Effects of music intervention with nursing presence and recorded music on psycho-physiological indices of cancer patient caregivers

Expressive Arts Interventions to Improve Psychosocial Well-Being in Caregivers: A Systematic Review

CONTEXT

Over 43 million caregivers provide care and support in the United States. Increased stress and burden may contribute to poor psychosocial well-being. Recently, there has been an emergence of art-based interventions to improve well-being among care receivers and caregivers. A synthesis of this literature evaluating expressive arts interventions (EAIs) with caregivers is needed.

OBJECTIVES

Identify the nature and impact of EAIs for caregivers and outline directions for future research.

METHODS

Systematic searches were conducted in PubMed/MEDLINE, CINAHL, PsychINFO, and Web of Science for relevant studies between 2001 and 2022. Inclusion criteria included EAI addressing psychosocial well-being of caregivers, quantitative and mixed methods studies, and written in English.

RESULTS

Twenty-seven studies were included (1359 participants). There was a diverse global representation of countries (n = 14). Twelve studies were randomized controlled trials. The majority (n = 11) were conducted with dementia/alzheimers caregivers and 41% (n = 11) were delivered to the caregiver/receiver dyad. Fifty-nine percent of the EAIs were music-based, 22% were visual arts, and 10% were writing. Intervention length varied from a single one-hour session to biweekly for 10-months; eight lasted two-weeks. Overall, stress improved in 80% of the studies, anxiety in 69%, caregiver burden in 57%, and depressive symptoms in 31%.

CONCLUSION

Caregivers are essential to the care of people with medically complex and life-limiting conditions. EAIs hold the potential to improve psychosocial outcomes for caregivers, are used globally, and can be culturally tailored. Future research should examine intervention duration and intensity, measures to address additional dimensions of psychsocial well-being, and implementation in additional caregiver populations.

Effects of Music on the Quality of Life of Family Caregivers of Terminal Cancer Patients: A Randomised Controlled Trial

The aim of this study was to investigate the effects of listening to self-chosen music on the quality of life of family caregivers of cancer patients receiving palliative home care. A total of 82 family caregivers were assigned either to the intervention group (n = 41) or to the control group (n = 41) in this double-blind, multicentre, randomised controlled clinical trial. The recruitment period was between July 2020 and September 2021. The intervention group received individualised pre-recorded music in daily 30 min sessions for 7 consecutive days. The control group was given a recorded repetition of the basic therapeutic training education also in 30 min sessions for 7 consecutive days. The primary endpoint assessed was the caregivers' quality of life (Quality of Life Family Version and European Quality of Life visual analogue scale) before and after the intervention. The secondary endpoint was their perceived satisfaction with the intervention (Client Satisfaction Questionnaire). The music intervention was successful, producing a tangible improvement in the caregivers' quality of life (p < 0.01) and satisfaction with the care provided (p = 0.002). The intervention was not only effective but produced no adverse effects. This study encourages the use of self-chosen music as a complementary intervention in nursing care for family caregivers of palliative cancer patients.

Effect of Self-Chosen Music in Alleviating the Burden on Family Caregivers of Patients with Advanced Cancer: A Randomised Controlled Trial

The experience of caregiver burden among family members of patients with advanced cancer is a common problem. The aim of this study was to determine whether the burden may be alleviated by means of a therapeutic approach based on self-chosen music. This randomised controlled trial (ClinicalTrials.gov, NCT04052074. Registered 9 August 2019) included 82 family caregivers of patients receiving home palliative care for advanced cancer. The intervention group (n = 41) listened to pre-recorded, self-chosen music for 30 min/day for seven consecutive days, while the control group (n = 41) listened to a recording of basic therapeutic education at the same frequency. The degree of burden was assessed by the Caregiver Strain Index (CSI), calculated before and after the seven-day intervention. According to this measure, caregiver burden fell significantly in the intervention group (CSI change: -0.56, SD 2.16) but increased in the control group (CSI change: +0.68, SD 1.47), with a significant group x moment interaction F(1, 80) = 9.30, p = 0.003, η²_p = 0.11. These results suggest that, in the short term at least, the use of therapy based on self-chosen music alleviates the burden on family caregivers of palliative cancer patients. Moreover, this therapy is easy to administer at home and does not present any problems in practice.

Live music in hospital oncology settings: environmental, interpersonal, and personal outcomes for staff, patients, and carers

BACKGROUND

This paper explores the environmental, interpersonal, and personal outcomes of music performance in a hospital oncology setting. An original, qualitative research study examined the impact of live music for staff, patients, and carers.

METHODS

Data were collected using a multi-method approach of observations and semi-structured interviews and were analysed using inductive and theory-driven theming that was shaped by a determinants of health framework.

RESULTS

The research found that live music promoted stronger relationships and calmer environments, among other environmental, social and individual outcomes. Improved communication between staff through the creation of a more supportive environment was a pertinent finding of the research. No negative effects were reported.

CONCLUSIONS

We discuss research findings in the context of relevant literature and suggest recommendations for future hospital-based live music programs. Results of this study indicate that live music interventions impacted individual, interpersonal, social and environment factors that led to health and wellbeing outcomes for participants.

Effect of Carnatic raga-Bilahari based music therapy on anxiety, sleep disturbances and somatic symptoms among caregivers of cancer patients

Carnatic raga-Bilahari based intervention is a music therapy technique that enhances relaxation and positivity by reducing anxiety. With extensive empirical evidence pointing out the detrimental challenges faced by the caregivers of cancer patients, the present study intends to find out the effectiveness of a Carnatic raga based music therapy on reducing anxiety, sleep disturbances, somatic symptoms and distress level among this population A single group pre-post research design was was used to conduct the study. General Health Questionnaire (GHQ-28) was used as a screening tool to select participants, and 30 participants were chosen using the purposive sampling. These individuals received instruction in listening to Carnatic music (raga-Bilahari), 5 days a week. The vocal and instrumental recordings were given on alternative days with each session lasting 15–30 min over a month of standard care. From the findings it is observed that there is significant decrease in the anxiety (p < 0.001), sleep disturbances (p < 0.001), somatic symptoms (p < 0.001) and distress level (p < 0.001) after the intervention.The study result thus indicates that Carnatic raga-Bilahari-based music intervention is effective among caregivers of cancer patients to reduce anxiety, sleep disturbances, somatic symptoms presentation, and their distress level.

Listening to music for insomnia in adults

BACKGROUND

Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.

OBJECTIVES

To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.

SELECTION CRITERIA

Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.

AUTHORS' CONCLUSIONS

The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.

Music-based Intervention for Improving Sleep Quality of Adults without Sleep Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Listening to music is often used as a self-help intervention to improve sleep quality, but its efficacy among individuals without sleep disorder remains unclear.

METHODS

A search was performed on five databases to identify for studies that examined the use of music-based intervention to improve sleep quality among individuals without sleep disorder. Random-effects meta-analysis was performed, and the certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

RESULTS

Twenty-two articles which recruited 1,514 participants were included for review. Meta-analysis of six studies including 424 participants did not find an improvement in sleep quality among recipients of music-based intervention compared to those with standard care (mean difference: -0.80; 95% CI: -2.15 to 0.54, low-quality evidence). Subgroup analysis showed a clear improvement in sleep quality when interventions were administered for at least 3 weeks (-2.09; -3.84 to -0.34, n = 3). No difference in terms of sleep onset latency (standardized mean difference (SMD) -0.32; 95% CI -0.88 to 0.25, n = 4, very-low quality evidence) and sleep efficiency (SMD: -0.59; 95% CI -3.15 to 1.97, n = 2, very-low quality evidence) were observed. The effect of music-based intervention on anxiety, depression and quality of life were mixed with suggestions of possible benefits.

CONCLUSION

Music-based intervention in addition to standard care appears to be a promising strategy to improve sleep quality when delivered for 3 week or longer. However, effects are inconsistent across studies and larger randomized controlled studies reporting long-term outcomes are needed before it can be recommended for routine use.

PROSPERO REGISTRATION

CRD42018081193.

Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery

Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.

Effect of handholding on heart rate variability in both patients with cancer and their family caregivers: a randomized crossover study

BACKGROUND

Many family caregivers of patients with cancer feel guilty about self-care. A meaningful relationship with patients reduces such negative feelings and functions as self-care for family caregivers. Moreover, handholding improves autonomic functions in non-cancer patients. However, the effects of handholding on both patients with cancer and family caregivers remain unknown.

METHODS

We evaluated the effects of handholding on heart rate variability (HRV) in patients with cancer and their family caregivers. This randomized crossover study divided patients with cancer and their family caregivers into two trial groups: Handholding trial (the family caregiver holds the patient's hand for five minutes) and Beside trial (the family caregiver stays beside the patient without holding their hand). The study included 37 pairs of patients with cancer who received treatment in the cancer department of a university hospital in Japan and their family caregivers (n = 74). The primary end-point was the change in HRV before and during the intervention.

RESULTS

The median performance status of the patients was 3. An interaction was observed between trials in the standard deviation of the normal-to-normal interval (SDNN) of HRV for family caregivers (F = 7.669; p = 0.006), and a significant difference in time course was observed between the trials (before p = 0.351; during p = 0.003). No interaction was observed between trials in the SDNN for patients (F = 0.331; p = 0.566). Only a main effect in time course (F = 6.254; p = 0.014) was observed. SDNN increased significantly during the intervention in both trials (Handholding trial: p = 0.002, Beside trial: p = 0.049).

CONCLUSIONS

Handholding improves autonomic functions of family caregivers and may function as self-care for family caregivers.

TRIAL REGISTRATION

UMIN000020557 . Registered on January 15, 2016.

Conversational Task Increases Heart Rate Variability of Individuals Susceptible to Perceived Social Isolation

Studies showed that introversion is the strongest personality trait related to perceived social isolation (loneliness), which can predict various complications beyond objective isolation such as living alone. Lonely individuals are more likely to resort to social media for instantaneous comfort, but it is not a perpetual solution. Largely negative implications including poorer interpersonal relationship and depression were reported due to excessive social media usage. Conversational task is an established intervention to improve verbal communication, cognitive and behavioral adaptation among lonely individuals. Despite that behavioral benefits have been reported, it is unclear if they are accompanied by objective benefits underlying physiological changes. Here, we investigate the physiological signals from 28 healthy individuals during a conversational task. Participants were ranked by trait extraversion, where greater introversion is associated with increased susceptibility to perceived social isolation as compared to participants with greater extraversion as controls. We found that introverts had a greater tendency to be neurotic, and these participants also exhibited significant differences in task-related electrodermal activity (EDA), heart rate (HR) and HR variability (HRV) as compared to controls. Notably, resting state HRV among individuals susceptible to perceived loneliness was below the healthy thresholds established in literature. Conversational task with a stranger significantly increased HRV among individuals susceptible to isolation up to levels as seen in controls. Since HRV is also elevated by physical exercise and administration of oxytocin hormone (one form of therapy for behavioral isolation), conversational therapy among introverts could potentially confer physiological benefits to ameliorate social isolation and loneliness. Our findings also suggest that although the recent pandemic has changed how people are interacting typically, we should maintain a healthy dose of social interaction innovatively.

Animal Signals, Music and Emotional Well-Being

Playing music or natural sounds to animals in human care is thought to have beneficial effects. An analysis of published papers on the use of human-based music with animals demonstrates a variety of different results even within the same species. These mixed results suggest the value of tailoring music to the sensory systems of the species involved and in selecting musical structures that are likely to produce the desired effects. I provide a conceptual framework based on the combined knowledge of the natural communication system of a species coupled with musical structures known to differentially influence emotional states, e.g., calming an agitated animal versus stimulating a lethargic animal. This new concept of animal-based music, which is based on understanding animal communication, will lead to more consistent and specific effects of music. Knowledge and appropriate use of animal-based music are important in future research and applications if we are to improve the well-being of animals that are dependent upon human care for their survival.

Songwriting intervention for cognitively-impaired children with life-limiting conditions: Study protocol

Investigations evaluating the effectiveness of music-based interventions as a complementary approach to symptom management and health promotion for cognitively-impaired children with life-limiting conditions and their families are needed to minimize the physical and psychological burdens on individuals and their caregivers. Songwriting is one music-based strategy for a remote family-centered complementary approach to improve outcomes for cognitively-impaired children with life-limiting conditions, their parents, and families. The overall purpose of this study is to test the feasibility and preliminary efficacy of a songwriting intervention for cognitively-impaired children (ages 5-17 years) who are receiving palliative or complex care and their parents. Specific aims are to: (1) determine the feasibility of songwriting for cognitively-impaired children with life-limiting conditions and their parents, and (2) examine preliminary efficacy of songwriting for child psychological distress and physical symptoms, parent psychological distress, and family environment. The protocol for this 1-group pre-and post-intervention clinical trial (N = 25) is described.

The efficacy of music therapy to relieve pain, anxiety, and promote sleep quality, in patients with small cell lung cancer receiving platinum-based chemotherapy

PURPOSE

Chemotherapy induces a range of physical and psychological symptoms, including pain, sleep disorders, fatigue, and anxiety. We aimed to assess the efficacy of six-step music therapy in relieving pain and anxiety and improving sleep quality in lung cancer patients receiving platinum-based chemotherapy.

METHODS

Between March 2013 and October 2015, we enrolled a total of 100 patients who were diagnosed with small cell lung cancer and scheduled for platinum-based chemotherapy. Patients were randomly assigned to two groups: the music therapy group (received six-step music therapy, n=50) and the control group (not received six-step music therapy, n=50). The anxiety, pain, and sleep quality of all patients were assessed using the self-rating anxiety scale (SAS), the visual analogue scale (VAS), and the Pittsburgh Sleep Quality Index (PSQI), respectively.

RESULTS

There were no significant differences in the demographic characteristics and music background between the two groups. The SAS and VAS scores in the two groups were not statistically different before chemotherapy. However, patients in the music therapy group showed significantly lower SAS and VAS scores compared with the control group at both 1 day and 5 days after chemotherapy. (SAS score at 1-day post-therapy, 49.48±2.14 vs 61.46±8.8, P=0.011; SAS score at 5-day post-therapy, 39.73±1.79 vs 62.02±8.83, P=0.005; VAS score at 1-day post-therapy, 2.14±0.78 vs 4.74±1.01, P=0.005; VAS score at 5-day post-therapy, 2.06±0.79 vs 4.74±1.08, P=0.004). In addition, the total PSQI score of patients who received music therapy was also significantly higher than that of the control group after therapy (total PSQI score at 1-day post-therapy, 8.50±1.69 vs 17.81±3.01, P=0.006; total PSQI score at 5-day post-chemotherapy, 9.84±3.02 vs 18.66±2.91, P=0.012).

CONCLUSION

The music therapy was an effective approach in alleviating pain and anxiety and promoting sleep quality in lung cancer patients receiving platinum-based chemotherapy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (registration number: ChiCTR-TRC-13003993).

Interventions that Improve Sleep in Caregivers of Adult Care-Recipients: A Systematic Review

The purpose of the present review was to compile and analyze all interventions aimed at improving the sleep-rest pattern of adult caregivers. A database search was performed in PubMed, Embase, Scopus, CINAHL and PsycINFO. Twenty-four papers published between 1998 and 2020 met the inclusion criteria. Informal caregivers can benefit from various types of sleep interventions, including (a) cognitive-behavioral sleep interventions (CBIs), (b) caregiver health interventions (CHIs), and (c) exercise programs. Other types of interventions such as acupressure, back massage, reflexology, music, and heart rate variability biofeedback sessions may have beneficial effects on the sleep of caregivers. Yet, studies on this topic are heterogeneous and often have considerable methodological shortcomings. Few clinical trials have explored sleep problems as a dyadic caregiver-patient relationship. It is necessary to conduct new clinical trials to determine the viability and level of evidence of the various strategies aimed at improving sleep of informal caregivers.

Identification of Psychological and Social Problems in Caregivers of Individuals Diagnosed with Hematologic Malignancy

Objective:

Caring for patients with hematological malignancy could lead to many problems in different aspects regarding the lives of caregivers. However, there is limited data on the emotional and social problems of caregivers, who deal with patients of hematological malignancy. The aim of this study is to determine the emotional and social problems in caregivers of individuals diagnosed with hematological malignancy.

Methods:

The study was carried out descriptively to identify the emotional and social problems in the relatives of the patients diagnosed with hematological malignancy as their caregivers, as well as the factors affecting these problems. The data of the study were collected with the Introductory Information Form and Identification of Emotional and Social Problems Form that were administered to the relatives of the patients. The data were evaluated by using Spearman's Rho correlation analysis and the Logit analysis in Statistical Package for the Social Sciences software.

Results:

Among the caregivers, 59.8% were in the age group of 30–51 years, and 66.2% were female. Of the caregivers, 70.1% had difficulty in fulfilling their responsibilities. Spiritual distress had the highest score among the emotional problems, and experiencing caregiver strain had the highest score among the social problems. In the Logit model, the changes in the professional life was the variable that affects the emotional and social problems the most and significantly. In addition, emotional problems were affected by the financial problems at a statistically significant level.

Conclusions:

In this study, it is suggested that the caregivers should be provided with certain conveniences in their professional lives based on the fact that the problem, which affected emotional and social problems the most, is the change in the professional life; it is recommended that further studies should be carried out on the caregivers.

Tailored music listening intervention to reduce sleep disturbances in older adults with dementia: Research protocol

Sleep disruption in older adults living with Alzheimer's disease and related dementias (ADRD) is debilitating and contributes to increased institutionalization, reduced cognitive function, and accelerated disease progression. Furthermore, sleep disruption is linked to poor health outcomes in caregivers, such as decreased quality of life and increased caregiver burden. Given the potentially harmful side effects of pharmacologic treatment, nonpharmacologic approaches, such as music, may provide a safer alternative to reducing sleep disruption in this vulnerable population. A growing body of literature suggests that calming tailored music may improve sleep quality in older adults with memory loss, but its efficacy has not been demonstrated in older adults with ADRD in the community, where most older adults with ADRD live. If shown to be feasible and acceptable, tailored music interventions can then be tested for efficacy in reducing sleep disruption. This protocol details a wait-list randomized controlled trial (NCT04157244), the purpose of which is to test the feasibility, acceptability, and examine the preliminary efficacy of a tailored music listening intervention in older adults with ADRD who report sleep disruption. Music selections will be tailored to the music genre preferences of older adults with ADRD and account for known sleep-inducing properties. The feasibility of processes that is key to the success of the subsequent study will be examined. Preliminary efficacy of the intervention will be assessed using objective (actigraphy) and subjective (proxy-reported) sleep quality measures. In addition, qualitative data will be solicited, examining the acceptability and satisfaction with the intervention by individuals with ADRD.

Music, heart rate variability, and symptom clusters: a comparative study

PURPOSE

This study aimed to explore the possible range of change of a single-session music intervention (SMI) on symptom clusters and neurological reactivity for women with breast cancer undergoing chemotherapy.

METHODS

A parallel and randomized, controlled study with repeated measures design was used. A total of 100 women with breast cancer were randomly assigned to the SMI or a control group. The outcome measurements of symptom cluster were collected using the Multidimensional Fatigue Symptom Inventory, Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and the neurological reactivity with heart rate variability at four time points: before commencement of the intervention (T0), immediately afterward (T1), 1 week later (T2), and 3 weeks after the intervention (T3).

RESULTS

Of the 50 women in each group, 46 in the SMI and 48 in the control group completed the post-test at T3. Multivariate analysis of variance indicated that the SMI group had a medium effect in change of symptom clusters compared to the control group at T2. Moreover, after adjusting for baseline between normal and higher levels of sympathetic tone activity, significant differences existed in fatigue and depression at T2 and sleep disturbance at T3.

CONCLUSIONS

A single-session music intervention can be effectively used to reduce symptom clusters for women with breast cancer. Targeting those who have a higher level of sympathetic tone activity is recommended.

Start making sense: Art informing health psychology

Growing evidence suggests that the arts may be useful in health care and in the training of health care professionals. Four art genres - novels, films, paintings and music - are examined for their potential contribution to enhancing patient health and/or making better health care providers. Based on a narrative literature review, we examine the effects of passive (e.g. reading, watching, viewing and listening) and active (e.g. writing, producing, painting and performing) exposure to the four art genres, by both patients and health care providers. Overall, an emerging body of empirical evidence indicates positive effects on psychological and physiological outcome measures in patients and some benefits to medical training. Expressive writing/emotional disclosure, psychoneuroimmunology, Theory of Mind and the Common Sense Model of Self-Regulation are considered as possible theoretical frameworks to help incorporate art genres as sources of inspiration for the further development of health psychology research and clinical applications.

The effect of music therapy on depression and physiological parameters in elderly people living in a Turkish nursing home: a randomized-controlled trial

OBJECTIVE

This study was carried out in an effort to determine the effect of music therapy on depression and physiological parameters in elderly people who were living in a nursing home.

METHOD

The study was a randomized controlled trial. The study sample consisted of 64 elderly people who complied with the criteria of inclusion for the study. The data were collected using the 'Elderly Information Form' and 'Geriatric Depression Scale'. The music group listened to music three days in a week during 8 weeks. The depression levels were assessed at baseline (week 0) and follow-up in the eight week.

RESULTS

It was found that the difference between post-test depression scores of the two groups was found to be statistically significant (t = -2.86, p <.01). The mean scores of post-test systolic blood pressure in the music group were found to be significantly lower than those of the control group (t = -3.11, p < .05).

CONCLUSION

It was concluded that music therapy decreased the depression level and systolic blood pressure in elderly people. The study results implies that music therapy can be an effective practice for public health and home care nurses attempting to reduce depression and control physiological parameters of elderly people.

The Role of Biomarkers in Research on Caregivers for Cancer Patients: A Scoping Review

BACKGROUND

Biomarkers can be used as prognostic, predictive, or monitoring indicators of an associated outcome. The purpose of this review was to provide a comprehensive summary of the research examining the use of biomarkers as surrogate end points for clinical outcomes in family caregivers for cancer patients, identify gaps, and make recommendations for future research.

METHODS

A scoping review, a process of mapping the existing literature, was conducted. Studies comparing biomarkers across caregivers and controls and/or examining relationships between biomarkers and psychological health were reviewed.

RESULTS

The studies ( N = 18) of caregivers for cancer patients who were identified used biomarkers to predict outcomes ( n = 13) and to monitor the efficacy of interventions ( n = 6). Biomarkers were divided into two categories based on physiological systems involved: (1) neuroendocrine function (sympathetic-adrenal-medullary axis activity, hypothalamic-pituitary-adrenal axis activity) and (2) immune function. Predictive biomarkers were sensitive to differences between caregivers and controls. The biomarkers were used to evaluate outcomes frequently associated with stress, depression, and anxiety. Cortisol was the biomarker most commonly measured to monitor the efficacy of interventions.

DISCUSSION

Biomarkers are most commonly incorporated into caregiver studies to predict group membership and psychological health. Neuroendocrine biomarkers, specifically cortisol, are most frequently assessed. Future research should include biomarkers of other physiologic functions (e.g., cardiovascular function, cognitive dysfunction, and cell aging) and those that serve as multisystem indicators. Expanding the scientific study of biomarkers will contribute to our understanding of the mechanisms through which stress may influence caregiver health.

Effect of Stimulative and Sedative Music Videos on Depressive Symptoms and Physiological Relaxation in Older Adults: A Pilot Study

Music has been found to improve depressive symptoms and relaxation. However, few studies related to this issue have been conducted using music videos (MVs). The aim was to compare the effects of stimulative and sedative MVs on depressive symptoms and physiological relaxation (i.e., electromyography, heart rate variability, and skin conductance) in older adults with depressive symptoms. Using a 2-week crossover design, interventions alternated between watching a stimulative and sedative MV and vice versa. Each intervention lasted for 30 minutes on 1 day during the first week, and was then alternated to another intervention for 1 day during the following week. Stimulative MVs were more effective in treating depressive symptoms than sedative MVs. Stimulative and sedative MVs had beneficial effects on depressive symptoms and physiological relaxation compared with baseline data. These findings add new knowledge to the literature for health care providers to improve psychophysiological health in older adults with depressive symptoms. [Res Gerontol Nurs. 2016; 9(5):233-242.].

A review of family caregiving intervention trials in oncology

This article contains a review of literature published from 2010 to 2016 on family caregiving in oncology. An analysis of 810 citations resulted in 50 randomized trials. These trials describe the need to prepare family caregivers for the complex role they play in cancer care. Several studies have demonstrated improved quality of life for family caregivers and improved emotional support from interventions. Several studies addressed communication and relational intimacy, which are key concerns. An additional focus of these trials was in the area of caregiving tasks and ways to diminish the burden of caregiving and preparedness for this role. Further research is needed in this area given the shift to outpatient care and as family caregivers become the primary providers of care. Future research should include expanding tested models of family caregiver support in clinical practice and in diverse populations. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:318-325. © 2017 American Cancer Society.

A Systematic Review of Psychosocial Interventions to Cancer Caregivers

Objective: To systematically review the effect of psychosocial interventions on improving QoL, depression and anxiety of cancer caregivers.

Methods: We conducted a systematic review of psychosocial interventions among adult cancer caregivers published from 2011 to 2016. PsycINFO, PubMed, Proquest, Cochrane Library, Embase, Applied Social Sciences Index and Abstracts (ASSIA), Cumulative Index to Nursing and Allied Health Literature, Social Sciences Citation Index (SSCI) and EBSCO, China National Knowledge Infrastructure (CNKI) and WANFANG were searched. Inclusion criteria were: randomized controlled trails (RCTs); psychosocial intervention to cancer caregivers; psychosocial health indicators including quality of life, depression or anxiety.

Results: 21 studies out of 4,666 identified abstracts met inclusion criteria, including 19 RCTs. The intervention modes fell into the following nine categories: family connect intervention, self-determination theory-based intervention (SDT), cognitive behavioral therapy (CBT), emotion-focused therapy (EFT), comprehensive health enhancement support system (CHESS), FOCUS programme, existential behavioral therapy (EBT), telephone interpersonal counseling (TIP-C), problem-solving intervention (COPE).

Conclusion: paired-intervention targeting self-care and interpersonal connections of caregivers and symptom management of patients is effective in improving quality of life and alleviating depression of cancer caregivers while music therapy is helpful for reducing anxiety of cancer caregivers.

Concept Analysis: Music Therapy

Down through the ages, music has been universally valued for its therapeutic properties based on the psychological and physiological responses in humans. However, the underlying mechanisms of the psychological and physiological responses to music have been poorly identified and defined. Without clarification, a concept can be misused, thereby diminishing its importance for application to nursing research and practice. The purpose of this article was for the clarification of the concept of music therapy based on Walker and Avant’s concept analysis strategy. A review of recent nursing and health-related literature covering the years 2007–2014 was performed on the concepts of music, music therapy, preferred music, and individualized music. As a result of the search, the attributes, antecedents, and consequences of music therapy were identified, defined, and used to develop a conceptual model of music therapy. The conceptual model of music therapy provides direction for developing music interventions for nursing research and practice to be tested in various settings to improve various patient outcomes. Based on Walker and Avant’s concept analysis strategy, model and contrary cases are included. Implications for future nursing research and practice to use the psychological and physiological responses to music therapy are discussed.

A pilot, quasi-experimental, mixed methods investigation into the efficacy of a group psychotherapy intervention for caregivers of outpatients with cancer: the COPE study protocol

INTRODUCTION

Despite the rising trend of cancer prevalence and increase in family caregiving, little attention has been paid to the efficacy of psychosocial interventions among Asian caregiver samples, particularly support groups, given the benefits that have been shown in studies on Western populations. This trial aims to evaluate the effectiveness of a pilot 4-week group psychotherapy for Singaporean family caregivers of patients receiving outpatient care.

METHODS AND ANALYSIS

Facilitated by a clinical psychologist, this intervention is primarily based on the brief integrative psychological therapy with a supportive-expressive intent. Participants will be recruited while they are accompanying their care recipients for outpatient consultations. Since this is a pilot study, a sample size of 120 participants is targeted on the basis of sample sizes of previous studies. The study adopts a quasi-experimental design, as participants are assigned the intervention or control arms based on their availability to attend the intervention. A mixed methods approach is used to evaluate the outcomes of the intervention. A self-administered battery of tests is completed at four time points: baseline, postintervention and follow-up at 1-month and 2-month postinterventions; semi-structured interviews are conducted at baseline and post-intervention. Primary outcomes are quality of life and anxious and depressive symptoms; secondary outcomes are stress and basic psychological needs. Analysis using analysis of covariance would be conducted to determine the effectiveness of the intervention.

ETHICS AND DISSEMINATION

This study protocol has ethics approval from the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref: 2013/00662). Written informed consent is obtained from every participant. Results will be disseminated through journals and conferences, and will be particularly relevant for clinicians intending to implement similar support groups to address the psychosocial concerns of caregivers, as well as for researchers seeking to refine the structure and evaluate the effectiveness of such programmes.

TRIAL REGISTRATION NUMBER

Current Controlled Trials NCT02120183 (https://clinicaltrials.gov/show/NCT02120183).

Music for insomnia in adults

BACKGROUND

Insomnia is a common sleep disorder in modern society. It causes reduced quality of life and is associated with impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults.

OBJECTIVES

To assess the effects of listening to music on insomnia in adults and to assess the influence of specific variables that may moderate the effect.

SEARCH METHODS

We searched CENTRAL, PubMed, Embase, nine other databases and two trials registers in May 2015. In addition, we handsearched specific music therapy journals, reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.

SELECTION CRITERIA

Randomised controlled trials and quasi-randomised controlled trials that compared the effects of listening to music with no treatment or treatment-as-usual on sleep improvement in adults with insomnia.

DATA COLLECTION AND ANALYSIS

Two authors independently screened abstracts, selected studies, assessed risk of bias, and extracted data from all studies eligible for inclusion. Data on pre-defined outcome measures were subjected to meta-analyses when consistently reported by at least two studies. We undertook meta-analyses using both fixed-effect and random-effects models. Heterogeneity across included studies was assessed using the I² statistic.

MAIN RESULTS

We included six studies comprising a total of 314 participants. The studies examined the effect of listening to pre-recorded music daily, for 25 to 60 minutes, for a period of three days to five weeks.Based on the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach, we judged the evidence from five studies that measured the effect of music listening on sleep quality to be of moderate quality. We judged the evidence from one study that examined other aspects of sleep (see below) to be of low quality. We downgraded the quality of the evidence mainly because of limitations in design or being the only published study. As regards risk of bias, most studies were at high risk of bias on at least one domain: one study was at high risk of selection bias and one was judged to be at unclear risk; six studies were at high risk of performance bias; three studies were at high risk of detection bias; one study was at high risk of attrition bias and was study was judged to be at unclear risk; two studies were judged to be at unclear risk of reporting bias; and four studies were at high risk of other bias.Five studies (N = 264) reporting on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) were included in the meta-analysis. The results of a random-effects meta-analysis revealed an effect in favour of music listening (mean difference (MD) -2.80; 95% confidence interval (CI) -3.42 to -2.17; Z = 8.77, P < 0.00001; moderate-quality evidence). The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention compared to no treatment or treatment-as-usual.Only one study (N = 50; low-quality evidence) reported data on sleep onset latency, total sleep time, sleep interruption, and sleep efficiency. However, It found no evidence to suggest that the intervention benefited these outcomes. None of the included studies reported any adverse events.

AUTHORS' CONCLUSIONS

The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with insomnia symptoms. The intervention is safe and easy to administer. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.

Effects of Music Videos on Sleep Quality in Middle-Aged and Older Adults With Chronic Insomnia

Listening to soothing music has been used as a complementary therapy to improve sleep quality. However, there is no empirical evidence for the effects of music videos (MVs) on sleep quality in adults with insomnia as assessed by polysomnography (PSG). In this randomized crossover controlled trial, we compared the effects of a peaceful Buddhist MV intervention to a usual-care control condition before bedtime on subjective and objective sleep quality in middle-aged and older adults with chronic insomnia. The study was conducted in a hospital’s sleep laboratory. We randomly assigned 38 subjects, aged 50–75 years, to an MV/usual-care sequence or a usual-care/MV sequence. After pretest data collection, testing was held on two consecutive nights, with subjects participating in one condition each night according to their assigned sequence. Each intervention lasted 30 min. Sleep was assessed using PSG and self-report questionnaires. After controlling for baseline data, sleep-onset latency was significantly shorter by approximately 2 min in the MV condition than in the usual-care condition ( p = .002). The MV intervention had no significant effects relative to the usual care on any other sleep parameters assessed by PSG or self-reported sleep quality. These results suggest that an MV intervention may be effective in promoting sleep. However, the effectiveness of a Buddhist MV on sleep needs further study to develop a culturally specific insomnia intervention. Our findings also suggest that an MV intervention can serve as another option for health care providers to improve sleep onset in people with insomnia.

The psychoneuroimmunological effects of music: a systematic review and a new model

There has been a growing interest over the past decade into the health benefits of music, in particular examining its psychological and neurological effects. Yet this is the first attempt to systematically review publications on the psychoneuroimmunology of music. Of the selected sixty-three studies published over the past 22 years, a range of effects of music on neurotransmitters, hormones, cytokines, lymphocytes, vital signs and immunoglobulins as well as psychological assessments are cataloged. Research so far points to the pivotal role of stress pathways in linking music to an immune response. However, several challenges to this research are noted: (1) there is very little discussion on the possible mechanisms by which music is achieving its neurological and immunological impact; (2) the studies tend to examine biomarkers in isolation, without taking into consideration the interaction of the biomarkers in question with other physiological or metabolic activities of the body, leading to an unclear understanding of the impact that music may be having; (3) terms are not being defined clearly enough, such as distinctions not being made between different kinds of stress and 'music' being used to encompass a broad spectrum of activities without determining which aspects of musical engagement are responsible for alterations in biomarkers. In light of this, a new model is presented which provides a framework for developing a taxonomy of musical and stress-related variables in research design, and tracing the broad pathways that are involved in its influence on the body.

A randomized controlled trial of the effects of listening to non-commercial music on quality of nocturnal sleep and relaxation indices in patients in medical intensive care unit

AIM

The purpose was to examine the effects of non-commercial music on quality of sleep and relaxation indices, including heart rate, mean arterial pressure, and respiratory rate in patients in intensive care units.

BACKGROUND

There is currently insufficient scientific knowledge for the effects of music on quality of sleep in critically ill patients.

DESIGN

A randomized controlled trial.

METHODS

Between January-December 2010, 28 patients aged 39-78 years were randomly assigned to music and control groups. Participants in the music groups listened to non-commercial music for 45 minutes at nocturnal sleep time. In the control group, participants slept with no music. Participants were assessed using vital signs monitors, standardized questionnaire, and polysomnography. Polysomnography sleep was recorded for the first 2 hours of the nocturnal sleep. General estimating equation was applied to analyse data.

FINDINGS

Participants in the music group had shorter stage N2 sleep and longer stage N3 sleep in the first 2 hours of the nocturnal sleep and improved self-reported sleep quality, compared with those in the control group. The music group patients also had significantly lower heart rates than those in the control group. The intensive care units patients experienced fragmented sleep with a high frequency of awakenings and severe reduction in random eye movement sleep during the first 2 hours of the nocturnal sleep.

CONCLUSION

The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for intensive care unit patients' sleep improvement.