Evidence-Based Practice Project

“Music therapy reduces the intensity of pain among patients with cancer.” Article Review

Background

Evidence indicates that most cancer patients suffer from pain. Patients suffering from cancer are known to be in need of home-based care and therapy. Among the patients’ needs that must be addressed is the management of complications such as pain. Pain affects a large proportion of cancer patients and poses various challenges in its management. Many patients experience severe afflictions and 20-90% have different degrees of pain. The pain among cancer patients is caused by different things such as tumor growth, side effects of treatment, surgeries or background diseases. People seeking medical professional’s assistance mainly complain of pain. Most treatments available have negative side effects on the body and mind. Analgesics are known to be potentially addictive and their use over a long period has side effects such as drug dependency, hypotension, weakening of vital functions, drowsiness, nausea, vomiting, and even shock. The methods have been observed to be time-consuming and costly. This highlights the needs for use of a non-pharmacological approach to relieving pain. Music therapy has been shown to use sound stimuli to minimize the level of pain.

Review of Literature

The researchers review six articles to inform on their study. It is noted that listening to music causes muscle relaxation, a distraction from pain, minimizes pain intensity, and decreased the transfer of pain impulses to the central nervous system (Lepage, Drolet, Girard, Grenier, & DeGagné, 2001; Hilliard, 2005). It has been indicated that listening to music may reduce the heart rate, enhance the depth of breathing and positively affect anxiety, depression, and pain (Bekhuis, 2009). The best thing about music therapy is that it can be used at home (Schmid, & Ostermann, 2010). It is indicated that music has been used as a therapeutic tool tracing back to hundreds or thousands of years. Inscriptions found in Egypt, Greece, China, India, and Rome reveal that music was considered a healing tool. It was noted that music has a calming effect and can be essential in minimizing the use of analgesics (Shaban, RasoolzadehN, & MoradAlizadeh, 2006). It is however noted that despite its effectiveness, it has not been adopted as a therapeutic intervention. It reveals that the exact effectiveness of music on reducing pain has not yet been established. Majority of previous studies have evaluated the analgesic efficacy of music in acute pain, however, cancer patients may frequently suffer from chronic pain (Archie, Bruera, & Cohen, 2013). This pointed to the direction of the study to ensure it explored the effects of music therapy on the intensity of pain among cancer patients through the use of visual analog scale. It also sought to establish the connection between demographic variables and pain intensity.

Methodology

The study was a quantitative design that used the semi-experimental approach. It involved the selection of 60 patients from Imam Khomeini teaching hospital of Urmia. The inclusion criteria used include patients aged 18-65 years, in stage one, two, or three cancer, literate, with no previous history of severe disorders, and who were diagnosed within the last three months. The patients included in the sample had soft tissue cancer, bone cancer, and leukemia. The subjects were divided into control and intervention group. Data was gathered using a demographic questionnaire and visual analog scale for pain intensity. Pain intensity levels were assessed – pre- and post-intervention were assessed using VAS. Patients in the intervention group listened to their favorite music for three days with an evaluation done daily. No music was played for the control group. The consumption of analgesic drugs and their type were also recorded for the two groups.

Analysis

The data collected was analyzed at the three-time intervals using SPSS software 13. The information was described using mean, SD. The statistical analysis that was carried out included t-test, Pearson correlation coefficient, and ANOVA. 

Researchers Conclusion

The researchers reached the conclusion that considering the positive effects of music on pain in cancer patients, healthcare providers can use music. Healthcare practitioners need to encourage patients to use it for enhancing the effects of analgesics, reduce the pain, and increase the quality of life. This conclusion is supported by the section on background that indicated that other pain management models were observed to be time-consuming and costly and, thus, indicated the need to develop another pain management approach. The researcher’s conclusion is supported by the literature reviewed that indicated that listening to music causes muscle relaxation, a distraction from pain, minimizes pain intensity, and decreased the transfer of pain impulses to the central nervous system. The statistical analysis methods used included student t-test, Pearson correlation coefficient, and ANOVA, which facilitated the conclusion that pain reducing was better achieved where music therapy was included.

Protection and Consideration

The researchers in this study adhered to an ethical principle on informed consent. It is indicated that the researchers only engaged the participants after they acquired the informed written consent from the participants. Another ethical principle that researchers needed to consider was confidentiality and anonymity. These principles are connected with rights of beneficence, respect for dignity, and fidelity. The ethical principle on anonymity seeks to protect the subject’s identity to avoid it being linked with personal identity. On the other hand, confidentiality aims at ensuring that the respondents are free to provide and withhold as much information as they want.

Strengths and Limitations

A major strength of this study was the study design, which involved a comparative analysis between a control group and test group. This allowed making of a conclusion that the differences experienced were due to an intervention of music therapy. A key limitation that faced the study is the use of small sample size. This is likely to have affected the generalizability of the results to the entire population of cancers patients. Another limitation that the researchers noted was the short follow-up methods on the participants and thus it affects how to differentiate the difference in the result as being caused by the intervention.

Evidence Application

The evidence presented in this research can be applied in practice in the management of pain among cancer patients. It is revealed that listening to one’s favorite type of music as part of music therapy is effective in significantly minimizing cancer pain and the healthcare practitioners need to collaborate with the patients to determine their favorite music. The study findings inform the healthcare practitioners that music therapy can be considered as a nonpharmacological method of minimizing cancer pain.

References

Archie, P., Bruera, E., & Cohen, L. (2013). Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature. Supportive Care in Cancer, 21(9), 2609-2624.

Bekhuis, T. (2009). Music therapy may reduce pain and anxiety in children undergoing medical and dental procedures. Journal of Evidence-Based Dental Practice, 9(4), 213-214.

Hilliard, R. E. (2005). Music therapy in hospice and palliative care: a review of the empirical data. Evidence-Based Complementary and Alternative Medicine, 2(2), 173-178.

Lepage, C., Drolet, P., Girard, M., Grenier, Y., & DeGagné, R. (2001). Music decreases sedative requirements during spinal anesthesia. Anesthesia & Analgesia, 93(4), 912-916.

Schmid, W., & Ostermann, T. (2010). Home-based music therapy-a systematic overview of settings and conditions for an innovative service in healthcare. BMC health services research, 10(1), 291.

Shaban, M., RasoolzadehN, M. A., & MoradAlizadeh, F. (2006). Effectiveness of non-pharmacological methods) PMR and music therapy) on pain in patients with cancer. Life, 12(3), 63-72.

“Music as a method of coping with cancer: A qualitative study among cancer patients in Sweden” Article Review

Background

The article by Ahmadi (2013) highlights the background information by examining the effects of receptive interventions such as listening to music, music, and imagery, or a mixture of different music therapies. Such therapies have been indicated to lead to outcomes such as reduction in pain and nausea, enhancement of mood, and improvement of the quality of life among cancer patients. The article indicates that there is a need for more investigation to identify how music may be used as a coping mechanism, especially from a patient’s perspective. The authors have described the problem in a manner that is easily understandable. They have clearly outlined why the research is important.

Review of Literature

To inform their research, the authors used about 11 previous studies. Majority of the articles reviewed had examined the effects of a receptive intervention. The results indicated that music and music therapy, yielded outcomes such as reduced pain and nausea, improved mood, and increased quality of life among cancer patients (Bradt, Dileo, Grocke, & Magill, 2011; Cassileth & Gubili, 2009; Daykin, McClean, & Blunt, 2007; Hart, 2009; Kaliyaperumal & Gowri Subash, 2010; Magill, 2009; Nainis et al., 2006; Sahler, Hunter, & Liesveld, 2003). A number of studies have revealed that music is beneficial in enhancing the well-being of cancer patients. Only a number of countries have been noted to have integrated the use of music into care delivery. The review of the literature led to the revelation that the reason for slow adoption of the therapy in healthcare could be the perception of patients who are noted to be uncomfortable engaging in music therapy as an intervention. This prompted the need to understand how music could be adopted as a coping method among cancer patients. Coping is defined as a mechanism that can be applied to deal with or prevent stress. It is regarded as a process of managing the differences between the demands of the circumstances and the available resources. A coping mechanism has been noted to have the potential to change a stressful issue and managing an emotional response.

Methodology

The research design used for this research was qualitative design. It followed the qualitative research subtype of the grounded theory approach. The research involved the selection of a sample of 17 cancer patients aged between 24 and 73 years. The research was carried out using semi-structured interviews that were conducted using face-to-face interviews. The interviews were recorded and took an interval of one and two and a half hours. The interviews were mostly carried out at the respondent’s residence with a few happening at their workplace. The recruitment of the respondent was by reaching out to the already established contacts within four cancer organizations in Sweden. The number of respondents to be involved in the research was established through the point of saturation principle. The principle requires that the interview procedure progress up to a point where no new themes emerge. After 15 interviews, the saturation point was attained but two more interviews were added to ensure that no new themes emerged.

Data Analysis

The interviews that had been recorded and transcribed were analyzed to identify themes and subthemes that were present. The first step in the data analysis process was coding, thematizing, and creating networks of different themes. The program used for coding was Altas Data Program, which is a qualitative Data Analysis Management system. This was followed by a verification process through counterchecking with the original interviews to ascertain that all relevant information was included in the thematic condensation. The above process progressed until there were no new emergent themes, which indicated that the saturation point had been reached. The final process of data analysis was to determine the essential features that make up different music that had been played to the respondents.

Researchers’ Conclusion

The conclusion of the study highlighted the impact of using music as a coping method during times of serious life crisis such as after cancer diagnosis. The types of music that were assessed included music of nature, healing music, religious music, cheerful music, and hard and heavy music. The music of nature was noted to provide the respondents with a feeling of belonging to an immense whole that allowed cancer patients to view problems as a natural part of life. Healing music was found to enhance the mind/body connection and assisted the patients to get in touch with their inner environment. Religious and cheerful music was found to enable the patients to acquire stability in their deep feelings. Hard and heavy music was found to enable the young cancer patients to manage their anger and regain their self-image. The nature of the music was found to be dependent on the perception of an individual. However, irrespective of the nature of music used, it was noted that music generally played an essential role as a coping mechanism for cancer patients.

The conclusion is supported by other information provided in the other sections of the paper. The introduction part highlighted how music therapies have been known to cause outcomes such as a reduction in pain and nausea, mood enhancement, and improvement of the quality of life among cancer patients. The section of literature review observed how a number of studies have revealed the benefits of music in enhancing the well-being of cancer patients. The section on methodology supports the researcher’s conclusion as it included respondents who had used music as a coping mechanism to deal with their illness. The analysis led to the identification of the different types of music that the respondents had listened to and therefore, supported the conclusion that music, in general, had an impact as a coping mechanism among the cancer patients.

Protections and Considerations

It is important to note that the research had been approved by the regional ethics committee at Uppsala University. The researcher adhered to the informed consent as he made the respondents aware of the purpose of the study, its aims, and the research process to be applied. The respondents were also made aware that their privacy rights would be protected and they had the right to answer the questions that they only wished to answer. The participants of the research were issued with a letter of consent that informed them on how the collected data would be used and that the recordings would be destroyed after the study. The respondents were made aware that they had the right to withdraw at any point of the research process. The anonymity of the research respondents was also upheld.

Strengths and Limitations

A major strength of this research is in the analysis of the effects of different types of music as opposed to analyzing music in general terms. This assisted the researcher to identify that a specific type of music may have positive effects to a particular patient but have negative effects to another patient. This highlighted the importance of individuals factor in determining the effects of music as a coping mechanism. A major limitation of this study is the size of the sample and sampling technique. The sampling technique used affected the randomization of the respondents being selected. The small sample size presented a limitation of the study in terms of generalizability of the results to the large population.

Evidence Application

The research findings influence nursing practice as it informs on the type of music that nurses can incorporate as part of music therapy for different cancer patients. It requires the nurses to understand the individual characteristics that determine the type of music that is helpful to a patient. This mandated the nurses to understand the patient’s situation.

References

Ahmadi, F. (2013). Music as a method of coping with cancer: A qualitative study among cancer patients in Sweden. Arts & health, 5(2), 152-165.

Brandt J. Dileo C. Grocke D., Magill L. (2011). Music interventions for improving psychological and physical outcomes in cancer patients.  Cochrane Database of Systematic Reviews (Online). doi/10.1002/14651858.CD006911.

Cassileth B., Gubili J. Integrative oncology: Complementary therapies in cancer care. In: Ettinger D.S., editor. Supportive care in cancer therapy. Totowa, NJ: Humana Press; 2009. pp. 1–9

Daykin, N., McClean, S., & Bunt, L. (2007). Creativity, identity and healing: participants’ accounts of music therapy in cancer care. Health, 11(3), 349-370.

Huang, S. T., Good, M., & Zauszniewski, J. A. (2010). The effectiveness of music in relieving pain in cancer patients: a randomized controlled trial. International journal of nursing studies, 47(11), 1354-1362.

Krishnaswamy, P., & Nair, S. (2016). Effect of music therapy on pain and anxiety levels of cancer patients: a pilot study. Indian journal of palliative care, 22(3), 307-311.

Kaliyaperumal, R., & Subash, J. G. (2010). Effect of music therapy for patients with cancer pain. Int J Biol Med Res, 1(3), 79-81.

Magill, L. (2009). The meaning of the music: The role of music in palliative care music therapy as perceived by bereaved caregivers of advanced cancer patients. American Journal of Hospice and Palliative Medicine®, 26(1), 33-39.

McClean, S., Bunt, L., & Daykin, N. (2012). The healing and spiritual properties of music therapy at a cancer care center. The journal of alternative and complementary medicine, 18(4), 402-407.

Myskja, A., & Lindbaek, M. (2000). Examples of the use of music in clinical medicine. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke, 120(10), 1186-1190.

Sahler, O. J. Z., Hunter, B. C., & Liesveld, J. L. (2003). The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: a pilot feasibility study. Alternative therapies in health and medicine, 9(6), 70.