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Music Therapy in Hospice & Palliative Care
August 4, 2020
Presented by Joseph T. Goelz, MA, MAPC, MT-BC, HPMT
National Director of Patient Experience Seasons Healthcare Management, Inc.
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• Complete evaluationo You will be redirected to a post-activity survey and post-test when
webinar endso Your NCPD (Nursing Continuing Professional Development)/ CME/ SW CE
Category I certificate for 1 credit hour(s) will be emailed to you within 24 hours.
Send questions to communityeducation@seasons.org and our Community Education team will be happy to help.
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Declarations• This program is provided to you by Seasons Hospice & Palliative Care.
• There is no commercial support for this educational event.
• The speaker declares that they are an employee of Seasons Hospice & Palliative Care, which provides the service described herein.
• Planners, presenters, faculty, authors and content reviewers declare no conflict of interest.
o Joseph T. Goelz, MA, MAPC, MT-BC, HPMT, National Director of Patient Experience, Seasons Healthcare Management, Inc., Presenter, Content Reviewer
o Russell Hilliard, PhD, LCSW, LCAT, MT-BC, CHRC, SVP-Key Initiatives, Author
• Approval by ANCC/ASWB/AAFP does not indicate endorsement of any products.
• This presentation expires August 4, 2023.
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Music Therapy in Hospice & Palliative Care
August 4, 2020
Presented by Joseph T. Goelz, MA, MAPC, MT-BC, HPMT
National Director of Patient Experience Seasons Healthcare Management, Inc.
Objectives
1. Define Music Therapy in Healthcare.
2. Describe the purpose and benefits of Board Certification in Music Therapy.
3. List clinical uses of Music Therapy in hospice care.
4. Discuss qualitative and quantitative research to date and relate emerging evidence to actual cases.
5. Utilize case review to demonstrate anticipated benefits of Music Therapy.
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Music TherapyMusic Therapy, as defined by the American Music Therapy Association (AMTA):
Music Therapy 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.
Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals.
Music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication, and promote physical rehabilitation.
Research in music therapy supports its effectiveness in a wide variety of healthcare and educational settings
(www.musictherapy.org)
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Music Therapy:MT-BC Educational Requirements
A professional music therapist:▪ Holds a bachelor’s degree (or higher) from an AMTA-approved college and university program
through which the curriculum and coursework imparts entry-level competencies in:
▪ Musical Foundations
▪ Clinical Foundations
▪ Music Therapy Foundations and Principles
• Has completed 1200 hours of clinical training (which includes practicum experience and a supervised internship experience)
• Has sat for and successfully passed the Board Certification Exam to obtain the credential “MT-BC” granted by a separate accredited organization (the Certification Board for Music Therapists)
• Has maintained certification by earning 100 continuing education credits every five years
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Music Therapy: MT-BC CredentialMusic Therapist-Board Certified
▪ The purpose of board certification in music therapy is to provide an
objective national standard that can be used as a measure of
professionalism by interested agencies, groups, and individuals.
▪ Earning the Music Therapy Board Certification (MT-BC) credential
demonstrates advanced clinical competence by the clinician; the MT-
BC credential holder is subject to the rules and regulations set forth by
CBMT in accordance with the National Commission for Certifying
Agencies (NCCA)
(www.cbmt.org/about-certification)
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Music Therapy: Ethical Considerations
Using the Term “Music Therapy” – Who gets to call it Music Therapy?
▪ Is this Music Therapy?
▪ A chaplain singing hymns at bedside...
▪ A hospice aide playing music in background while providing cares…
▪ A threshold choir singing at bedside…
▪ Music Therapy must be provided by a Board-Certified Music Therapist (MT-BC)
▪ Music IN Therapy vs. Music AS Therapy
▪ Therapeutic Uses of Music vs. Music Therapy
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Music Therapy: Techniques
▪ Song selection
▪ Live singing/instrument
playing
▪ Music-prompted
reminiscence
▪ Music therapy relaxation
techniques
▪ Iso-principle
▪ Song writing
▪ Song parody
▪ Legacy projects
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Music Therapy:Care Plan Needs
▪ Pain
▪ Dyspnea
▪ Anxiety
▪ Depression
▪ Isolation
▪ Quality of life
▪ Death vigil
▪ Spiritual needs
▪ Caregiver support
▪ Family conflict
▪ Anticipatory grief
▪ Bereavement support
▪ Restlessness/agitation
▪ Emotional expression
▪ Loss of control
▪ Confusion/disorientation
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Music Therapy: Pain Abatement
▪ Gate Control Theory of Pain
▪ Melzack & Wall 1965
▪ Proposes that a neural “gate” present in the spinal cord
can open and close thereby modulating the perception
of pain.
▪ Suggests that psychological factors play a role in the
perception of pain
▪ Music can act as a stimulus to “close the gates”
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Music Therapy: Protocol for Pain Management
• Based on a cognitive behavioral model of therapy
• The process occurs when music listening is paired with deep relaxation through
repeated practice
• Over time and repetition, the music alone cues the response
• Protocol is designed to:
o Direct attention away from pain or anxiety
o Provide a musical stimulus for rhythmic breathing
o Offer a rhythmic structure for release of body tension
o Cue positive visual imagery
o Condition a deep relaxation response
o Change mood
o Focus on positive thoughts and feelings
www.musictherapy.org/research/factsheets
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Music Therapy: Quality of Life▪ Research indicates that hospice patients who experience music therapy
report an increase in QOL
▪ Explore meaning and purpose of life through lyric analysis and music assisted reminiscence
▪ Increase interpersonal interactions
▪ Increase mood and relaxation
▪ Decrease pain
▪ Randomized Clinical Trial support use of MT to increase QOL among hospice patients with cancer residing at home
▪ Hilliard, R.E. (2003) The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. Journal of Music Therapy, Summer;40(2):113-37.
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Music Therapy: Utilizing Specialized Programs
▪ Cultural Awareness &
Considerations
▪ Leaving a Legacy
▪ Open Access
▪ Programs for Patients with
Dementia
▪ Bereavement
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Music Therapy: Culture
Music is a cultural experience
▪ Cultural elements of music:
▪ Tonality
▪ Rhythm
▪ Instrumentation and Aesthetics
▪ Group identification/membership/association
▪ Uses of music
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Music Therapy: Culture
▪ Music Therapists have special training about cultural
awareness and using culturally appropriate music
▪ Culturally appropriate and sensitive music interventions
increase dignity and patient engagement
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Music Therapy: Leaving a Legacy
▪ Music Autobiography
▪ Song Dedications
▪ Song writing
▪ Live Recordings
▪ Multi-media integration
(i.e., pictures, songs, voice,
narrative) or social media
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Music Therapy: Open Access
• A blended model between curative and palliative care that
allows patients access to hospice services earlier in disease
process
• These patients have unique needs that can be addressed by
MT, including increasing family support, increasing
opportunities for emotional/spiritual expression, and offering
legacy projects
• Music Therapy as Procedural Support for Extubations
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Music Therapy:Dementia
▪ MT can be an integral part of
specialized programs for
patients with diagnosis of
Dementia, i.e., Namaste
program
▪ Patient-preferred music
▪ Patients can often sing song
lyrics when no longer able to
converse
▪ Entrainment with breathing
creates a supportive holding
environment
▪ Increase family engagement
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Music Therapy: Bereavement
▪ Music is processed in the limbic system (Brown, Martinez &
Parsons 2004) which is associated with emotional expression
and processing as well as long term memory
▪ Common MT interventions include songwriting, music
listening/lyric analysis, and improvisation
▪ Individual and group sessions
▪ MT can be an integral part of helping children to cope with
grief and loss
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Music Therapy: Bereavement
MT can be integral to therapeutic
group sessions:
▪ Age appropriate interventions
▪ Drumming can express
physicality of grief
▪ Instrument play/improvisation
can encourage expression
feelings
▪ Song writing can reinforce the
skills learned in group that day
(i.e., Camp Song)
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Music Therapy: Spirituality
▪ Music is an integral part of many spiritual traditions
▪ Patients may no longer be able to participate in religious rituals to the same degree as they did in their past
▪ Joint visits with Chaplain
▪ Research indicates an increase in self reported spiritual well-being after MT sessions
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Music Therapy: Emerging Evidence
✓A reduction in perceived pain
✓ An increase in physical comfort
✓ Decreased anxiety and increased relaxation
✓ Increased energy and decreased fatigue
✓Increased quality of life
✓Increased sense of spiritual support
✓Increased amount of time with staff
For people receiving music therapy, there is:
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Music Therapy: In Action
Video
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References
• American Music Therapy Association: www.musictherapy.org (Accessed 8/ 2020).
• Bailey, L. (1985). Music therapy in pain management. Journal of Pain and
Symptom Management, 1(2), 25-28. Retrieved from https://www.jpsmjournal.com
• Burns. D., Perkins, S., Tong, Y., Hilliard, R. (2015). Music therapy is associated with
family perception of more spiritual support and decreased breathing problems in
cancer patients receiving hospice care. Journal of Pain and Symptom
Management 50(2), 225-31. Retrieved from https://www.jpsmjournal.com
• Certification Board for Music Therapists: www.cbmt.org (Accessed 8/2020)
• Center for Music Therapy in End of Life Care: www.hospicemusictherapy.org
(Accessed 8/2020).
• Ezegbe. B.N., Ede, M.O., Eseadi, C. et al. (2018). Effect of music therapy combined
with cognitive restructuring therapy on emotional distress in a sample of Nigerian
married couples. Medicine (Baltimore). 97(34):e11637.
doi:10.1097/MD.0000000000011637
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References
• Economos, A. (2018). Music therapy when death is imminent: A
phenomenological inquiry. Journal of Music Therapy, 55(3), 309-339. Retrieved
from https://academic.oup.com/jmt
• Gallagher, L.M. Lagman, R., Rybicki, L. (2018). Outcomes of music therapy
interventions on symptom management in palliative medicine patients.
American Journal of Hospice & Palliative Medicine, 35(2), 250-257. Retrieved from
https://journals.sagepub.com/home/ajh
• Gao, Y., Wei, Y., Yang, W. et al. (2019)The effectiveness of music therapy for
terminally ill patients: A meta-Analysis and systematic review. Journal of Pain
Symptom Management, 57(2) 319-329. doi:10.1016/j.jpainsymman.2018.10.504
• Guetin, S., Ginies, P., Siou, D.K., Picot M.C., Pommie, C., Guldner, E., Gosp A.M.,
Ostyn, K., Coudeyre, E., & Touchon, J. (2012). The effects of music intervention in
the management of chronic pain: A single-blind, randomized, controlled trial.
Clinical Journal of Pain, May;28(4)329-37. Retrieved from
https://journals.lww.com/clinicalpain/pages/default.aspx
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References
• Gutgsell, K.J., Schluchter, M., Margevicius, S., DeGolia, P.A., McLauglin, B., Harris,
M. et al. (2013). Music therapy reduces pain in palliative care patients: A
randomized controlled trial. Journal of Pain and Symptom Management, 45(5),
822-831. Retrieved from https://www.jpsmjournal.com
• Horne-Thompson, A. & Grocke, D. (2008). The effects of music therapy on
anxiety in patients who are terminally ill. Journal of Palliative Medicine, 11(4):
582-590. Retrieved from https://www.liebertpub.com/loi/jpm
• Howlin, C., & Rooney, B. (2020). The cognitive mechanisms in music listening
interventions for pain: A scoping review. Journal of Music Therapy. 57(2), 127-
167. Retrieved from https://academic.oup.com/jmt
• Koelsch, S. (2009). A neuroscientific perspective on music therapy. Annals of the
New York Academy of Sciences. Neurosciences and Music III – Disorders and
Plasticity, 1169: 374-375. Retrieved from https://www.nyas.org/
• Liu, X., Burns, D. & Hilliard, R. (2015). Music therapy clinical practice in hospice:
Differences between home and nursing home delivery. Journal of Music
Therapy, 52(3), 376-93. Retrieved from https://academic.oup.com/jmt
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References• Madson, A.T., Silveran, M.J. (2010). The effect of music therapy on relaxation,
anxiety, pain perception and nausea in adult solid organ transplant patients.
Journal of Music Therapy, 47(3), 220-232. Retrieved from
https://academic.oup.com/jmt
• McCarthy, M. (2013). Children’s spirituality and music learning: Exploring deeper
resonances with arts-based research. International Journal of Education & the
Arts, 14 (4). Visual Abstract. Retrieved from http://www.ijea.org/
• McClean, S., Bunt, L., Daykin, N. (2012). The healing and spiritual properties of
music therapy at a cancer care center. Journal of Alternative and
Complementary Medicine, 18(4), 402-407. Retrieved from
https://www.liebertpub.com/loi/acm
• Myers-Coffman, K., Daly, B., Palisano, R., & Bradt, J. (2019). The resilience
songwriting program for adolescent bereavement: A mixed method exploratory
study. Journal of Music Therapy, 56(4), 348-380. Retrieved from
https://academic.oup.com/jmt
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• Potvin, N., Flynn, C., & Storm, J. (2020). Ethical decision-making at intersections of
spirituality and music therapy in end-of-life care. Music Therapy Perspectives,
38(1), 20-24. Retrieved from https://academic.oup.com/mtp
• Potvin, N. & Flynn, C. (2019). Music therapy as a psychosocial ministry of
intercession during imminent death. Music Therapy Perspectives, 37(2), 120-132.
Retrieved from https://academic.oup.com/mtp
• Silva Pereira, C., Teieira, J., Figueiredo, P., Xaview, J., Luis Castro, S., Brattico, E.
(2011). Music and emotions in the brain: Familiarity matters. PLoS ONE, 6(11),
e27241. https://doi.org/10.1371/journal.pone.0027241
• Taylor, D. (2010). Biomedical Foundations of Music as Therapy. (2nd ed.) Eau
Claire, WI: Barton Publications.
References
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Music Therapy in Hospice & Palliative Care
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