Music therapy – Background
Anne is a clinician at Calvary Health Care Bethlehem; patients are referred for music therapy by doctors, nurses and allied health staff. A common reason for the referral was that the patient was anxious. In Anne’s clinical experience music therapy was very effective in helping reduce anxiety in terminally ill patients. Anne designed her study to collect empirical evidence on the effect of music therapy. She compared a music therapy treatment with a control treatment. Patients were randomly assigned to receive one of the two treatments.
Music therapy treatment
The music therapy treatment was tailored for each patient. Anne worked with each patient to decide what kind of activities and interaction would be most appropriate. The music therapy included relaxation to music, listening to recorded music, singing and playing familiar music.
The control treatment was a single session with a volunteer from the hospital. The volunteer spent time with the patient discussing things of interest or importance to the patient. The volunteer had an empathetic and supportive role.
This measure is designed to indicate the degree of disease progression in a patient and evaluates his or her capacity to carry out activities of daily living, including the capacity to work and to care for oneself. The scale has six levels.
0 Fully active and able to carry out activities of daily living
1 Mobile and able to carry out light activities, including light work
2 Mobile, able to care for oneself but unable to work
3 Limited capacity to care for oneself; in a chair or bed for more than half the waking hours
4 Unable to care for oneself; in a chair or bed for the waking hours
Behavioural Observation Checklist
Anne developed this instrument for her study. She worked with other professionals working with patients in palliative care to devise a list of behaviours that could relate to underlying anxiety in these patients. The final checklist had 15 behaviours, such as shivering, muscle tensing, irritability and nausea. Health care professionals rated 14 of the 15 items on a scale from 1 indicating ‘not at all’ to 5 indicating ‘extreme’. Patients were asked to rate their own nausea on the same scale.
Edmonton Symptom Assessment System
The Edmonton Symptom Assessment System was used to assess nine different symptoms in patients in palliative care. The patients were asked to describe the intensity of each symptom on a visual analogue scale (VAS); Anne provided a scale with markings from 0 to 10. The VAS was 10cm long, so Anne measured the length of the scale to the mark made by the patient. Higher scores indicated higher intensity for a symptom.
The symptoms assessed were pain, tiredness, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath.
The patient’s heart rate was measured using a pulse oximeter. This is an instrument that clips to the patient’s finger (for example) and provides a read-out of his or her heart rate.
Bruera, E., Kuehn, N., Miller, M., Selmser, P., Macmillan, K. (1991) The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6-9.
Oken, M., Creech, R., Tormey, D., Horton, J., Davis, T., McFadden, E., Carbone, P. (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5, 649-655.