MUSIC THERAPY IN HOSPICE AND PALLIATIVE CARE FACT SHEET

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1 MUSIC THERAPY IN HOSPICE AND PALLIATIVE CARE FACT SHEET A middle-aged man with lung cancer breathes more easily and with less pain while participating in music focused relaxation. An eight year old boy with cancer writes songs and records a CD for his family. An elderly woman in the final stages of Alzheimer s who is no longer able to speak sings a few words of her favorite lullaby to her adult daughter. A much-loved grandmother dies peacefully as her family sings her favorite spiritual songs to the accompaniment of the music therapist s folk harp. These illustrations demonstrate the role that music therapy plays in attending to the physical, emotional and spiritual needs of hospice and palliative care patients and families while respecting their dignity and celebrating their lives. WHAT IS MUSIC THERAPY? Music Therapy is the clinical and evidence-based use of music to address the needs of patients and families. A well-established healthcare profession, music therapy provides pain management and emotional and spiritual support for patients while supporting their families. Music therapy offers a compassionate and non-invasive approach to end of life care. It integrates patients musical preferences with their cultural background and spiritual beliefs to respect their dignity and celebrate their lives. WHY MUSIC THERAPY FOR HOSPICE AND PALLIATIVE CARE PATIENTS AND FAMILIES? Clinical and empirical evidence in music therapy reports that it is effective for meeting the physical, emotional and spiritual needs of patients and families. Music therapy is used to: Reduce physical symptoms of pain, agitation and shortness of breath Address and alleviate feelings of depression, fear, isolation, disorientation, confusion, anxiety, loss of control, loss of independence and loneliness Support spiritual beliefs and practices Improve quality of life Provide emotional support to families Provide opportunities for meaningful interactions among family members Provide respiratory entrainment and alleviation of anxiety during removal from ventilators Leave a legacy Inspire life review Discover meaning from the dying process Celebrate the lives of patients and families Provide support and comfort during the dying process Provide music for rituals such as funerals and memorials Support bereaved families

2 WHAT HAPPENS DURING A MUSIC THERAPY SESSION? A music therapist evaluates an individual s needs and musical preferences in addition to his/her cultural background and spiritual beliefs. Patients are engaged in a therapeutic process that speaks to their unique needs and preferences. They may benefit from actively engaging in music therapy interventions such as song-writing, singing, music-making, making musical choices or moving to music. Patients may also benefit by receiving the music through active music listening, music focused relaxation, music and imagery or live music entrainment. Music therapy provides actively dying patients and their families with music that supports a peaceful death. Music therapists are trained to use a variety of instruments depending on patients preferences and needs. These may include guitar, harp, keyboard, autoharp, dulcimer, tone chimes, tambourines, maracas, egg shakers and other rhythm instruments. WHO BENEFITS FROM MUSIC THERAPY? The universal appeal of music makes it possible for nearly every individual to relate to music and participate in music therapy in meaningful ways. Patients can benefit regardless of their musical experiences and background. HOW DOES MUSIC THERAPY AFFECT CHILDREN AND THEIR FAMILIES WHO ARE IN HOSPICE AND PALLIATIVE CARE? Children facing terminal illness are supported with music therapy interventions that are both developmentally appropriate as well as age appropriate. Because music therapy is a powerful, nonthreatening and non-invasive approach, unique outcomes are possible. Music therapy can help a child manage pain and stressful situations and provide opportunities for socialization, self-expression and communication. Music therapy supports siblings, parents and extended family members throughout the child s illness and during the grief journey. HOW IS MUSIC THERAPY USED WITH PEOPLE WHO ARE BEREAVED? Music therapy provides adults and children who are living with loss with the opportunity to express grief, relieve tension and stress, develop coping skills, receive emotional support and validation, find meaning in the grief journey and honor the person who died. Music therapy techniques are designed to respect the circumstances of the death and the needs of the bereaved. Music therapy allows a person to go beyond the limitations of words and to express their inner-most feelings in a safe, supportive and therapeutic environment. WHAT DO MUSIC THERAPISTS DO? The professionally trained music therapist integrates the patients musical preferences with music therapy approaches that are designed to meet their needs and celebrate their strengths. Music therapists draw from psychological models to incorporate counseling techniques with music experiences to provide support both verbally and musically. Music therapists readily adapt their approaches to support patients as they transform from higher levels of functioning into death. Music therapists play an integral role on the interdisciplinary team because they address a wide variety of needs including physical symptoms and psychosocial and spiritual issues. WHO IS A QUALIFIED MUSIC THERAPIST? Graduates of colleges or universities from one of approximately seventy approved music therapy degree programs approved by the American Music Therapy Association are eligible to take a national certification examination in music therapy. Those who pass the exam become Board Certified (MT-BC), demonstrating entry level skills in the profession. In addition to the MT-BC credential, other recognized professional designations are Registered Music Therapist (RMT), Certified Music Therapist (CMT), and Advanced Certified Music Therapist (ACMT) listed with the National Music Therapy Registry. Any individual who does not have proper training and credentials is not qualified to provide music therapy services. Music therapists who specialize in hospice and palliative care may advance their knowledge and clinical skills with continuing education courses.

3 IS THERE RESEARCH TO SUPPORT MUSIC THERAPY FOR HOSPICE AND PALLIATIVE CARE PATIENTS AND FAMILIES? Research demonstrating the benefits of music therapy can be found in various medical, nursing, hospice, and palliative care journals, as well as in all three music therapy journals (Journal of Music Therapy, Music Therapy Perspectives, and Music Therapy). Research data and clinical experiences attest to the viability of music therapy as an effective treatment for hospice and palliative care patients and families. WHY MUSIC THERAPY? Music therapy is a vital service. We use it to control physical symptoms of pain, breathlessness and agitation. We have a large population with severe cognitive dysfunction that does not appear to communicate but does respond to music therapy very well by mouthing music or tapping the beat I think that it is very important to think outside the box to find modalities that may bring comfort and lessen the reliance of traditional narcotics and anxiety medications. Music therapy can be used in many situations when people are hesitant to using medications. We have received countless letters from families who see the positive changes that music therapy made in their loved as a magical accomplishment. There is no downside to music therapy. And, there is no why when considering music therapy. There is only why not? -Diane Rapaport, MD, Senior Medical Director, VITAS Innovative Healthcare "I suggest the music therapist for many patients that I bring in the hospital if I think they're struggling with depression or if they are struggling with anxiety. We've done research on the effect of music therapy on particular symptoms. And I watched as it truly made a difference. So, the music therapist was able to touch them in a way that I had been unable to do. -Dr. Susan B. LeGrand, MD, FACP. Director of Education for the Harry R. Horvitz Center for Palliative Medicine. Music Therapy does many things to improve the quality of end of life care. Most importantly is the 'normalizing' that happens when music is utilized as a therapeutic modality. Music is a universal bridge between people and their experiences and it is such a tender, healing moment when a person can be embraced by it. Hospice patients and their families are so weary - they have usually traveled a long and arduous journey. Music therapy provides a refreshment along the way that has the power to revitalize, remind and recover. The employees and volunteers who are called to do hospice work are uniquely talented and challenged. We are always seeking inventive resources so that there is never a time when we have to say that there is nothing more that we can do. It is a great resource for our employees and volunteers to have the option of music therapy to offer patients and families. No matter how difficult that case is or how far away the sick person seems to be, music therapy is almost always a resource that helps our staff and volunteers appreciate the dignity and story of the person we're caring for. -Patricia A. Ahern, RN, MBA, President/Executive Director, Rainbow Hospice, Inc. Music therapists are given the possibility of touching that which is essentially human, that which transcends creed and confession. As they come to know our patients and shape their interventions to fit the patient s preferences and life experience, music therapists are able to unlock memory, to recover images and words of faith, and to give voice to sadness or hope or gratitude. For me there is always a bit of surprise and delight in learning from the music therapists what makes the connection for each patient. We ve done everything from Dean Martin to J.S.Bach, country & western to Orthodox chant, Roll Out the Barrel to Amazing Grace, Let It Be to Just a Closer Walk with Thee. -John Schumacher, M.Div., BCC, Manager, Spiritual Care & Healing Arts, Rainbow Hospice, Inc.

4 In the eighteen years I have worked in hospice nothing I have experienced has improved the quality of life for patients and families as much as the addition of a full-time music therapist to the hospice team. -Marcia Norman, RN, BS, President and Founder of Seasons Hospice Music therapy helps me focus on something besides pain. It makes me completely forget about it. I focus on the music and my soul. It s a wonderful relief from pain. It s one therapy that you can share with friends and family. It s a meaningful way for us to be together that takes us away from the everyday going s on. I feel it adds a richness and depth, something nothing else can do. There s northing else quite like music. -Peggy Eisen, seventy-six year old woman with metastatic melanoma When I stop and listen to the music it has so many profound lyrics. They make me remember the good times and some of the difficult times in my life. I want to remember all the good memories and the bad times because that is what made my life mine. -Sixty-four year old man with colon cancer Music was my mom s livelihood and a significant part of who she is. Through music therapy my mom and I connect so deeply in a way that is special for both of us. It s moments like these that enable us to continue to create beautiful memories together. -Jackie Matthews, daughter of Dolly, a 74 year old patient with Alzheimer s disease Music takes me to lost places." -One hundred year old woman with cerebral degeneration Music therapy made me communicate with my daughter. With her in a coma, somehow we reached each other. I got through to her with the music she loves. I was able to reach her with music in a way I couldn t have in any other way. It was a wave of emotion that I was able to give to her that I couldn t have done without music therapy. We had some humor, too. If she could have seen me singing the Beatles to her, she would have laughed! Even today I love to listen to the Beatles. -Penny Dussault, mother of a Jackie Blohm, a 42 year old woman with sudden brain damage Our family cannot imagine our hospice experience without music therapy. To us, it is the music that punctuates our memory. We felt shared joy in the music therapy and creating an original song of music with our son; relief when we observed a deeper sense of calm in him as a result of our music therapist meshing her music with his altered heartbeat and pain medication; comfort in the harp during his final days and hours; an oasis in the calming, ethereal music selections she left for us following his death easing the immense stress in the tough weeks that followed; and finally a very special legacy of his personality and our time with him in the music we created together. The songs continue to be an amazing comfort and source of joy when we most need it holidays, anniversaries, and whenever waves of grief come to us. -Julie Koenigsberger-Morley, mother of eleven month old son, Brian * Permission to share the above information was granted by the patients or family members listed above.

5 SELECTED BIBLIOGRAPHY IN MUSIC THERAPY IN HOSPICE AND PALLIATIVE CARE Aldridge, D. (Ed.). (1999). Music therapy in palliative care: New voices. London and Philadelphia: Jessica Kingsley Publishers. Bailey, L.M. (1984). The use of songs in music therapy with cancer patients and their families. Music Therapy, 4, Beck S.L. (1991). The therapeutic use of music for cancer-related pain. Oncology Nursing Forum, 18: Clements-Cortes, A. (2004). The use of music in facilitating emotional expression in the terminally ill. American Journal of Hospice and Palliative Medicine, 21(4), Curtis S.L. (1996). The effect of music on pain relief and relaxation of the terminally ill. Journal of Music Therapy, 3: Daveson, B.A. (2000). Music therapy in palliative care for hospitalized children and adolescents. Journal of Palliative Care, 16(1), Dileo, C. & Loewy, J. (2005). Music therapy at the end of life. Cherry Hill, NJ: Jeffrey Books. Gallagher, L.M., Huston, M.J., Nelson, K.A., Walsh, D., & Steele, A.L. (2001). Music therapy in palliative medicine. Support Care Cancer, 9, Gallagher, L.M. & Steele, A.L. (2001). Developing and using a computerized database for music therapy in palliative medicine. Journal of Palliative Care, 17, Hilliard, R.E. (2001). The use of music therapy in meeting the multidimensional needs of hospice patients and families. Journal of Palliative Care, 17 (3), 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, 40(2), Hilliard, R.E. (2005). Hospice and palliative care music therapy: A guide to program development and clinical care. Cherry Hill, NJ: Jeffrey Books. Krout, R.E. (2001). The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. American Journal of Hospice and Palliative Care, 18(6), Krout, R.E. (2003). Music therapy with imminently dying hospice patients and their families: Facilitating release near the time of death. American Journal of Hospice & Palliative Care, 20(2), Kwekkeboom, K.L. (2003). Music versus distraction for procedural pain and anxiety in patients with cancer. Oncology Nursing Forum, 30: Lee, C. (Ed.). (1995). Lonely waters. Oxford: Sobell Publications. Martin, J. (Ed.). (1989). The next step forward: Music therapy with the terminally ill. New York, NY: Calvary Hospital. Munro, S. (1984). Music therapy in palliative/hospice care. St. Louis: Magnamusic-Baton. O Callaghan, C. (1996). Pain, music creativity and music therapy in palliative care. American Journal of Hospice and Palliative Care, 13, O Callaghan, C. (2001). Bringing music to life: A study of music therapy and palliative care experiences in a cancer hospital. Journal of Palliative Care, 17, Salmon, D. (1993). Music and emotion in palliative care. Journal of Palliative Care, 9(4), Slivka, H., & Magill, L. (1993). Working with children of cancer patients. Caring, 12, 90-92,

6 Smith, M; Casey, L; Johnson, D; Gwede, C; Riggin, O.Z. (2001). Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncology Nursing Forum, 28: Standley, J.M. (1992). Clinical applications of music and chemotherapy: The effects of nausea and emesis. Music Therapy Perspectives, 10: Zimmerman, L; Pozehl, B; Duncan, K; Schmitz, R. (1989). Effects of music in patients who had chronic cancer pain. Western Journal of Nursing Research, 11: WHAT IS AMTA? The American Music Therapy Association (AMTA) represents over 5,000 music therapists, corporate members, and related associations worldwide. AMTA s roots date back to organizations founded in 1950 and Those two organizations merged in 1998 to ensure the progressive development of the therapeutic use of music in rehabilitation, special education, and medical and community settings. AMTA is committed to the advancement of education, training, professional standards, and research in support of the music therapy profession. The mission of the organization is to advance public knowledge of music therapy benefits and increase access to quality music therapy services. Currently, AMTA establishes criteria for the education and clinical training of music therapists. Members of AMTA adhere to a Code of Ethics and Standards of Practice in their delivery of music therapy services. Through the Journal of Music Therapy, Music Therapy and Music Therapy Perspectives, as well as other publications offered by AMTA, research findings and clinical studies relevant to the practice of music therapy are shared with interested professionals. HOW CAN YOU FIND A MUSIC THERAPIST OR OBTAIN MORE INFORMATION? American Music Therapy Association 8455 Colesville Road, Suite 1000 Silver Spring, MD (301) Fax (301) [email protected] Web: