As a music therapist I am privileged to work with children and young people with life-limiting conditions and their families to explore music-facilitated experiences in deep and meaningful ways where words often fail. This blog will hopefully provide insight into what a music therapist does when working in paediatric palliative care.

What is music therapy?

Music therapy is an allied health research-based profession practiced worldwide. Music therapists apply creative and professionally informed music to support health, functioning and wellbeing of people of any age. [1]

We know music is a human phenomenon so, why use music in health? Internationally, music therapy is a growing modality in medical settings. Music is also the only sensory experience that can activate all areas of the brain simultaneously. [2] Neurologist Oliver Sacks (2008) described music as an innate human ability and a universal human characteristic that is retained by people with severe cognitive deficits. The elements of music rhythm, melody, harmony, dynamics, timbre, and form address our basic sensory needs.

Music therapy in paediatric palliative care

Integrated palliative and medical care is recommended for children with life-limiting conditions. The past two decades have seen the rapid development and growth of specialised paediatric palliative care (PPC) services in Australia. Music therapy is regarded as an integral part of PPC, with its capacity to provide comfort; ameliorate distress and provide adaptive coping and wellbeing; provide opportunities for fun, and improved quality of life. [3-5] Music therapy also provides opportunity for choice and control; enables bonding between parent and child; and facilitates stimulation and relaxation, enhances communication and fosters positive experiences for children and their families. [6-8] Music therapy is used primarily in PPC to enhance quality of life and provide non-pharmacological support to symptom management.

Many PPC services offer music therapy as a component of an integrated multidisciplinary team. Music therapists may begin at any point along the illness trajectory with sessions in hospital, at home or through a specialist children’s hospice. We also provide consultation and provision of therapeutic resources, both for inpatients and in-home settings. Music therapy can provide a model of interaction in which the whole family can participate and further replicate independently at other times. In this context, I often arrive prepared to engage in music interventions with the whole family unit. Through music I can tap into the sense of feeling within the family and in the room then use music therapeutically to meet the needs of the child or young person and their family. In this context, music therapy has the capacity to offer joy and meaning to the child and family, and potentially help to alleviate suffering which is a major goal of PPC. [9-11]

How music therapists work

Referral to and engagement with a music therapist can vary widely. I might see a patient for a single-session intervention or deliver programs that continue regularly or sporadically from months to years. Realistic goals and expectations are developed together with the child and family.

My therapeutic role involves using music and all its elements to engage with the child or young person and/or family to. [12-13]

• Assist with management of symptoms such as pain, tension, fatigue, anxiety, delirium, depression, spiritual needs, and the ability to cope. For example, in order to assist in alleviating pain, I might use low arousal music - gentle guitar and humming. Direct physiological response to music can alter neural components of pain sensation and this type of music is associated with a relaxation response and pain reduction.
• Assist to maintain function or adaptation to decreasing function
• Facilitate spiritual connection by experiencing pleasure, “normalcy”, creativity, and community, by singing or discussing lyrics of favourite songs with a teenager with life-limiting conditions
• Create recordings and songs as a legacy for family and friends. These experiences can become meaningful memories for the family after the child has died. [11]

Even now sometimes I watch the videos (of music therapy) because, it makes me, you know be healing… it is sad but sometimes it (video of music therapy) reminds me of enjoying those times.’ (Bereaved parent)

• Facilitate connection with others and reduce isolation, including for the cognitively impaired. Music offers expanded opportunities for aesthetic experience and meaningful communication through its capacity to activate more areas of preserved neural function
• Collaborate with the care team to promote best outcomes
• Support expression of grief and bereavement.

Music therapy has potential to contribute significantly to the quality of life for patients and their families. Music therapy is a pivotal ingredient to bring comfort, resolution and spirituality; and in providing a compassionate space for a family’s transition to the changing interpersonal connection after death.

References

1. Australian Music Therapy Association. What is Music Therapy [Internet]. 2012 [cited 2020 Feb 27]. 
2. Sacks OW. Musicophilia. 1st ed. New York: Knopf; 2007.
3. The contribution to palliative care of allied health professions. In: Watson MS, Ward S, Vallath N, Wells J, Campbell R, editors. Oxford Handbook of Palliative Care. 3rd ed. Oxford: Oxford University Press; 2019.
4. Daveson BA, Kennelly J. Music Therapy in Palliative Care for Hospitalized Children and Adolescents. J Palliat Care. 2000 Spring;16(1):35-8.
5. Hilliard RE. Music therapy in paediatric palliative care: complementing the interdisciplinary approach. J Palliat Care. 2003 Summer;19(2):127-32.
6. Amadoru S, McFerran K. The role of music therapy in children’s hospices. Eur J Palliat Care. 2007 14(3): 124-127
7. Duda L. Integrating music therapy into paediatric palliative care. Progress in Palliative Care. 2013 12(2), 65-77
8. Lindenfelser KJ, Hense C, McFerran, K. Music therapy in paediatric palliative care: family-centred care to enhance quality of life. Am J Hosp Palliat Care. 2012 May;29(3):219-26. doi: 10.1177/1049909111429327. Epub 2011 Dec 4.
9. McConnell T, Porter S. Music therapy for palliative care: A realist review. Palliat Support Care. 2017 Aug;15(4):454-464. doi: 10.1017/S1478951516000663. Epub 2016 Oct 24.
10. Schmid W, Rosland JH, von Hofacker S, Hunskar I, Bruvik F. Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review. BMC Palliat Care. 2018 Feb 20;17(1):32. doi: 10.1186/s12904-018-0286-4.
11. O’Callaghan C. Music therapy in palliative care. In: Cherny N, Fallon M, Kaasa S, Portenoy RK, Currow DC, editors. Oxford Textbook of Palliative Medicine. 5th ed. Oxford: Oxford University Press; 2015.
12. O’Callaghan CC, McDermott F, Hudson P, Zalcberg JR. Sound continuing bonds with the deceased: the relevance of music, including preloss music therapy for eight bereaved caregivers. Death Stud. 2013 Feb;37(2):101-25.
13. Stegemann T, Geretsegger M, Phan Quoc E, Riedl H, Smetana M. Music Therapy and Other Music-Based Interventions in Pediatric Health Care: An Overview. Medicines (Basel). 2019 Feb 14;6(1). pii: E25. doi: 10.3390/medicines6010025.

Angela Delaney, Allied Health Clinical Education Coordinator in Paediatric Palliative Care at Children’s Health Queensland Hospital and Health Service

For more information relating to the role of music therapists in palliative care and relevant evidence visit the Music Therapist page in the CareSearch website.