Introduction
Music therapy is a growing service provided in end-of-life care, with music therapists gaining employment opportunities in hospices and as members of palliative care teams in hospitals each year. With new music therapy programs being implemented in hospice and palliative care, more patients and families have access to this service (1). In addition, data from a survey study of 300 randomly selected hospices indicated that the most popular forms of complementary therapies were massage therapy and music therapy (2). The primary goal of palliative care is to promote patients' quality of life by alleviating physiological, psychological, social and spiritual distress, and improving comfort. Although there are several forms of complementary therapy (e.g. massage, art therapy, aromatherapy, reflexology, therapeutic touch), this article evaluates the music therapy literature and provides data on the emergence of an evidenced-based approach to music therapy in end-of-life care.
Music therapy is an established allied health profession, and music therapists are Board Certified (MT–BC) by the Certification Board for Music Therapists (CBMT) upon the completion of at least an undergraduate degree in music therapy or its equivalent, a clinical internship (averaging 1040 hours), and successfully passing the CBMT examination. In hospice and palliative care, music therapists use methods such as song writing, improvisation, guided imagery and music, lyric analysis, singing, instrument playing and music therapy relaxation techniques to treat the many needs of patients and families receiving care. Needs often treated by music therapists in end-of-life care include the social (e.g. isolation, loneliness, boredom), emotional (e.g. depression, anxiety, anger, fear, frustration), cognitive (e.g. neurological impairments, disorientation, confusion), physical (e.g. pain, shortness of breath) and spiritual (e.g. lack of spiritual connection, need for spiritually-based rituals) (3–10).
The literature on music therapy in end-of-life care is rich in qualitative studies. Most of these provide descriptions of music therapy programs in hospices or hospital-based palliative care units and utilize case examples to illustrate how music therapy addressed patient and family needs (11–21). Theories on the use of music therapy have been published in the literature, and they describe the various theoretical perspectives in the utilization of music for people who are dying. Elisabeth Kubler-Ross recognized the value of music therapy in helping dying patients who are withdrawn become more engaged with others (22). Others have provided theoretical frameworks for the use of music therapy for people nearing the end of their life (23–27). Phenomenological research has been used to document the process of music therapy with patients who have a terminal illness (28–30). Modified grounded theory and content analysis have been used in the literature to categorize lyrical themes in songs written by terminally ill patients (31,32). Primary caregivers of hospice patients who had received complementary therapies, including music therapy, reported that the therapies had improved the patients' quality of life (33).