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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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• 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.



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.


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)


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


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)


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


Music Therapy: Techniques

▪ Song selection

▪ Live singing/instrument

playing

▪ Music-prompted

reminiscence

▪ Music therapy relaxation

techniques

▪ Iso-principle

▪ Song writing

▪ Song parody

▪ Legacy projects


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


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”


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


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.


Music Therapy: Utilizing Specialized Programs

▪ Cultural Awareness &

Considerations

▪ Leaving a Legacy

▪ Open Access

▪ Programs for Patients with

Dementia

▪ Bereavement


Music Therapy: Culture

Music is a cultural experience

▪ Cultural elements of music:

▪ Tonality

▪ Rhythm

▪ Instrumentation and Aesthetics

▪ Group identification/membership/association

▪ Uses of music


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


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


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


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


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


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)


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


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:


Music Therapy: In Action

Video


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


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


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


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


• 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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