The experience and expectations of terminally ill patients receiving music therapy in the palliative setting: a systematic review.

BACKGROUND: Music therapy is a popular form of complementary therapy used in the hospice in Western countries, as people who are terminally ill have several needs arising directly from the disease process. In the area of palliative care, no systematic review has been conducted on the experience of patients using music therapy from the qualitative perspective. Hence, a synthesized summary of the experience of music therapy is presented.

OBJECTIVES: The aim of this review was to critically analyse and synthesize existing evidence related to terminally ill patients' experiences of using music therapy in the palliative setting.

INCLUSION CRITERIA: This review considered quantitative descriptive studies, and qualitative research with adult participants who were terminally ill receiving palliative care in a hospital, an in-patient hospice, a nursing home, or their own homes, regardless of their diagnosis who had undergone at least one music therapy session with a trained music therapist and were not cognitively impaired. Healthcare workers who have witnessed patients participating in music therapy were also included in the review.

SEARCH STRATEGY: Only published primary research studies were included in the review. This review was limited to papers in English. A three-step search strategy was undertaken. First, an initial limited search of CINAHL and MEDLINE was done. Second, an extensive search using all identified keywords and index terms across all included databases was done. Finally, a hand search of the reference lists and bibliographies of included articles was conducted METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI) for qualitative papers, and Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quantitative descriptive papers. Any disagreement that arose between the reviewers was resolved through discussion with a third reviewer.

DATA COLLECTION: Information was extracted by two reviewers from each paper using the Joanna Briggs Institute Qualitative Assessment and Review data extraction tool (QARI) for qualitative papers, and the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quantitative descriptive papers. Any disagreement that arose between the reviewers was resolved through discussion with a third reviewer.

DATA SYNTHESIS: Qualitative findings were pooled using the JBI-QARI while quantitative data were presented in narrative format.

RESULTS: A total of 10 studies were identified, and of these, 3 were included in the review. Only qualitative papers were included in the studies as the quantitative descriptive papers did not meet the inclusion criteria. Two synthesized findings were developed - "Music therapy should be used in palliative settings to promote social interaction and communication with family, friends, other patients, and healthcare workers", and "Music therapy should be promoted in palliative care setting to provide support for holistic needs of patients".

CONCLUSION: From the meta-syntheses of review, it was shown that patients experienced improved social interaction and communication with the people around them, and a more holistic care for as their physical, psychological and spiritual needs were met. No papers relating to the patients' expectations of music therapy was found.

IMPLICATIONS FOR RESEARCH: Further research should be conducted to explore the expectations of terminally ill patients with music therapy as no such paper was found from the systematic review. Quantitative studies to find out the effectiveness of music therapy in promoting social interaction and communication and in providing holistic care for patients can be done to quantify the findings. It can also be investigated if the quality of life of terminally ill patients improve after receiving music therapy, since music therapy has been found to have positive benefits for the patients. Also, qualitative studies that aim to find out the experiences of terminally ill patients through the interviewing of the patients should also be done, as the papers found either reported on the perception of healthcare providers, or through the analysis of patients' song lyrics.

IMPLICATIONS FOR PRACTICE: The use of music therapy should be encouraged in the palliative setting as the review has shown that music therapy is able to promote social interaction and communication with family members, healthcare workers and the people in their lives, and provides holistic care for patients by relieving physical symptoms, facilitating "moving on" to the next phrase of their life, improving their personal well-being, and providing an outlet for spirituality.