Medical Manuscript

American Journal of Hospice

& Palliative Medicine®
Outcomes of Music Therapy Interventions 1-8
ª The Author(s) 2017
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on Symptom Management in Palliative sagepub.com/journalsPermissions.nav
DOI: 10.1177/1049909117696723
Medicine Patients journals.sagepub.com/home/ajh

Lisa M. Gallagher, MA, MT-BC1,2,

Ruth Lagman, MD, MPH, MBA, FACP, FAAHPM2,
and Lisa Rybicki, MS3

Abstract
Purpose: Evidence has demonstrated the positive effects of music therapy on symptom management for palliative medicine
patients. Previous studies have addressed patient needs, with limited discussion involving the relationship between interventions
utilized to improve symptoms. The purpose of this study was to understand the impact of music therapy sessions; identify
common music therapy goals and interventions and assess their effect; and investigate the effects of gender, age, and type of
cancer on symptoms in patients who experienced music therapy. Methods: This was a retrospective study of data collected
during music therapy sessions. Patients scored their symptoms (pain, anxiety, depression, shortness of breath, and mood) before
and after sessions. Data collected from over 1500 patients included symptom evaluation, goals, interventions, music used, patient/
family reactions, and narratives. Results: Among 293 patients who met all study inclusion criteria, significant improvement in pain,
anxiety, depression, shortness of breath, mood, facial expression, and vocalization scores was noted. In addition, 96% of patients
had positive responses to participating in music therapy. Vocal and emotional were the 2 most effective interventions in improving
symptoms. All 5 patient-reported symptoms improved when the therapist focused on these symptoms as goals. Age, gender, and
diagnosis had no impact on symptom improvement. Conclusions: This study demonstrated the importance of music therapy for
addressing symptoms and behaviors of palliative medicine patients. Statistically and clinically significant effects were noted. The
most effective interventions were identified. More research needs to be conducted to better understand the benefits of music
therapy for palliative medicine patients.

Keywords
music therapy, palliative medicine, symptoms, pain, anxiety, mood

Introduction comfort, relaxation, and shortness of breath in palliative med-

Music has been used in treating patients since biblical and
ancient days of Plato, Hippocrates, and Alpharabius.1 It was
used by Native Americans to address mood, spirituality, emo-
tional disturbances, neurological disorders, and unhealthy
souls, and it was used from the Middle Ages through the
17th century for its preventative, curative, and psychological
value.1,2 More recently, it has been used by music therapists to
help address patients’ social, physical, emotional, psychologi-
cal, and spiritual needs.3
Music therapy is an evidence-based practice in which board-
certified music therapists (MT-BCs) work within a therapeutic
relationship to address patients’ individualized goals.4 Kordo-
van et al5 found that music therapy was rather or very helpful in
68% of the patients on their inpatient palliative care unit and
that those who died there indicated they drew strength from
music therapy (P ¼ .0007). Research has demonstrated the
effectiveness of music therapy in addressing pain, fatigue,
icine patients.2,3,6-14 It has also addressed anxiety, depression,
sadness, grief, hope, stress/distress, and mood.2,3,6-14
Music therapy has been used in palliative medicine to
enhance quality of life; communication; coping; and expres-
sion of feelings such as fear, loneliness, anger, and isola-
tion.2,3,5-15 Finally, it has been used to support patients and
families during the actively dying process.6,12 Any of these
physical, social, psychological, emotional, and spiritual needs
may be addressed by music therapists.
1
Cleveland Clinic, Arts and Medicine Institute, Lyndhurst, OH, USA
2
Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
3
Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
Corresponding Author:
Lisa M. Gallagher, MA, MT-BC, Cleveland Clinic Arts & Medicine Institute,
1950 Richmond Rd/TR308, Lyndhurst, OH 44124, USA.
Email: gallagl@ccf.org
2 American Journal of Hospice & Palliative Medicine® 00(0)
Music therapy interventions have included music-assisted
imagery, instrument playing, music listening, choosing songs,
music-assisted relaxation/imagery, singing, musical life
review, song-writing, entrainment, lyric analysis, improvisa-
tion, and verbal processing.2,5,8,9 These interventions can com-
monly be categorized as receptive, recreative, creative, or
combined, and the patient’s participation level depends upon
his or her level of energy and symptom management at the time
of the session.2,6,9
Gutgsell et al9 used 1 intervention of live music paired with
autogenic relaxation exercises guided by the MT-BC. Patients
who regularly sang, previously played an instrument, previ-
ously participated in music therapy, or significantly felt music
played a role in their lives appeared to benefit more from active
music therapy; however, there was no significant correlation
between any of these factors and the intervention that was
chosen.5
An active music therapy program has been in place since
1994 on the Harry R. Horvitz Center for Palliative Medicine at
the Cleveland Clinic where music therapy is offered free of
charge. A rich database has been collected since the beginning
of the program with our past studies demonstrating that music
therapy is effective in improving anxiety, depression, mood,
pain, shortness of breath, facial expression, body movement,
and verbalization.7,8 However, the effects of patient character-
istics, patient goals of music therapy, and music therapist inter-
ventions have not been studied in depth relative to these
outcomes. This study was designed to address this gap.
The objectives of this study were (1) to describe patient
characteristics, patient goals, and interventions used by the
music therapist; (2) to assess the impact of music therapy ses-
sions on outcomes; and (3) to identify which patient character-
istics, goals, and interventions had an effect on outcomes.
Patient-reported outcomes included changes in pain, depres-
sion, anxiety, shortness of breath, and mood before and after
the music therapy session. Therapist-reported outcomes
included changes in facial expression, body movement, and
vocalization.
Methods
Participants
This study was approved, and a waiver of informed consent
granted, by the institutional review board at The Cleveland
Clinic. All procedures followed were in accordance with the
Helsinki Declaration of 1964 and its later amendments or com-
parable ethical standards.16 Patients included those admitted to
the Horvitz Center and those followed by the Palliative Med-
icine consult service on other acute inpatient units at the Cleve-
land Clinic. This was a retrospective study of data obtained
from music therapy sessions with these patients held between
September 2000 and May 2012. These data can be accessed as
necessary by the authors upon request. All palliative medicine
patients were eligible to receive music therapy sessions. They
could request it themselves or could be referred by physicians,
nurses, social workers, physician assistants, chaplains, nursing
assistants, music therapists, psychologists, and/or family mem-
bers. Data collected was entered into a password-protected
database on a secured drive on the hospital computer. During
the data analysis stage, the data were downloaded into an Excel
spreadsheet and deidentified in order to maintain patient anon-
ymity and confidentiality.
Sessions/Procedures
One of the board-certified music therapists (MT-BCs) who
worked on the palliative medicine unit conducted a music ther-
apy session with individual palliative medicine patients and
any family members present. More than 1 goal may have been
addressed per session. A variety of interventions were used,
with more than 1 being utilized in the majority of sessions.
These interventions were consolidated into 6 main categories:
music listening, verbal/cognitive participation (eg, music dis-
cussion, choices, songwriting, etc), vocal participation (eg,
singing and humming), physical participation (eg, playing
instrument, clapping, tapping foot, etc), verbal/emotional par-
ticipation (verbal processing, musical life review, lyric analy-
sis, etc), and music-assisted relaxation. Live, patient-preferred
music was utilized in the majority of the sessions. Our experi-
ence and the literature have suggested that patient-preferred
music has the best effect for patients.15,17
Data Collected
Data collected on all patients who agreed to participate in
music therapy was included in the music therapists’ clinical
notes in the patients’ medical records and was documented in
a computerized database on a secured drive utilizing FileMaker
Pro (FileMaker, Inc, Santa Clara, CA, USA).18 This clinical
database was created prior to the implementation of electronic
medical records. Data included the standardized music therapy
assessment, elements of the standardized music therapy clinical
note, patient-related information (Table 1), patient goals for the
music therapy session, interventions used by the music thera-
pist, symptom evaluations from the patient, behavioral evalua-
tion from the music therapist, music used, patient and family
member reactions, and narratives. Specifically, patient-related
information included age, gender, diagnosis, reason for refer-
ral, and referral source. Symptom evaluations from the patient
included pre- and postsession severity of pain, depression,
anxiety, and shortness of breath, all of which were rated on a
0- to 10-point scale and mood which was rated on a 0- to 4-
point scale based on the Rogers Happy/Sad Faces Assessment
Tool.19 The music therapist scored 3 behavior variables on a 0-
to 3-point scale before, during, and after the music therapy
session (facial expression, body movement, and vocalization)
based on the Nursing Assessment of Pain Intensity20 and the
Riley Infant Pain Scale.20 For all of these assessments, higher
scores represent worse outcomes. The outcome measures were
used in prior studies, but they have not yet been validated.
Gallagher et al 3

Table 1. Patient and Music Therapy Characteristics. Statistical Considerations

Study (293) Categorical variables are described using frequency counts and
percentages and continuous variables using mean, standard
Variable n %
deviation, median, minimum, and maximum. Limited demo-
Age, years graphic comparisons were made between 293 study patients
Mean + SD 60 + 15 and 254 who were excluded for incomplete outcome data to
Median (range) 61 (20-89) make sure there were no apparent exclusion biases and were
Gender found to be similar (P ¼ .90 age, P ¼ .55 gender, P ¼ .67
Female 196 66.9 diagnosis; results not otherwise shown). Changes in the 5
Male 97 33.1
Diagnosis category (top 7 listed)
patient-reported outcomes and 3 therapist-reported outcomes
Lung cancer 47 16.0 before and after the music therapy session were compared
Hematologic cancer 42 14.3 using the paired t test. Multiple linear regression analysis was
Breast cancer 38 13.0 used to assess the effect of gender, age, type of cancer, goals,
Gastrointestinal cancer 35 11.9 and interventions on the change in each of the 8 outcome
Genitourinary cancer 27 9.2 scores. For the purpose of this analysis, diagnosis was categor-
Gynecologic cancer 22 7.5 ized as cancer of not cancer, while goals and interventions were
Noncancer diagnosis, ALS, sickle cell disease, 20 6.8
cardiovascular, chronic pain/RSD/fibromyalgia, categorized as present or absent. Goals or interventions occur-
liver disease/cirrhosis, ESRD, AIDS, bowel ring in <5% of patients were not included in the analysis.
obstruction, multiple sclerosis Regression results are reported as the parameter estimate and
Total number of goals addressed per session P value to indicate if the parameter estimate differs from 0,
1 17 5.8 where 0 represents no effect of the variable in question. Para-
2 41 14.0 meter estimates indicate the change in outcome score for each
3 68 23.2 variable. Because higher scores represent worse outcomes, pos-
4 72 24.6
5 72 24.6 itive parameter estimates indicate that the outcome score wor-
6 23 7.8 sened (increased) and negative estimates indicate that the score
Percentage of goals met improved (decreased). Clinical relevance is a topic of much
Mean + SD 81 + 26 debate, and previous authors have determined that it depends
Median (range) 100 (0-100) on how severe the initial rating is, how much of a change
Total number of interventions addressed per session occurs, and the patient’s perception of the change.21,22 There-
1 97 33.1
fore, we arbitrarily decided that a change of 2 points was
2 112 38.2
3 66 22.5 considered to be clinically relevant on variables measured on
4 16 5.5 a 10-point scale, and a change of 1 point was considered rele-
5 2 0.7 vant on variables measured on a 4-point scale. As another way
Specific interventions (more than 1 type possible) of summarizing outcome data, the 8 primary outcomes were
Music listening 282 96.2 described as the number and percentage of patients whose scores
Verbal/cognitive participation 88 30.0 improved, stayed the same, or worsened and as the number and
Vocal participation 87 29.7
percentage with clinically relevant improvement. Basic data
Verbal/emotional participation 1 27.6
Physical participation 39 13.3 description was conducted with the tools built into FileMaker
Music-assisted relaxation 16 5.5 Pro. All other analyses were done with SAS software (SAS
Institute, Inc, Cary, North Carolina). All statistical tests were 2
Abbreviations: ALS, amyotrophic lateral sclerosis; RSD, reflex sympathetic sided, and P < .05 was used to indicate statistical significance.
dystrophy; ESRD, end-stage renal disease.

Study Inclusion
The music therapy database contained 5970 music therapy ses-
sions from 1570 patients. Inclusion criteria for this study con-
sisted of patients being at least 18 years of age and having at
least 1 patient-reported rating of pain, depression, anxiety,
shortness of breath, or mood before and after the music therapy
session. Only the first session with data was included in this
study for patients who had more than 1 session. This inclusion
resulted in a total of 547 patients. Among these, 293 patients
had complete data on all primary outcomes measures and were
included in the data analysis.
Results
Patients were primarily female (67%), with a median age of 61
years and a cancer diagnosis (93%; Table 1). The most com-
mon diagnoses were lung cancer (16%), hematologic cancers
(14%), breast cancer (13%), and gastrointestinal cancer (12%).
The top 5 referral sources included social workers (32%), phy-
sicians (18%), physician assistants (13%), patient availability
(12%), and nurses (11%). In order of frequency the top 5 rea-
sons for referral included enjoyment (23%), anxiety, (16%),
pain (13%), depression (12%), and support (7%).
Of the 287 who identified their preferred style of music, 37
different styles were identified. The top 5 styles of music were
4 American Journal of Hospice & Palliative Medicine® 00(0)

gospel/religious (19%), various/any (16%), country western Table 2. Goals of Music Therapy (Ordered From Most to Least
(11%), semiclassical/ classical (8%), and jazz/Frank Sinatra Common).a
(8%). Other styles included rock various decades, musicals, Goal met
and hip hop. In addition to the religious music mentioned ear-
lier, Jehovah Witness and Jewish music were also utilized. Goal Yes Yes No Unknown
Various ethnic music used included polkas, Irish, Native Amer- Improve/maintain mood
ican, Brazilian, Spanish, and Filipino. N 243 200 40 3
Twenty total goals were identified in all patients (Table 2), % 82.9 82.3 16.5 1.2
with individual patients having 1 to 6 goals (Table 1). The Decrease perception of pain
N 164 93 68 3
music therapist documented whether goals were met, but if
% 56 56.7 41.5 1.8
unknown, they were considered to be unmet. One to 5 inter- Decrease anxiety
ventions were utilized per session, with at least 1 or 2 being N 141 111 29 1
utilized in 71% of sessions (Table 1). % 48.1 78.7 20.6 0.7
There were statistically significant reductions (improve- Decrease depression
N 103 78 25 0
ments) in pre- to postsession mean scores for all measurements % 35.2 75.7 24.3
except body movement (Table 3). However, the percentage of Decrease shortness of breath
patients reaching the clinical significance threshold ranged N 93 56 36 1
from 0.7% (body movement) to 66.2% (mood; Table 4). % 31.7 60.2 38.7 1.1
Self-expression/emotional release/emotional processing
Ninety-six percent of patients had a positive verbal response
N 85 83 1 1
to the session, with the remaining 4% having an ambivalent or % 29 97.6 1.2 1.2
no verbal response. Decrease stress/provide distraction
Twenty variables were included in multiple linear regres- N 55 52 3 0
sion analysis to determine their effect on change in each of the % 18.8 94.5 5.5
Increase participation/interaction, leisure skills, mobility
8 scores (Tables 5 and 6). The most improvement in pain, N 54 51 3 0
depression, anxiety, shortness of breath, and mood was seen % 18.4 94.4 5.6
among patients who had each of these goals for their music Relaxation
therapy session. In addition, utilizing a vocal intervention also N 47 46 1 0
% 16 97.9 2.1
improved depression, anxiety, and mood while a verbal/emo- Comfort and solace/end of life issues/anticipatory grief
tional intervention improved mood. Facial expression signifi- N 34 34 0 0
cantly improved when vocal, emotional, and physical % 11.6 100
interventions were used. Vocalization significantly improved Enjoyment
when a verbal/emotional intervention was used and when dis- N 19 18 1 0
% 6.5 94.7 5.3
traction was a goal of music therapy. No variable was associ- Assessment
ated with body movement. The demographics and cancer N 12 11 0 1
diagnosis had no impact on outcomes. % 4.1 91.7 8.3
Increase positive family interaction
N 8 7 1 0
Discussion % 2.7 87.5 12.5
Increase coping skills: emotional, physical, combination
Music therapy was found to improve pain, anxiety, depression, N 7 7 0 0
shortness of breath, mood, facial expression, and vocalization % 2.4 100
at a statistically significant level (P < .001). The variables with Increase acceptance of music therapy/music therapist
N 7 7 0 0
the highest percentage of patients reaching a clinically relevant % 2.4 100
improvement were mood, vocalization, and facial expression. Decrease nausea
These results were consistent with our previous findings.7,8 N 6 4 2 0
Although results were positive overall in addressing numer- % 2 66.7 33.3
Increase cognition/orientation/decision-making/alertness
ous goals with various interventions while attempting to N 6 6 0 0
improve 8 variables, some results were more positive than % 2 100
others. Based on the findings it can be concluded that vocal Increase self-esteem
and verbal/emotional interventions have the most impact on N 3 3 0 0
improving symptoms. It was found that mood, pain, anxiety, % 1 100
Decrease restlessness
depression, and shortness of breath all improved when the MT- N 1 1 0 0
BC specifically focused on these symptoms as goals. % 0.3 100
In addition, the music therapists on the palliative medicine Increase/maintain comfort (physical)
unit were often called in to assist with patients who were hav- N 1 1 0 0
% 0.3 100
ing extreme pain or who were having difficulty expressing their
emotions. The music therapist was often seen as someone in a
N ¼ 293.
Gallagher et al 5

Table 3. Continuous Assessment of Score Changes.a Table 4. Categorial Summary of Score Change.a

Scale Mean SD Median Minimum Maximum P value Any Change

Pain (scored 0-10) Scale Better Same Worse CRI

Before 2.8 3 2 0 10 -
After 2.2 2.6 0 0 10 Pain
Change 0.6 1.4 0 8 2 <.001 N 95 185 13 57
Depression (scored 0-10) % 32.4 63.1 4.4 19.5
Before 2.1 3.2 0 0 10 - Depression
After 1.3 2.3 0 0 1 N 81 207 5 57
Change 0.8 1.9 0 10 6 <.001 % 27.6 70.6 1.7 19.5
Anxiety (scored 0-10) Anxiety
Before 2.7 3.2 0 0 10 - N 110 175 8 78
After 1.7 2.6 0 0 10 % 37.5 59.7 2.7 26.6
Change 1 1.8 0 10 6 <.001 Shortness of breath
Shortness of breath (scored 0-10) N 55 226 12 36
Before 1.6 2.7 0 0 9 - % 18.8 77.1 4.1 12.3
After 1.1 2.2 0 0 9 Mood
Change 0.5 1.5 0 8 4 <.001 N 207 78 8 194
Mood (scored 0-4) % 70.6 26.6 2.7 66.2
Before 1.6 1 2 0 4 - Facial expression
After 0.7 0.8 0.5 0 4 N 163 127 3 163
Change 0.9 1 1 4 3 <.001 % 55.6 43.3 1 55.6
Behavior: facial expression (scored 0-3) Body movement
Before 0.9 0.5 1 0 2 - N 2 291 0 2
After 0.4 0.5 0 0 2 % 0.7 99.3 0.7
Change 0.6 0.6 1 2 1 <.001 Vocalization
Behavior: body movement (scored 0-3) N 172 118 3 172
Before 0 0.1 0 0 1 - % 58.7 40.3 1 58.7
After 0 0.1 0 0 1
Abbreviations: Better, any score decrease; Same, no change; Worse, any score
Change 0 0.1 0 1 0 .16 increase; CRI, clinically relevant improvement (see text for definition).
Behavior: vocalization (scored 0-3) a
N ¼ 293.
Before 0.8 0.5 1 0 2 -
After 0.2 0.4 0 0 2
Change 0.6 0.6 1 2 1 <.001
There are, however, some limitations. One is the use of
a
N ¼ 293. observational behavioral data, which could be considered
biased as it is based on the therapist’s opinion. Although only
1 MT-BC worked on the unit at 1 time, and all were trained by
which patients could easily confide, as they did not wear white the original MT-BC, it is possible that they did not all interpret
coats and brought something aesthetically pleasing into the their observations in the same manner, and interrater reliability
room. It was also noted on many occasions by the staff of the of the rating scales was not assessed. We collected data across a
unit that once patients worked on difficult emotional or exis- wide range of years, during which standards of care in pallia-
tential issues with the music therapist their physical pain often tive medicine have evolved. On the other hand, this time range
decreased. These anecdotal observations, combined with allowed us to achieve a larger sample size. The MT-BC col-
aggregate outcome data, strongly suggest that MT should be lected the pre- and postsession data, which could also be con-
an integral part of the palliative care team. sidered biased. If the MT-BC felt the patient was trying to skew
This study is the largest of its kind in utilizing music therapy the results, she would tell the patient she was looking for honest
to address symptom management in palliative medicine. The responses even if they did not appear favorable. Although this
study is unique, however, in that for the first time the results form of data collection may increase the opportunity for bias, it
were compared to age, gender, diagnosis, interventions, and is realistic for clinical practice.
goals and that some of the results were significant at P  Another limitation is missing data in patients who experi-
.05. This supports that while we take age, gender, and diagnosis enced severe pain or high anxiety, were actively dying, had
into consideration, what we are doing is working and we do not fallen asleep, or sessions were interrupted. Although the MT-
need to do anything different based on these variables. Specific BC often hung a sign on the door indicating that a music ther-
intervention categories were identified and their effectiveness apy session was in progress, sessions were still interrupted by
in meeting specific goals was ascertained. This study contains a patient transporters, physical therapists, nurses, and physicians.
large amount of data, calculated utilizing different methods in Many interruptions were brief and sessions could continue;
order to pinpoint the findings and identify the clinical and however, many took several minutes. Although this sometimes
statistical significance of the results. negatively affected the postsession data, it often provided an
6 American Journal of Hospice & Palliative Medicine® 00(0)

Table 5. Multiple Linear Regression Models for Pain, Depression, Anxiety, and Shortness of Breath.a

Pain Depression Anxiety SOB

Variable Estimate P value Estimate P value Estimate P value Estimate P value

Demographics
Age 0.005 .35 0.003 .79 0.003 .64 0.007 .23
Female 0.03 .86 0.2 .34 0.07 .73 0.13 .5
Diagnosis
Cancer 0.08 .8 0.17 .65 0.31 .41 0.1 .78
Interventions
Listen 0.5 .24 0.6 .25 0.4 .43 0.45 .34
Cognitive 0 .99 0.49 .024 0.07 .74 0.15 .44
Vocal 0.16 .41 0.59 .015 0.53 .025 0.08 .7
Emotional 0.02 .95 0.41 .15 0.1 .72 0.39 .12
Physical 0.14 .55 0.01 .98 0.19 .52 0.03 .92
Relax 0.08 .82 0.58 .19 0.39 .36 0.31 .43
Goals
Mood 0.03 .89 0.12 .67 0.09 .74 0.19 .44
Pain 1.11 <.001 0.22 .31 0.41 .046 0.08 .66
Anxiety 0.05 .77 0.2 .36 1.98 <.001 0.27 .17
Depression 0.32 .07 2.33 <.001 0.05 .82 0.19 .34
SOB 0.27 .11 0.17 .41 0.22 .29 1.62 <.001
Self-expression 0.04 .85 0.57 .041 0.19 .48 0.4 .11
Distraction 0.03 .87 0.1 .68 0.21 .39 0.14 .54
Participation 0.35 .14 0.59 .046 0.4 .16 0.08 .75
Relaxation 0.03 .88 0.45 .09 0.04 .87 0.17 .49
Comfort 0.12 .65 0.37 .25 0.27 .38 0.17 .55
Enjoyment 0.52 .1 0.44 .26 0.43 .25 0.07 .84
Abbreviation: SOB, shortness of breath.
a
N ¼ 293.

Table 6. Multiple Linear Regression Models for Mood and Behavior.a

Mood Facial Expression Body Movement Vocalization

Variable Estimate P value Estimate P value Estimate P value Estimate P value

Demographics
Age 0.001 .79 0.003 .19 0 .87 0.004 .1
Female 0.06 .6 0.03 .64 0.01 .6 0.04 .58
Diagnosis
Cancer 0 .99 0.12 .39 0.01 .54 0.08 .57
Interventions
Listen 0.11 .71 0.2 .27 0.01 .76 0.06 .73
Cognitive 0.06 .62 0.18 .02 0.01 .2 0.31 <.001
Vocal 0.4 .004 0.19 .028 0.02 .19 0.04 .67
Emotional 0.39 .015 0.22 .024 0.02 .16 0.2 .049
Physical 0.18 .28 0.3 .004 0.01 .72 0.1 .37
Relax 0.27 .29 0.13 .42 0.01 .84 0.13 .41
Goals
Mood 0.93 <.001 0.08 .4 0.01 .36 0.14 .15
Pain 0.08 .53 0.08 .27 0.02 .09 0.11 .15
Anxiety 0.01 .96 0.03 .67 0.02 .13 0.03 .72
Depression 0.11 .38 0.03 .69 0.01 .46 0.04 .57
SOB 0.04 .75 0 .97 0.01 .43 0.06 .45
Self-expression 0.19 .24 0.02 .85 0.02 .1 0.03 .78
Distraction 0.02 .86 0.07 .41 0.02 .16 0.19 .039
Participation 0.17 .32 0.01 .9 0.01 .42 0.16 .13
Relaxation 0.13 .41 0.09 .34 0.02 .09 0.01 .91
Comfort 0.05 .77 0.01 .93 0.01 .68 0.09 .43
Enjoyment 0.1 .65 0.11 .41 0.01 .63 0.14 .3
a
N ¼ 293.
Gallagher et al
opportunity for the patient to express feelings and process what
was happening. There were also times when it was difficult or
inappropriate to initiate the use of the scales such as when the
patient was reluctant, confused about the scales, or stated they
did not have the symptoms.
The 10-point scales were utilized for ease of use and patient
understanding. Further research could validate these scales
against existing validated scales for anxiety, depression, and
so on. Other research is needed regarding the cost-effectiveness
and duration of effect of music therapy as well as more in-depth
look at the specific interventions used to address goals. Due to
the possible impact of music therapy on patients in palliative
medicine, it is necessary for more research to be conducted
regarding the efficacy and value of music therapy to the insti-
tution, the patient, and the patient’s family.
Conclusion
This study demonstrated the importance of music therapy for
addressing symptoms and behaviors of palliative medicine
patients. There was a positive effect on pain, anxiety, depres-
sion, shortness of breath, mood, facial expression, and verba-
lization. In addition, the connection between the effect on
change in each of the variables as compared with age, gender,
diagnosis, goals, and interventions was identified. This will be
an important addition to the literature. Based on these, as well
as our previous findings, it is recommended that music therapy
be utilized in palliative medicine settings to aid in symptom
management.
Authors’ Note
The authors had full access to all of the data in this study, and we take
complete responsibility for the integrity of the data and the accuracy of
the data analysis.
Acknowledgments
The authors wish to acknowledge Dr Francois Bethoux for his support
and help; Maria Jukic for her support; and the various music therapists
and music therapy interns who conducted the music therapy sessions
for our patients.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: The authors
wish to thank The Kulas Foundation and the Jack Belcher Music
Therapy Fund for financial support which made this research possible.
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