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Warth M, Koehler F, Weber M, Bardenheuer HJ, Ditzen B, Kessler J. "Song of Life (SOL)" study protocol: a multicenter, randomized trial on the emotional, spiritual, and psychobiological effects of music therapy in palliative care. BMC Palliat Care 2019; 18:14. [PMID: 30700278 PMCID: PMC6354383 DOI: 10.1186/s12904-019-0397-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/21/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although patients in palliative care commonly report high emotional and spiritual needs, effective psychosocial treatments based on high quality studies are rare. First research provides evidence for benefits of psychosocial interventions in advanced cancer care. To specifically address end-of-life care requirements, life review techniques and creative-arts based therapies offer a promising potential. Therefore, the present study protocol presents a randomized controlled trial on the effectiveness of a newly developed music therapy technique that is based on a biographically meaningful song ("Song of Life"; SOL). METHODS In a design with two parallel arms, 104 patients at two palliative care units will be randomly assigned to three sessions of either SOL (experimental group) or relaxation exercises (control group). Improvements in the psychological domain of quality of life will be the primary endpoint, while secondary outcomes encompass spiritual well-being, ego-integrity, overall quality of life, and distress. Additionally, caregivers will be asked to provide feedback about the treatment. Assessment of biopsychological stress markers and qualitative analysis of perceived strengths and weaknesses will complement data collection. DISCUSSION Based on the results of a previous pilot study, we dedicated considerable efforts to optimizing the intervention and selecting appropriate outcomes for the present trial. We are confident to have designed a methodologically rigorous study that will contribute to the evidence-base and help to develop the potential of psychosocial interventions in palliative care. TRIAL REGISTRATION German Clinical Trials Register (DRKS) - DRKS00015308 (date of registration: September 07th 2018).
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Affiliation(s)
- Marco Warth
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Friederike Koehler
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Hubert J Bardenheuer
- Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jens Kessler
- Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120, Heidelberg, Germany
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Bieligmeyer S, Helmert E, Hautzinger M, Vagedes J. Feeling the sound - short-term effect of a vibroacoustic music intervention on well-being and subjectively assessed warmth distribution in cancer patients-A randomized controlled trial. Complement Ther Med 2018; 40:171-178. [PMID: 30219444 DOI: 10.1016/j.ctim.2018.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES So far, the effects of vibroacoustic music therapy in cancer patients are unknown. However, used in anthroposophic medicine, it could be an approach to enhance well-being. The goal of this study was to evaluate the immediate effects of a sound-bed music intervention with respect to the subjective well-being as well as body warmth and pain. PATIENTS AND METHODS We treated 48 cancer patients with 10 min of sound-bed intervention in a cross-over design. Primary outcome was the total sum of the Basler Mood Questionnaire (BMQ), secondary outcomes were subscales of the BMQ and questions addressing body warmth and pain. The EORTC-QLQ C30 was used as baseline assessment for quality of life (QOL). RESULTS Patients had lower QOL values than the EORTC reference samples (p < .001, d = 0.90). The primary outcome increased after music (p < .001, d = 0.47), no changes were seen in the control condition (p = .73, d = 0.04), the time by condition interaction was significant (p < .05). SECONDARY OUTCOMES Increase after music for the BMQ subscales inner balance (p < .001, d = 0.73), vitality (p < .001, d = 0.51) and vigilance (p < .001, d = 0.37) as well as for the additional questions satisfaction (p < .001, d = 0.43), current mood (p < .001, d = 0.43), body warmth (p < .05, d = 0.44) and warmth distribution (p < .01, d = 0.49). No significant changes were seen in pain levels and social extroversion. CONCLUSION Sound-bed intervention improved momentary well-being and caused self-perceived physiological changes associated with relaxation beyond the benefits of simple resting time (control condition). Thus, it might be a promising approach to improve well-being in cancer patients.
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Affiliation(s)
- Sarah Bieligmeyer
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - E Helmert
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Germany
| | - Jan Vagedes
- ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany; Department of Neonatology, University Children's Hospital, University of Tuebingen, Germany.
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Ramirez R, Planas J, Escude N, Mercade J, Farriols C. EEG-Based Analysis of the Emotional Effect of Music Therapy on Palliative Care Cancer Patients. Front Psychol 2018; 9:254. [PMID: 29551984 PMCID: PMC5840261 DOI: 10.3389/fpsyg.2018.00254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/15/2018] [Indexed: 11/13/2022] Open
Abstract
Music is known to have the power to induce strong emotions. The present study assessed, based on Electroencephalography (EEG) data, the emotional response of terminally ill cancer patients to a music therapy intervention in a randomized controlled trial. A sample of 40 participants from the palliative care unit in the Hospital del Mar in Barcelona was randomly assigned to two groups of 20. The first group [experimental group (EG)] participated in a session of music therapy (MT), and the second group [control group (CG)] was provided with company. Based on our previous work on EEG-based emotion detection, instantaneous emotional indicators in the form of a coordinate in the arousal-valence plane were extracted from the participants’ EEG data. The emotional indicators were analyzed in order to quantify (1) the overall emotional effect of MT on the patients compared to controls, and (2) the relative effect of the different MT techniques applied during each session. During each MT session, five conditions were considered: I (initial patient’s state before MT starts), C1 (passive listening), C2 (active listening), R (relaxation), and F (final patient’s state). EEG data analysis showed a significant increase in valence (p = 0.0004) and arousal (p = 0.003) between I and F in the EG. No significant changes were found in the CG. This results can be interpreted as a positive emotional effect of MT in advanced cancer patients. In addition, according to pre- and post-intervention questionnaire responses, participants in the EG also showed a significant decrease in tiredness, anxiety and breathing difficulties, as well as an increase in levels of well-being. No equivalent changes were observed in the CG.
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Affiliation(s)
- Rafael Ramirez
- Music and Machine Learning Lab, Department of Information and Communication Technologies, Pompeu Fabra University, Barcelona, Spain
| | - Josep Planas
- Palliative Care Unit, Oncology Service, Parc de Salut Mar, Instituto Mar de Investigaciones Médicas, Barcelona, Spain
| | - Nuria Escude
- Catalan Institute of Music Therapy, University of Barcelona, Barcelona, Spain
| | - Jordi Mercade
- Catalan Institute of Music Therapy, University of Barcelona, Barcelona, Spain
| | - Cristina Farriols
- Palliative Care Unit, Oncology Service, Parc de Salut Mar, Instituto Mar de Investigaciones Médicas, Barcelona, Spain
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Edwards J, Kaimal G. Using meta-synthesis to support application of qualitative methods findings in practice: A discussion of meta-ethnography, narrative synthesis, and critical interpretive synthesis. ARTS IN PSYCHOTHERAPY 2016. [DOI: 10.1016/j.aip.2016.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Preissler P, Kordovan S, Ullrich A, Bokemeyer C, Oechsle K. Favored subjects and psychosocial needs in music therapy in terminally ill cancer patients: a content analysis. BMC Palliat Care 2016; 15:48. [PMID: 27176621 PMCID: PMC4866407 DOI: 10.1186/s12904-016-0122-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 05/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Research has shown positive effects of music therapy on the physical and mental well-being of terminally ill patients. This study aimed to identify favored subjects and psychosocial needs of terminally ill cancer patients during music therapy and associated factors. Methods Forty-one Patients receiving specialized inpatient palliative care prospectively performed a music therapy intervention consisting of at least two sessions (total number of sessions: 166; per patient average: 4, range, 2–10). Applied music therapy methods and content were not pre-determined. Therapeutic subjects and psychosocial needs addressed in music therapy sessions were identified from prospective semi-structured “field notes” using qualitative content analysis. Patient- and treatment-related characteristics as well as factors related to music and music therapy were assessed by questionnaire or retrieved from medical records. Results Seven main categories of subjects were identified: “condition, treatment, further care”, “coping with palliative situation”, “emotions and feelings”, “music and music therapy”, “biography”, “social environment”, and “death, dying, and spiritual topics”. Patients addressed an average of 4.7 different subjects (range, 1–7). Some subjects were associated with gender (p = .022) and prior impact of music in patients’ life (p = .012). The number of subjects per session was lower when receptive music therapy methods were used (p = .040). Psychosocial needs were categorized into nine main dimensions: “relaxing and finding comfort”, “communication and dialogue”, “coping and activation of internal resources”, “activity and vitality”, “finding expression”, “sense of self and reflection”, “finding emotional response”, “defocusing and diversion”, and “structure and hold”. Patients expressed an average of 4.9 psychosocial needs (range, 1–8). Needs were associated with age, parallel art therapy (p = .010), role of music in patient’s life (p = .021), and the applied music therapy method (p = .012). Conclusion Seven main categories of therapeutically relevant subjects and nine dimensions of psychosocial needs could be identified when music therapy was delivered to terminally ill cancer patients. Results showed that patients with complex psychosocial situations addressed an average number of five subjects and needs, respectively. Some socio-demographic factors, the role of music in patient’s lives and the applied music therapy methods may be related with the kind and number of expressed subjects and needs.
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Affiliation(s)
- Pia Preissler
- Department of Oncology, Hematology and BMT with section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Sarah Kordovan
- Department of Oncology, Hematology and BMT with section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Anneke Ullrich
- Department of Oncology, Hematology and BMT with section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT with section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and BMT with section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany.
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Kordovan S, Preissler P, Kamphausen A, Bokemeyer C, Oechsle K. Prospective Study on Music Therapy in Terminally Ill Cancer Patients during Specialized Inpatient Palliative Care. J Palliat Med 2016; 19:394-9. [DOI: 10.1089/jpm.2015.0384] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Sarah Kordovan
- Department of Oncology, Hematology, and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Germany
| | - Pia Preissler
- Department of Oncology, Hematology, and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Anne Kamphausen
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology, and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Germany
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Potvin N, Bradt J, Kesslick A. Expanding Perspective on Music Therapy for Symptom Management in Cancer Care. J Music Ther 2015; 52:135-67. [DOI: 10.1093/jmt/thu056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/22/2014] [Indexed: 11/14/2022]
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Warth M, Kessler J, Koenig J, Hillecke TK, Wormit AF, Bardenheuer HJ. Methodological challenges for music therapy controlled clinical trials in palliative care. NORDIC JOURNAL OF MUSIC THERAPY 2014. [DOI: 10.1080/08098131.2014.987803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Warth M, Kessler J, Koenig J, Wormit AF, Hillecke TK, Bardenheuer HJ. Music therapy to promote psychological and physiological relaxation in palliative care patients: protocol of a randomized controlled trial. BMC Palliat Care 2014; 13:60. [PMID: 25587239 PMCID: PMC4292835 DOI: 10.1186/1472-684x-13-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Music therapy is one of the most frequently used complementary therapies in different palliative care settings. Despite its long tradition and high acceptance by other health-care professionals, evidence on the effectiveness of music therapy interventions for terminally ill patients is rare. Recent reviews and health-care reports consistently point out the need of music therapists to provide an evidence-based rationale for their clinical treatments in this field. Therefore, the present study evaluates the psychological and physiological response of palliative care patients to a standardized music therapy relaxation intervention in a randomized controlled trial. METHODS/DESIGN A sample of 84 participants from a palliative care unit in Heidelberg is randomized to either two sessions of music therapy or two sessions of a verbal relaxation exercise, each lasting 30 minutes. The music therapy sessions consist of live played monochord music and a vocal improvisation, the control group uses a prerecorded excerpt from the mindfulness-based stress reduction program containing no musical elements. Outcome measures include self-report data on subjective relaxation, well-being, pain intensity, and quality of life, as well as continuous recording of heart rate variability and blood volume pulse as indicators of autonomous nervous system functioning. DISCUSSION To our knowledge, this study is the first clinical trial in Europe and one of very few randomized controlled trials worldwide to systematically examine the effects of music therapy in palliative care. TRIAL REGISTRATION German Clinical Trials Register - DRKS00006137.
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Affiliation(s)
- Marco Warth
- />School of Therapeutic Sciences, SRH University Heidelberg, Maria-Probst-Strasse 3, 69123 Heidelberg, Germany
- />Centre of Pain Therapy and Palliative Care Medicine, Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120 Heidelberg, Germany
| | - Jens Kessler
- />Centre of Pain Therapy and Palliative Care Medicine, Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120 Heidelberg, Germany
| | - Julian Koenig
- />Department of Psychology, The Ohio State University, 175 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210 USA
| | - Alexander F Wormit
- />School of Therapeutic Sciences, SRH University Heidelberg, Maria-Probst-Strasse 3, 69123 Heidelberg, Germany
| | - Thomas K Hillecke
- />School of Therapeutic Sciences, SRH University Heidelberg, Maria-Probst-Strasse 3, 69123 Heidelberg, Germany
| | - Hubert J Bardenheuer
- />Centre of Pain Therapy and Palliative Care Medicine, Department of Anaesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120 Heidelberg, Germany
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Musiktherapie in der palliativmedizinischen Versorgung: Gegenwärtiger Stand und aktuelle Entwicklungen. ACTA ACUST UNITED AC 2014. [DOI: 10.13109/muum.2014.35.4.261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Callaghan CC, McDermott F, Michael N, Daveson BA, Hudson PL, Zalcberg JR. "A quiet still voice that just touches": music's relevance for adults living with life-threatening cancer diagnoses. Support Care Cancer 2013; 22:1037-47. [PMID: 24287507 DOI: 10.1007/s00520-013-2059-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/12/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Music has historically aided health and loss-adaptation, however, cancer patients' experience of music for self-care is not well understood. This study examines adult cancer patients' views about music's role before and after diagnosis. METHODS Constructivist approach, with grounded theory informed design using convenience, snowball and theoretical sampling. Patients from Australian metropolitan cancer and hospice settings completed demographic questionnaires and participated in semi-structured interviews. Qualitative inter-rater reliability was applied. RESULTS Fifty-two patients reported comparable time spent experiencing music pre-post diagnosis. Music may remain incidental; however, many patients adapt music usage to ameliorate cancer's aversive effects. Patients often draw from their musical lives and explore unfamiliar music to: remain connected with pre-illness identities; strengthen capacity for enduring treatment, ongoing survival (even when knowing "you're going to die"), or facing death; reframe upended worlds; and live enriched lives. Patients can ascribe human or physical properties to music when describing its transformative effects. Familiar lyrics maybe reinterpreted, and patients' intensified emotional reactions to music can reflect their threatened mortality. Sometimes music becomes inaccessible, elusive, and/or intensifies distress and is avoided. Families', friends' and professionals' recognition of patients' altered musical lives and music-based suggestions can extend patients' use of music for self-care. CONCLUSION Health professionals can support patients by inquiring about their music behaviours and recognising that altered music usage may signify vulnerability. Although commonly recommended, hospital concerts and music broadcasts need sensitive delivery. Patients' preferred music should be available in diagnostic, treatment and palliative settings because it can promote endurance and life enrichment.
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Affiliation(s)
- Clare C O'Callaghan
- Caritas Christi Hospice, St. Vincent's Hospital, 104 Studley Park Road, Kew, Melbourne, Australia, 3101,
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Archie P, Bruera E, Cohen L. Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature. Support Care Cancer 2013; 21:2609-24. [PMID: 23715815 PMCID: PMC3728458 DOI: 10.1007/s00520-013-1841-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 04/21/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE This study aimed to review quantitative literature pertaining to studies of music-based interventions in palliative cancer care and to review the neurobiological literature that may bare relevance to the findings from these studies. METHODS A narrative review was performed, with particular emphasis on RCTs, meta-analyses, and systematic reviews. The Cochrane Library, Ovid, PubMed, CINAHL Plus, PsycINFO, and ProQuest were searched for the subject headings music, music therapy, cancer, oncology, palliative care, pain, anxiety, depression, mood, quality of life, prevalence, neuroscience, functional imaging, endogenous opioids, GABA, 5HT, dopamine, and permutations of these same search terms. Data for the review were comprised of articles published between 1970 and 2012. References of all the cited articles were also reviewed. RESULTS Available evidence suggests that music-based interventions may have a positive impact on pain, anxiety, mood disturbance, and quality of life in cancer patients. Advances in neurobiology may provide insight into the potential mechanisms by which music impacts these outcomes. CONCLUSIONS More research is needed to determine what subpopulation of cancer patients is most likely to respond to music-based interventions, what interventions are most effective for individual outcomes, and what measurement parameters best gauge their effectiveness.
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Affiliation(s)
- Patrick Archie
- Celilo Cancer Center, Mid-Columbia Medical Center, 1800 East 19th Street, The Dalles, OR 97058, USA.
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O'Callaghan C, Dun B, Baron A, Barry P. Music's relevance for children with cancer: music therapists' qualitative clinical data-mining research. SOCIAL WORK IN HEALTH CARE 2013; 52:125-143. [PMID: 23521381 DOI: 10.1080/00981389.2012.737904] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Music is central in most children's lives. Understanding its relevance will advance efficacious pediatric supportive cancer care. Qualitative clinical data-mining uncovered four music therapists' perspectives about music and music therapy's relevance for pediatric oncology patients up to 14 years old. Inductive and comparative thematic analysis was performed on focus group transcripts and qualitative interrater reliability integrated. Music can offer children a safe haven for internalizing a healthy self-image alongside patient identity. Music therapy can calm, relieve distress, promote supportive relationships, enable self-care, and inspire playful creativity, associated with "normalcy" and hope. Preferred music and music therapy should be available in pediatric oncology.
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