villa Marie Claire Hospice in Saddle River, New Jersey. The woman drew her final breaths as her husband held her hand and they listened to “Unchained Melody” by the Righteous Brothers – their wedding song, Orozovich says.

    Allowing terminally ill people to program the soundtrack to their last days can be therapeutic for those nearing the end of their life. Music won’t improve a dying patient’s prognosis, says Ann Hannan, a certified music therapist and director of the music therapy program at Riley Hospital for Children at Indiana University Health in Indianapolis, but it can provide a positive distraction for such patients and help them relax.

    Hannan is one of more than 7,100 certified music therapists in the U.S. who are accredited by the Certification Board for Music Therapists. In hospice and palliative care, music therapists use such approaches as song writing, improvisation, guided imagery and music, lyric analysis, singing, instrument playing and music therapy relaxation techniques to treat the array of needs of patients and their family members.

    This can include alleviating isolation, loneliness and boredom; emotional issues, such as depression, anxiety, fear, frustration and anger; and physical pain and shortness of breath. Music therapists are also trained to assist with spiritual needs, such as the desire to make spiritual connections or to engage in spiritual-based rituals.

    Relaxation

    Music therapists use music as a treatment tool to decrease a patient's anxiety and conjure happy memories. Hannan and many clinical workers who treat terminally or gravely ill people believe that, whether it's live or recorded, music can help lower the heart rate and blood pressure of agitated patients. In fact, it's common for medical monitors to show the heart rates and blood pressure levels of dying patients stabilize to normal levels when a music therapist is singing or playing an instrument or when patients are exposed to recorded music, clinical workers say.

    Jorge Murillo, an intensive care nurse at Lakeland Medical Center in St. Joseph, Michigan, says he commonly plays soft “mall music” or jazz for patients under sedation and on a ventilator to help them breathe. “Some of them get agitated when they realize they have a tube down their throat,” he says. “I do believe the music helps them relax. Patients become less agitated and become more in sync with the ventilator when the music’s playing.”

    And there's not just anecdotal evidence – research, too, suggests music therapy helps dying and severely ill or injured patients relax. Listening to music before, during and after surgery was beneficial to patients and significantly reduced pain, anxiety and the need for pain medication, according to a meta-analysis of 72 clinical trials published in 2015 in The Lancet.

    Another study, published in 2015 in Deutsches Arzteblatt, a German medical journal, found music therapy is effective in promoting relaxation for terminally ill patients undergoing palliative care, specialized medical treatment for people with a serious illness or condition that focuses on providing relief from symptoms and stress.

    Lifting Spirits

    In addition to relaxing them, music can lift the spirits of dying patients, Murillo says. When his father was in the hospital, terminally ill with cancer, his mother brought him a cassette player and fired up his favorite Glenn Miller Orchestra and salsa songs, he says.

    Though his father was exhausted, “you’d see a little light in his eyes” when the music played, Murillo recalls. Positive feelings can extend to the family members of dying patients, says Suzi Johnson, vice president of Sharp Hospice Care in San Diego, California. Music “helps people gather around as a family and to celebrate the person who’s ill and dying. It also creates a sense of cohesiveness and celebration.”

    Not every family member and loved one will feel a sense of celebration or cohesiveness from music, Hannan says, and they can derive other benefits. “It can mean whatever the family member needs it to mean at the time,” she says. “If they feel the need to be relaxed at the moment, that’s what they feel. If they need to feel comforted, or connected to the presence of God or a higher power, that’s what it means to them.”

    In one instance, Hannan's music helped a young couple feel connected to – and let go of – their baby girl, who'd been in Riley's intensive care unit for several months due to a metabolic condition that affected her ability to breathe, process nutrition and grow, Hannan says. At the request of her parents, who were originally from Mexico, Hannan played her guitar and gently sang lullabies in Spanish to the infant. For weeks, the parents had resisted abandoning life support.

    When they made the agonizing decision to stop extraordinary measures, Hannan sang and played her guitar for the baby one last time as the mother held the infant. As she played, a nurse told the mother that terminating life support wasn't necessary – the baby was gone. It was a small mercy for the parents to know they didn’t end their child’s life.


    As a music therapist, Hannan is trained in how to read body language and emotions and to respond to those cues, she says. In the moments after the baby died, Hannan caught the dad’s eyes. “Musica or no musica?” she asked. “Musica, por favor,” he replied. For a few minutes, Hannan strummed her guitar as the parents wept and held their daughter’s body. Musical therapists are trained to observe and reflect emotions, and Hannan says she did that, assuring the grieving parents their daughter had received their love.

    Feelings can understandably run high when a loved one is nearing the end of his or her life. People can feel helpless and bereft as they watch the life ebb from a spouse, parent, child, sibling or close friend. Music can help patients and those close to them process their emotions – and can also serve as a final gift for the patient. Here's what to consider before opting to play music for a patient with a terminal condition:

    Ask about resources. Most hospitals and hospices won’t have their own music therapists, but they should be able to find musicians or groups who have experience playing for people near the end of life – within their health group or not, Hannan says.

    These musicians don't necessarily have to be certified music therapists, but it's important they have experience playing for people at the end of their lives, so they'll know, for instance, to gather information about the patient's likes and dislikes and avoid playing any songs that might cause him or her emotional distress, Hannan says. One musical group that fits that bill is the Threshold Choir, an organization that has a cappella teams in about 150 regions nationwide. The Threshold Choir primarily sings original songs but will also take requests, says Kate Munger, the organization’s founder.


    Volunteer musical preferences. If you want access to music at a hospital or hospice for yourself or a loved one, tell caregivers what kind of music you or the person being cared for likes and dislikes, says Linda Chlan, associate dean for nursing research at the Mayo Clinic in Rochester, Minnesota. Some people might prefer recordings of nature sounds instead of music, she says. If that’s the case, it’s important to communicate what kinds of sounds might be distressful, Chlan says. “You wouldn’t want to play the sound of water for someone who’s afraid of drowning,” she says.


    Ask if you can bring your own music. Many health care providers allow patients to bring their own CDs or have loved ones provide them, Chlan says. If the patient shares a room, bring earbuds or headphones or ask hospital caregivers for that kind of gear, she advises. “Don’t be shy about asking,” she says. “It’s a simple request, but it could be comforting to have music you love available.”


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