See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/5397435

The Effect of Music Therapy on Anxiety in Patients who are Terminally Ill

Article  in  Journal of Palliative Medicine · June 2008

DOI: 10.1089/jpm.2007.0193 · Source: PubMed

CITATIONS READS
79 1,147

2 authors, including:

Denise Grocke
University of Melbourne
45 PUBLICATIONS   799 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

‘Singing in Spinal Cord Injury’: An investigation into the mechanisms used when singing and the efficacy of singing training for people with quadriplegia View project

All content following this page was uploaded by Denise Grocke on 07 February 2016.

The user has requested enhancement of the downloaded file.

JOURNAL OF PALLIATIVE MEDICINE
Volume 11, Number 4, 2008
© Mary Ann Liebert, Inc.
DOI: 10.1089/jpm.2007.0193

The Effect of Music Therapy on Anxiety

in Patients who are Terminally Ill

ANNE HORNE-THOMPSON, B.Mus., M.Mus., R.M.T.1

and DENISE GROCKE, Ph.D., R.M.T., M.T.-B.C., FAMI2

ABSTRACT

Background: The literature supporting the use of music therapy in palliative care is growing. How-
ever, the number of quantitative research studies investigating the use of music therapy in pallia-
tive care, and specifically anxiety, is limited.
Objective: The aim of this research project was to examine the effectiveness of a single music ther-
apy session in reducing anxiety for terminally ill patients.
Design: A randomized-controlled design was implemented and the following hypotheses tested.
There will be a significant difference between the experimental and control groups on anxiety lev-
els as demonstrated by the anxiety measurement of the Edmonton Symptom Assessment System
(ESAS), and heart rate. The experimental group received a single music therapy intervention and
the control group received a volunteer visit.
Setting/subjects: Twenty-five participants with end-stage terminal disease receiving inpatient hos-
pice services were recruited.
Results: The first hypothesis was supported. Results demonstrated a significant reduction in anx-
iety for the experimental group on the anxiety measurement of the ESAS (p  0.005). A post hoc
analysis found significant reductions in other measurements on the ESAS in the experimental group,
specifically pain (p  0.019), tiredness (p  0.024) and drowsiness (p  0.018). The second hypoth-
esis was not supported.
Conclusions: The study supports the use of music therapy to manage anxiety in terminally ill pa-
tients. Further studies are required to examine the effect of music therapy over a longer time pe-
riod, as well as addressing other symptom issues.

INTRODUCTION increases as patients become aware of their impend-

ing death.4

A NXIETY IS A COMMON SYMPTOM for patients diag-

nosed with a terminal illness, regardless of
whether the patient has a predisposition to anxiety or
Both clinical and research evidence indicate that the
prevalence of anxiety and depression in terminally ill
patients is high.5–10 In a recent study, physicians in-
not. This anxiety presents not only in patients, but also dicated that 70% of terminally ill patients experienced
in their family, friends and caregivers.1,2 For those en- either moderate anxiety (49%) or severe anxiety
during intrusive treatment and ultimately palliative (21%).11 In fact, anxiety and depression have been
care, anxiety can become extremely debilitating3 and found to be the most frequent psychological problems

1Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.

2The University of Melbourne, Victoria, Australia.

582
EFFECT OF MUSIC THERAPY ON ANXIETY 583

in palliative care,12 and in Smith and colleague’s of music therapy. Visual analogue scales measured pa-
study,13 25% of terminally ill patients were assessed tients (n  90) before and after music therapy sessions
as suffering from anxiety disorder. on symptoms including pain, anxiety, nausea, and de-
Even after physical symptom issues are controlled, pression. Music therapy was found to significantly re-
quality of life is still significantly affected by anxiety duce anxiety (p  0.012), and pain (p  0.008) as well
and depression.13 The implications of psychological as improve mood (p  0.001). A further study by Gal-
distress, specifically anxiety, can manifest in a num- lagher and colleagues57 evaluated the effect of music
ber of different ways. Common themes described by therapy on anxiety, as well as a number of other symp-
anxious terminally ill patients include fears about loss tom issues. Visual analogue scales implemented be-
of control and the manner in which they will die.3 In fore and after music therapy sessions found that anx-
addition, high levels of anxiety result in a wish to has- iety was significantly reduced (p  0.001).
ten death.14,15 Three research studies have measured the effect of
It is challenging for palliative care health profes- music therapy on reducing anxiety for terminally ill
sionals to manage anxiety for patients and their fami- patients. Krout58 measured the effectiveness of music
lies, and music therapy, provided by an accredited therapy to improve pain control, physical comfort, and
music therapist, can play an effective role in the man- relaxation. The study involved a single session music
agement of this debilitating condition. therapy intervention. Eighty subjects self-reported lev-
els of pain control, physical comfort, and relaxation.
In addition, independent behavioral observations were
Music and music therapy in palliative care
made immediately before and after the session. Re-
Recorded music has been effective in managing sults were significant, and the study found that pain
anxiety for patients before, during and after undergo- control, physical comfort, and relaxation were effec-
ing surgery,16–20 and in reducing anxiety for patients tively increased with a music therapy session, both
on ventilators21,22 and for those undergoing medical self-reported by the participant (p  0.005) and re-
examinations/procedures.23–28 ported by the independent observer (p  0.001).
Music therapy (provided by qualified music thera- A study by Calovini59 with 11 terminally ill patients,
pists, who engage the patient in live music experi- examined state anxiety levels (defined by Lazarus60 as
ences, including singing, songwriting, improvisation, unpleasant emotional arousal in face of threatening de-
and receptive methods), has an important role to play mands or dangers) within one music therapy session.
in the management of symptomatic issues within pal- A four-item questionnaire, and before and after read-
liative care. A growing body of clinical work suggests ings of blood pressure, pulse rate, and extremity tem-
that music therapy is effective in addressing physi- perature were taken. The physiologic measures were
cal29–34 emotional35–41 and spiritual42–46 needs of pal- also taken every 15 minutes during the music therapy
liative care patients. Research studies have also dem- intervention. The study found that state anxiety was
onstrated the benefits of music therapy.47–51 Rykov not statistically significantly affected by one music
and Salmon’s review52 of music therapy literature lo- therapy session. However, systolic blood pressure and
cated 161 music therapy and palliative care citations, pulse rate decreased, and finger temperature increased
while Krout’s comprehensive review53 included 88 for the participants, which may indicate a trend toward
clinical reports and 23 experimental reports/studies. reduced anxiety.
There is evidence that music therapy addresses anx- The effect of music therapy on pain relief, physical
iety in palliative care. In Krout’s study53 of 88 clini- comfort, relaxation, and contentment was examined by
cal reports in music therapy, the second and third most Curtis.61 Nine terminally ill patients participated, and
common patient goals were relaxation (n  58) and three experimental conditions were used: no music
reduction of anxiety (n  46). Horne-Thompson and (A), background sound (B), and music (C). While sig-
colleagues,54 also found that symptom-based referrals, nificant results were not achieved, individual re-
including anxiety, were the most common reason pal- sponses showed that the background sound condition
liative care patients were referred to music therapy. appeared to have a negative effect, and the music in-
In O’Brien’s survey55 assessing the effectiveness of tervention a positive affect.
music therapy in meeting patient needs 45% of pa- Research studies that have investigated the use of
tients surveyed (n  52) stated that music therapy was music therapy to manage anxiety for palliative care pa-
extremely helpful in reducing anxiety, 38% stated it tients have varied in focus and design. It is the aim of
was helpful and 17% stated it was quite helpful. Gal- this study to further examine the effect of music ther-
lagher and Steele56 also investigated the effectiveness apy on anxiety in palliative care patients.
584 HORNE-THOMPSON AND GROCKE

TABLE 1. AGE AND GENDER FREQUENCIES nosis of a terminal illness and were recruited by staff
members who were not associated with the study. Pa-
Control Experiment Total
tients were included if they had been referred to mu-
Age sic therapy with anxiety as the main reason for refer-
 50 1 0 1 ral, and they did not fall under the exclusion criteria.
50–59 1 1 2
60–69 1 2 3
They were invited to participate in research which
70–79 5 5 10 would “evaluate various services provided within the
80–89 4 4 8 hospital, including music therapy and volunteers.” Par-
90–99 0 1 1 ticipants were blinded to both the independent vari-
Gender
Male 6 8 14
able, music therapy, as well as the dependent variable,
Female 6 5 11 anxiety, minimizing the potential for bias.
The study was a randomized-controlled trial, and
participants were randomly assigned (using a num-
bered envelope system), to one of two groups. Ran-
The hypotheses for the study were: domization was undertaken by a university statistical
1. There will be a significant difference between the consulting service. Once the consent form had been
experimental and control groups on anxiety levels signed by the participant, the numbered envelope was
as demonstrated by anxiety measurement of the Ed- opened, determining the allocation to either group. A
monton Symptom Assessment Scale (ESAS).62 pretest–posttest design was implemented, and the ex-
2. There will be a significant difference between the perimental condition involved a single music therapy
experimental and control groups on anxiety levels session (undertaken by a registered music therapist) of
as demonstrated by a decrease in heart rate. between 20–40 minutes duration. The session length
was determined by accessing the mean length of a stan-
dard music therapy session in the hospital (29 min-
METHOD utes). The length of session was purposefully broad to
adjust for the clinical state of the patient at the time
Approval for the study was obtained through the re- of the session, while keeping within reasonable time
search and ethics committee in the hospital at which restraints to allow for consistent pre- and postmea-
this study was conducted, Calvary Health Care Beth- surement. Sessions falling outside this duration were
lehem, Melbourne, Australia. Written informed con- not included in the data.
sent was obtained from participants. The music therapy session comprised music ther-
The participants involved in this study were inpa- apy methods chosen by the registered music therapist
tients receiving palliative care services due to a diag- in consultation with the patient as being most appro-

TABLE 2. DIAGNOSIS FREQUENCIES

Diagnosis Control Experimental Total

Amyloidosis 0 1 1
Bowel cancer 1 0 1
Breast cancer 2 2 4
Chronic cardiac failure 1 0 1
Glioblastoma 2 0 2
Lung cancer 1 1 2
Lymphomaa 1 1 2
Mesothelioma 0 1 1
Metastatic melanoma 0 1 1
Non-Hodgkin’s lymphomaa 0 1 1
Non small cell lung carcinomaa 1 2 3
Esophageal cancer 1 0 1
Ovarian cancer 1 0 1
Rectal cancera 1 2 3
Thyroid cancer 0 1 1
aIndicates
that 1 patient in each diagnosis group also had a comorbidity: atrial fibrillation,
chronic cardiac failure, pneumonia, or Parkinson’s disease.
EFFECT OF MUSIC THERAPY ON ANXIETY 585

TABLE 3. PREINTERVENTION ESAS ANXIETY RATING— (  0.05), power  80%. Therefore, comparing the
MEAN AND STANDARD DEVIATION
experimental and control groups, if the true effect was
Control Experimental an average improvement of more than 18.4 mm, the
study would have adequate power to detect this (i.e.,
Standard Standard
Mean deviation Mean deviation
greater than 80%).
Exclusion criteria included a Blessed Orientation,
Anxiety 3.2 3.13 3.8 3.21 Memory and Cognition (BOMC)65 score of more than
10, indicating that the participant was cognitively im-
ESAS, Edmonton Symptom Assessment System.
paired and therefore unable to give informed consent.
The BOMC65 is a 28-item cognition test, routinely ad-
priate for the patient on the day. These techniques in- ministered to patients on medical admission to the hos-
cluded playing live familiar music, singing, music and pital. Participants were also excluded if they were un-
relaxation, music and imagery, improvisation, music- able to speak English, and therefore unable to complete
assisted counseling, reminiscence, and listening to the necessary documentation, or had a major hearing
recorded music. The music therapist was not blinded impairment.
to the purpose of the study. The following tools were used for the study:
The control group received a single session with a
volunteer. The volunteer was not blinded to the pur- • The ESAS,62 a commonly used tool devised for a
pose of the study. Although a control group tradition- palliative care population by Bruera and colleagues.
ally receives nothing other than standard care, it is fair This is a 0–10 scale, listing 9 common symptomatic
to argue that an intervention is obviously more effec- issues for palliative care patients and offering a fur-
tive than no intervention, and it is also difficult to un- ther scale for the patient to add another symptom
dertake pre- and posttesting with a group that receives they may be experiencing. Patients rate the severity
nothing. Therefore, the control sessions involved a vol- of their symptom, with 0 indicating no symptom and
unteer sitting with the participant, undertaking activi- 10 indicating worst possible symptom. The ESAS
ties that a volunteer would normally do, such as read- was completed by the patients immediately before
ing to the participant, engaging in conversation, and/or and after the intervention. For both groups, these
providing emotional support. The volunteers were in- data were collected by an independent staff member
structed not to use music. Patients assigned to the con- not involved with the study (most commonly the pri-
trol group continued to receive music therapy services mary nurse).
outside of this study. • A pulse oximeter.
Twenty-five participants aged between 18 and 90
years completed the study, and were randomly as- Independent staff members not involved with the
signed to either the experimental group (n  13), or study (most commonly the primary nurse) took the pre-
the control group (n  12). An original sample size of and postmeasurements of heart rate for both groups.
60 (30 in each group) had been set. In order to deter- Because of lower than expected recruitment, only
mine the power of the study, published research was 25 participants completed the study, instead of the ex-
used to estimate the standard deviation between two pected 60. As the numbers in each group were small,
proximate measures of anxiety.63,64 Assuming n  30 it was appropriate to use a nonparametric technique,
in each group and a standard deviation of 25 mm, with which makes fewer assumptions about the underlying
standard settings for a two-sample t test to test the dif- distribution of the data. Therefore, a Mann-Whitney
ference between the experimental and control groups test was used to compare the median changes. A p

TABLE 4. RANGE OF IMPROVEMENT ON ESAS ANXIETY SCALE (PRE MINUS POST)

Negative No
change change Positive change

2 1 0 1 2 3 4 5

Experimental 0 0 8 2 3 1 1 1
Control 1 2 5 1 0 0 0 0

ESAS, Edmonton Symptom Assessment System.

586 HORNE-THOMPSON AND GROCKE

FIG. 1. Results of pre- and postmeasurements on the Edmonton Symptom Assessment System (ESAS) anxiety scale.

value of 0.05 was considered evidence of a statistically surement of the ESAS, was supported. Table 3 shows
significant difference between the therapy and control the preintervention ESAS anxiety rating.
groups. A nonparametric test for independent samples was
used to compare the two groups. Table 4 reports the
change in the scale for each group. The Mann-Whitney
RESULTS test found that anxiety was significantly reduced for the
experimental group (p  0.005). The control group dem-
Baseline demographic onstrated no change over the same period of time.
As can be seen in Table 4, eight participants in the
The demographic data were similar for the two experimental group reported a decrease in anxiety of
groups (Table 1). The mean age for the control group between 1 and 5 points on the ESAS scale. In contrast,
was 71.4 years (SD  16.05), and 76.2 years for the only 1 participant in the control group reported a de-
experimental group (SD  10.36). Overall the mean crease in anxiety of 1 point. Three participants in the
age was 73.9 years (SD  13.32). control group reported that their anxiety had increased
Twenty-four participants in the study had a cancer pre–post intervention. Figure 1 graphically represents
diagnosis, and one participant had a diagnosis of end- the change in anxiety on the ESAS for the experi-
stage organ failure (Table 2). mental and control groups.
In addition to the anxiety measure, a post hoc anal-
Hypothesis 1 ysis was also performed for the other nine scales on
The first hypothesis, that there will be a significant the ESAS. Significant results were obtained for pain,
difference between the experimental and control groups tiredness and drowsiness (Tables 5 and 6). No signif-
on anxiety levels as demonstrated by the anxiety mea- icant results were obtained for either group on the mea-

TABLE 6. ESAS RESULTS FOR OTHER SCALES

TABLE 5. PREINTERVENTION ESAS RATINGS—
MEAN AND STANDARD DEVIATION ESAS scale p value

Control Experimental Pain 0.019

Tiredness 0.024
Standard Standard Drowsiness 0.018
Mean deviation Mean deviation Nausea 0.200
Depression 0.097
Pain 2.2 2.62 3.6 3.45 Appetite 0.092
Tiredness 4.3 2.89 6.5 2.44 Well-being 0.077
Drowsiness 2.8 2.95 5.3 2.36 Shortness of breath 0.073

ESAS, Edmonton Symptom Assessment System. ESAS, Edmonton Symptom Assessment System.
EFFECT OF MUSIC THERAPY ON ANXIETY 587

TABLE 7. RANGE OF IMPROVEMENT ON ESAS SUBSCALES (PRE MINUS POST)

No
Negative change change Positive change
ESAS subscale Group 4 3 2 1 0 1 2 3 4 5 6 6

Pain Exp 0 0 0 0 5 2 1 3 0 1 1 0
Control 0 1 1 1 7 1 0 0 1 0 0 0
Tiredness Exp 0 0 0 0 2 5 1 3 0 1 0 1
Control 0 0 0 3 5 1 1 2 0 0 0 0
Nausea Exp 0 0 0 1 8 1 1 0 1 0 0 1
Control 0 0 1 1 9 0 1 0 0 0 0 0
Depression Exp 0 0 1 0 7 2 0 2 0 1 0 0
Control 0 0 0 2 10 0 0 0 0 0 0 0
Drowsiness Exp 0 0 1 2 1 3 2 1 2 1 0 0
Control 0 0 2 4 4 2 0 0 0 0 0 0
Appetite Exp 0 0 1 0 4 3 1 2 0 1 0 1
Control 1 0 1 1 6 1 1 0 0 0 1 0
Well-being Exp 1 0 0 0 3 3 3 3 0 0 0 0
Control 0 0 1 1 7 1 1 1 0 0 0 0
Shortness of breath Exp 0 0 0 0 6 1 0 2 2 2 0 0
Control 0 0 0 2 6 3 1 0 0 0 0 0

ESAS, Edmonton Symptom Assessment System.

surements of nausea, depression, appetite, well-being, whether these participants were not willing to report
and shortness of breath. their anxiety, whether staff had been incorrect in
Table 6 demonstrates the p value results for the their assessment of the participant, or whether par-
other ESAS subscales and Table 7 demonstrates the ticipant anxiety had abated by the time they com-
range of improvement. pleted the ESAS.
The second hypothesis, that there will be a signifi-
cant difference between the experimental and control Post hoc results of the ESAS
groups in anxiety levels as demonstrated by a decrease
It was noteworthy that pain, tiredness, and drowsi-
in heart rate, was not supported (Table 8).
ness on the ESAS scale were also significantly reduced
for the experimental group. Given that the participants
in this study had not been referred to music therapy
DISCUSSION
for pain control, it is interesting that pain was signif-
icantly reduced for the experimental group (p 
The results of the study support the use of music
0.019). It is known that anxiety and pain are often in-
therapy as an effective intervention when working with
terrelated.4,67
anxious participants who are in the last stages of a ter-
Tiredness and drowsiness were also significantly re-
minal illness.
duced for the experimental group post music therapy.
Lethargy and fatigue are commonly experienced
Hypothesis 2 symptoms of palliative care patients,11 and can be the
The first hypothesis, that there will be a signifi-
cant difference between the experimental and con- TABLE 8. MEAN HEART RATE (bpm), STANDARD DEVIATION,
AND p VALUE (OUTLIERS REMOVED)
trol groups in anxiety levels as demonstrated by the
anxiety measure on the ESAS, was supported. This Control Experimental
result is particularly important, given that patient
self-reporting of symptoms is considered to be the Heart rate Heart rate
(bpm) SD (bpm) SD
gold standard.64,66 It was interesting to note that de-
spite participants being referred to music therapy for Pre 88 13.34 85 15.61
anxiety management as perceived by staff, three par- Post 87 14.32 84 14.92
ticipants in the control group, and three participants Median change 2 1.5
p value 0.8
in the experimental group, reported 0 anxiety on the
ESAS scale prior to the intervention. It is unclear bpm, beats per minute; SD, standard deviation.
588 HORNE-THOMPSON AND GROCKE

most distressing.68 The results of this study indicate nally ill patients after a single session. The use of self-
that music therapy may be a stimulating or an uplift- reporting, considered to be the most reliable method
ing experience for palliative care patients, and that re- of determining symptom issues, has demonstrated that
duction in anxiety does not necessarily lead to a a single session music therapy intervention can reduce
drowsy patient. The fact that both tiredness (p  anxiety and thereby improve quality of life for these
0.024) and drowsiness (p  0.018) were significantly patients. Results contribute to the limited literature that
reduced for the experimental group, demonstrates that is currently available addressing the impact of music
music therapy can be an effective intervention in man- therapy with the anxious terminally ill. In addition, this
aging this common problem. study has also demonstrated that music therapy sig-
Significance was not obtained on the other scales nificantly reduces pain, tiredness and drowsiness in
on the ESAS, specifically nausea, depression, appetite, palliative care patients.
well-being, and shortness of breath. However, trends Evidenced-based studies that provide quantitative
were noted toward a positive improvement for the ex- data are essential to demonstrate the effectiveness of
perimental group. music therapy interventions and to justify financial re-
sources.
Hypothesis 2 Further studies are needed to test the effects of mu-
sic therapy on distressing symptoms such as anxiety
The second hypothesis, that there will be a significant and pain. As these symptoms are in a state of flux in
difference between the experimental and control groups patients who are in the palliation stage of illness, re-
on anxiety levels as demonstrated by a decrease in heart search must focus on brief interventions over days, not
rate was not supported. However, Davis and Thaut69 re- weeks. This study has shown the benefits of music
ported that physiologic data from their study investigat- therapy after a single session, however further studies
ing the use of preferred relaxing music on state anxiety, are needed to explore the effects on other symptoms,
relaxation, and physiologic responses suggested that mu- and over a marginally longer time.
sic may energise participants rather than having a re-
laxation effect. Given that the participants in the exper-
imental group in the current study had significantly
reduced tiredness and drowsiness after music therapy, it REFERENCES
could suggest that increased energy levels may be re-
1. Cassem EH: Care and management of the patient at the end
flected through an increase in heart rate. of life. In: Chochinov HM, Breitbart W (eds): Handbook
of Psychiatry in Palliative Medicine. New York: Oxford
Methodological issues University Press, 2000, pp. 13–23.
2. Higginson I, Priest P: Predicators of family anxiety in the
The main limitation of the study was in recruitment, weeks before bereavement. Soc Sci Med 1996;43:1621–
considered to be a common problem for palliative care 1625.
researchers.70,71 Attrition rate is another challenge 3. Cherny NI: The treatment of suffering in patients with ad-
faced in undertaking research with palliative pa- vanced cancer. In: Chochinov HM, Breitbart W (eds):
tients.72 Seventeen percent (n  5) of the participants Handbook of Psychiatry in Palliative Medicine. New York:
in this study who had signed a consent form either died Oxford University Press, 2000, pp. 375–396.
or were discharged before the intervention was un- 4. Payne DK, Massie MJ: Anxiety in palliative care. In:
Chochinov HM, Breitbart W (eds): Handbook of Psychia-
dertaken. try in Palliative Medicine. New York: Oxford University
A further difficulty in recruitment was that patients Press, 2000, pp. 63–74.
did not qualify for the study due to the exclusion cri- 5. Akechi T, Okuyama T, Sugawara Y, Nakano T, Shima Y,
teria. Cognitive impairment and non-English–speak- Uchitomi Y: Major depression, adjustment disorders, and
ing backgrounds were the most frequent reasons for post-traumatic stress disorder in terminally ill cancer pa-
exclusion. Multisite data collection, which could pro- tients: associated and predictive factors. J Clin Oncol 2004;
vide a much larger sample size, or alternatively a long 22:1957–1965.
6. Breitbart W, Bruera E, Chochinov H, Lynch M: Neu-
data collection period would improve the study design.
ropsychiatric syndromes and psychological symptoms in
patients with advanced cancer. J Pain Symptom Manage
1995;10:131–141.
CONCLUSION AND RECOMMENDATIONS 7. Breitbart W, Passik SD: Psychiatric aspects of palliative
care. In: Doyle D, Hanks G, MacDonald N (eds): The Ox-
This study has been beneficial in demonstrating that ford Textbook of Palliative Medicine. New York: Oxford
music therapy significantly reduces anxiety for termi- University Press, 1995, pp. 609–626.
EFFECT OF MUSIC THERAPY ON ANXIETY 589

8. Derogatis LR, Morrow GR, Fetting J, Penman D, Piaset- 25. Sabo CE, Michael SR: The influence of personal message
sky S, Schmale AM, Henrichs M, Carnicke CL Jr: The with music on anxiety and side effects associated with che-
prevalence of psychiatric disorders among cancer patients. motherapy. Cancer Nurs 1996;19:283–289.
JAMA 1983;249:751–757. 26. Salmore RG, Nelson JP: The effect of preprocedure teach-
9. Lynch ME: The assessment and prevalence of affective dis- ing, relaxation instruction, and music on anxiety as mea-
orders in advanced cancer. J Palliat Care 1995;11:10–18. sured by blood pressures in an outpatient gastrointestinal
10. Roth AJ, Breitbart W: Psychiatric emergencies in termi- endoscopy laboratory. Gastroenterol Nurs 2000;23:102–
nally ill cancer patients. Hematol Oncol Clin North Am 110.
1996;10:235–259. 27. Smolen D, Topp R, Singer L: The effect of self-selected
11. Georges J, Onwuteaka-Philipsen BD, Van der Heide A, music during colonoscopy on anxiety, heart rate, and blood
Van der Wal G, Van der Maas PJ: Symptoms, treatment pressure. Appl Nurs Res 2002;15:126–136.
and “dying peacefully” in terminally ill cancer patients: 28. Weber S, Nuessler V, Wilmanns W: A pilot study on the
A prospective study. Support Care Cancer 2004;13: influence of receptive music listening on cancer patients
160–168. during chemotherapy. Int J Arts Med 1997;5:27–35.
12. Radbruch L, Nauck F, Ostgathe C, Elsner F, Bausewein C, 29. Hogan BE: Music therapy in palliative care: A state of the
Fuchs M, Lindena G, Neuwöhner K, Schulenberg D: What art. Prog Palliat Care 2002;10:108–112.
are the problems in palliative care? Results from a repre- 30. Magill L: The use of music therapy to address the suffer-
sentative survey. Support Care Cancer 2003;11:442–451. ing in advanced cancer pain. J Palliat Care 2001;17:167–
13. Smith EM, Gomm SA, Dickens CM: Assessing the inde- 172.
pendent contribution to quality of life from anxiety and de- 31. O’Callaghan C: Pain, music creativity and music therapy
pression in patients with advanced cancer. Palliat Med in palliative care. Am J Hosp Palliat Care 1996;13:43–49.
2003;17:509–513. 32. Trauger-Querry B, Haghighi KR: Balancing the focus: Art
14. Kelly B, Burnett P, Pelusi D, Badger S, Varghese F, Robert- and music therapy for pain control and symptom manage-
son M: Factors associated with the wish to hasten death: A ment in hospice care. Hosp J 1999;14:25–38.
study of patients with terminal illness. Psychol Med 33. Daveson BA, Kennelly J: Music therapy in palliative care
2003;33:75–81. for hospitalized children and adolescents. J Palliat Care
15. Mystakidou K, Rosenfeld B, Parpa E, Katsouda E, Tsilika 2000;16:35–38.
E, Galanos A, Vlahos L: Desire for death near the end of 34. Groen KM: Pain assessment and management in end of life
life: The role of depression, anxiety and pain. Gen Hosp care: A survey of assessment and treatment practices of
Psychiatry 2005;27:258–262. hospice music therapy and nursing professionals. J Music
16. Hamel WJ: The effects of music intervention on anxiety in Ther 2007;44:90–112.
the patient waiting for cardiac catheterization. Intensive 35. Aldridge D: Music therapy and the creative act. In:
Crit Care Nurs 2001;17:279–285. Aldridge D (ed): Music Therapy in Palliative Care: New
17. Koch ME, Kain ZN, Ayoub C, Rosenberg SH: The seda- Voices. London: Jessica Kingsley, 1999, pp. 15–28.
tive and analgesic sparing effect of music. Anesthesiology 36. Clements-Cortes A: The use of music in facilitating emo-
1998;89:300–306. tional expression in the terminally ill. Am J Hosp Palliat
18. MacDonald RAR, Ashley EH, Davies JB, Serpell MG, Care 2004;21:255–260.
Murray JL, Rogers K, Millar K: The anxiolytic and pain 37. Hilliard RE: Enhancing quality of life for people diagnosed
reducing effects of music on post-operative analgesia. In: with a terminal illness. In: Dileo C, Loewy J (eds): Music
RR Pratt RR, Grocke D (eds): MusicMedicine 3, Vol. 3. Therapy at the End of Life. New Jersey: Jeffrey Books,
Melbourne: University of Melbourne, 1999, pp. 12–18. 2005, pp. 19–24.
19. Mok E, Wong K: Effects of music on patient anxiety. 38. Hogan BE: Approaching the end of life: A role for music
AORN J 2003;77:396–397, 401–404, 6, 9–10. therapy within the context of palliative care models. Aust
20. Robb SL, Nichols RJ, Rutan RL, Bishop BL, Parker JC: J Music Ther 1998;9:18–34.
The effects of music assisted relaxation on preoperative 39. Ibberson C: A natural end: One story about Catherine. Br
anxiety. J Music Ther 1995;32:3–21. J Music Ther 1996;10:24–31.
21. Chlan LL: Music therapy as a nursing intervention for pa- 40. Krout RE: Music therapy with imminently dying hospice
tients supported by mechanical ventilation. Adv Pract patients and their families: Facilitating release near the time
Acute Crit Care 2000;11:128–138. of death. Am J Hosp Palliat Care 2003;20:129–134.
22. Wong HLC, Lopez-Nahas V, Molassiotis A: Effects of mu- 41. West TM: Psychological issues in hospice music therapy.
sic therapy on anxiety in ventilator-dependent patients. J Music Ther Perspect 1994;12:117–124.
Acute Crit Care 2001;30:376–387. 42. Foxglove T, Tyas B: Using music as a spiritual tool in pal-
23. Chlan LL, Evans D, Greenleaf M, Walker J: Effects of a liative care. Eur J Palliat Care 2000;7:63–65.
single music therapy intervention on anxiety, discomfort, 43. Magill L: Music therapy: Enhancing spirituality at the
satisfaction, and compliance with screening guidelines in end of life. In: Dileo C, Loewy J (eds): Music Therapy
outpatients undergoing flexible sigmoidoscopy. Gastroen- at the End of Life. New Jersey: Jeffrey Books, 2005, pp.
terol Nurs 2000;23:148–156. 3–17.
24. Haun M, Mainous RO, Looney SW: Effect of music on 44. Robertson-Gillam K: The role of music therapy in meeting
anxiety of women awaiting breast biopsy. Behav Med the spiritual needs of the dying person. In: Lee CA (ed):
2001;27:127–132. Lonely Waters: Proceedings of the International Confer-
 590 HORNE-THOMPSON AND GROCKE

ence Music Therapy in Palliative Care. Oxford: Sobell 61. Curtis SL: The effect of music on pain relief and relaxation
Publications, 1995, pp. 85–98. of the terminally ill. J Music Ther 1986;XXIII:10–24.
45. Salmon D: Music therapy as psychospiritual process in pal- 62. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K:
liative care. J Palliat Care 2001;17:142–14 The Edmonton Symptom Assessment System (ESAS): A
46. Wlodarczyk N: The effect of music therapy on the spiritu- simple method for the assessment of palliative care patients.
ality of persons in an inpatient hospice unit as measured J Palliat Care 1991;7:6–9.
by self-report. J Music Ther 2007;44:113–122. 63. Chang VT, Hwang SS, Feuerman M: Validation of the Ed-
47. Burns SJ, Harbuz MS, Hucklebridge F, Bunt L: A pilot monton Symptom Assessment Scale. Cancer 2000;88:
study into the therapeutic effects of music therapy at a can- 2164–2171.
cer help center. Altern Ther Health Med 2001;7:48–56. 64. Nekolaichuk CL, Bruera E, Spachynski K, MacEachern T,
48. Hilliard RE: The effects of music therapy on the quality Maguire TO: A comparison of patient and proxy symptom
and length of life of people diagnosed with terminal can- assessments in advanced cancer patients. Palliat Med
cer. J Music Ther 2003;40:113–137. 1999;13:311–323.
49. O’Callaghan C: Lyrical themes in songs written by pallia- 65. Katzman R, Brown T, Fuld P, Schechter R, Schimmel H:
tive care patients. J Music Ther 1996;23:74–92. Validation of a short Orientation-Memory-Concentration
50. O’Callaghan C, McDermott F: Music therapy’s relevance Test of cognitive impairment. Am J Psychiatry 1983;140:
in a cancer hospital researched through a constructivist lens. 734–739.
J Music Ther 2004;16:151–185. 66. Sprangers MAG, Aaronson NK: The role of health care
51. O’Kelly J: Multidisciplinary perspectives of music therapy providers and significant others in evaluating the quality of
in adult palliative care. Palliat Med 2007;21:235–2241. life of patients with chronic disease: A review. J Clin Epi-
52. Rykov MH, Salmon D: Bibliography for music therapy in demiol 1992;45:743–760.
palliative care, 1963–1997. Am J Hosp Palliat Care 1998; 67. Paice JA: Managing psychological conditions in palliative
15:174–180. care: Dying need not mean enduring uncontrollable anx-
53. Krout R: Hospice and palliative music therapy: A contin- iety, depression or delirium. Am J Nurs 2002;102:36–42.
uum of creative caring. In: Furman CD (eds): Effectiveness 68. Jenkins CA, Schulz M, Hanson J, Bruera E: Demographic,
of Music Therapy Procedures: Documentation of Research symptom, and medication profiles of cancer patients seen
and Clinical Practice, Vol. 3. Silver Spring, MD: Ameri- by a palliative care consult team in a tertiary referral hos-
can Music Therapy Association, 2000, pp. 323–411. pital. J Pain Symptom Manage 2000;19:174–184.
54. Horne-Thompson A, Daveson BA, Hogan BE: A bench- 69. Davis WB, Thaut MH: The influence of preferred relaxing
marking project investigating music therapy referral trends music on measures of state anxiety, relaxation, and physi-
within palliative care: An Australian perspective. J Music ological responses. J Music Ther 1989;XXVI:168–187.
Ther 2007;44:139–155. 70. Ross C, Cornbleet M: Attitudes of patients and staff to re-
55. O’Brien EK: Cancer patients’ evaluation of a music ther- search in a specialist palliative care unit. Palliat Med
apy program in a public adult hospital. In: Pratt RR, Grocke 2003;17:491–497.
D (eds): MusicMedicine 3, Vol. 3. Melbourne: The Uni- 71. Lovato L, Hill K, Hertert S, Hunninghake DB, Probstfield
versity of Melbourne, 1999, pp. 285–300. JL: Recruitment for controlled clinical trials: Literature
56. Gallagher LM, Steele AL: Developing and using a com- summary and annotated bibliography. Control Clin Trials
puterised database for music therapy in palliative medicine. 1997;18:328–357.
J Palliat Care 2001;17:147–154. 72. Jordhoy MS, Kaasa S, Fayers P, Ovreness T, Underland G,
57. Gallagher LM, Lagman R, Walsh D, Davis MP, LeGrand Ahlner-Elmqvist M: Challenges in palliative care research.
SB: The clinical effects of music therapy in palliative med- Recruitment, attrition and compliance: Experience from a
icine. Support Care Cancer 2006;14:859–866. randomized controlled trial. Palliat Med 1999;13:299–310.
58. Krout R: The effects of single-session music therapy in-
terventions on the observed and self-reported levels of pain Address reprint requests to:
control, physical comfort, and relaxation of hospice pa-
Anne Horne-Thompson, B.Mus., M.Mus., R.M.T.
tients. Am J Hosp Palliat Care 2001;18:383–390.
59. Calovini BS: The effect of participation in one music ther- Calvary Health Care Bethlehem, Melbourne
apy session on state anxiety in hospice patients [masters 476 Kooyong Road
thesis]. Ohio: Case Western Reserve University; 1993. Caulfield Sth, Victoria, 3162
68 p. Australia
60. Lazarus RS: Emotion and Adaptation. London: Oxford
University Press, 1991. E-mail: [email protected]

View publication stats