Gallagher, L.M., Lagman, R., & Rybicki, L. (2018). Outcomes of music therapy interventions on symptom management in palliative medicine patients. American Journal of Hospice and Palliative Care, 35, 250–257.

• To determine the impact of music therapy sessions on outcomes of pain, depression, anxiety, shortness of breath, and mood
• To understand which patient characteristics and goals and music therapist interventions had an effect on study outcomes

Data was collected on admitted palliative medicine patients receiving music therapy from September 2000 to May 2012. A board-certified music therapist (MT-BC) on the unit conducted music therapy sessions with individual palliative medicine patients and family members present. Multiple goals may have been addressed at a single session, using a variety of live patient-preferred musical interventions. Interventions included six main categories—music listening, verbal/cognitive participation, vocal participation, physical participation, verbal/emotional participation, and music-assisted relaxation. Symptom evaluations from patients included pre- and post-session severity of pain, depression, anxiety and shortness of breath. Data collected on patients included standardized music therapy assessment, elements of standardized music therapy, clinical note, patient related information, patient goals for the session, interventions used by the music therapist, symptom evaluations from patients, behavioral evaluations from the therapist, music used, patient and family member reactions, and narratives.

• N = 239   
• AGE: Average = 60 years; median = 61 years; range = 20-89 years
• MALES: 33.1%  
• FEMALES: 66.9%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: All palliative patients; diagnoses include lung cancer, hematologic cancer, breast cancer, gastrointestinal cancer, gynecologic cancer, ASL, sickle cell disease, cardiovascular, chronic pain/RSD/fibromyalgia, liver disease/cirrhosis, ESRD, AIDS, bowel obstruction, multiple sclerosis 
• OTHER KEY SAMPLE CHARACTERISTICS: Patients were included if they were 18 years or older, having at least one patient-reported rating of pain, depression, anxiety, shortness of breath, or mood before and after the music therapy session.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: The Cleveland Clinic (Ohio)

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Palliative care

This is a retrospective study of data collected on palliative medicine patients admitted from September 2000 to May 2012 who participated in music therapy sessions.

• Patient-reported severity of pain, depression, anxiety, and shortness of breath were all rated on a scale from 0 to 10 that was obtained pre- and post-music session.
• Patient-reported mood rated on a scale from 0 to 4 based on the Rogers Happy/Sad Faces Assessment Tool that was obtained pre- and post-music session.
• Music therapist-reported scores on facial expression, body movement, and vocalization based on a three-point scale before, during, and after the music therapy session based on the Nursing Assessment of Pain Intensity and Riley Infant Pain Scale.

Statistically significant reduction improvement in pre- and post-session mean scores were reported for all measurements (p < 0.001) except body movement (p = 0.16). However, the percentage of patients who achieved the clinical significant threshold ranged from 0.7% to 66.2%. Outcomes with the highest percentage of patients with clinically relevant improvement were mood (66.2%), vocalization (58.7%), and facial expression (55.6%). Only 12.3% of patients experienced any clinically relevant improvement. 96% of participants had an overall positive verbal response to the session versus 4% of participants that experienced an ambivalent or no verbal response. Patients who listed pain, depression, anxiety, shortness of breath, or mood as a goal for music therapy achieved the most improvement in these symptoms. Vocalization seemed to have significantly improved when verbal/emotional intervention was used and when distraction was a goal of music therapy. There was no impact on patient demographic or cancer diagnosis on outcomes.

Music therapy does appear to have a positive effect on symptoms of dyspnea and should be considered as an adjunct to current standard interventions. However, more research is needed to determine the degree of clinical benefit of music therapy in the improvement of dyspnea, as well as its cost-effectiveness and duration effect.

• Risk of bias (no control group)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement validity/reliability questionable
• Other limitations/explanation: Use of observational behavioral data (such as the music therapist-reported outcomes) could be biased as it relies on the therapist’s opinion. Therefore, inter-rater reliability of the rating scales was not assessed to account for multiple interpretations of various patient behaviors. Authors “arbitrarily” decided that a change of 2 points on a 10-point rating scale and a change in 1 point on a 4-point rating scale would be considered clinically relevant improvement of symptoms. The study results do not take into consideration the effects of session interruptions, patients with severe pain or high anxiety, actively dying, or those who had fallen asleep. Study also does not capture cost-effectiveness or duration effect of music therapy.

Music therapy should be considered as an adjunct to current standard interventions for dyspnea.