Evidence Based Practice Project

“Effect of music therapy on pain and anxiety levels of cancer patients: a pilot study” article review

Background

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In their article, Krishanswamy & Nair (2016) identify that the pain associated with cancer has been considered to negatively affect the quality of life of the affected individuals. Among the major effects that the article has highlighted, is the contribution of the anxiety levels to the patient. The advancements of the pain to higher levels over time has been noted to lead to psychological and physiological deterioration related to the disease. The article posits that there have been major advances with regard to pharmacological management of pain. However, it is clear that there is a need for a more holistic approach to pain management that can take into account different aspects such as health, physical, mental, spiritual, and emotional. It is on this basis that the article sought to investigate how this could be achieved through the use of music. In this case, the research was carried out to assess the effect of music therapy on pain scores and anxiety levels of cancer patients with pain. The purpose of the research is clearly stated. The background information provided helps one understand the nature of the problem and thereby, appreciate why the research was essential. 

Review of Literature

The author provided a review of literature from 14 articles. The literature review revealed that music has been for a long period considered to have therapeutic effects. A common belief that has been highlighted is that music can be effective in minimizing pain and anxiety. The various studies reviewed indicated that if music therapy could successfully be used to minimize cancer-related pain and anxiety, then it can be applied as a cost-effective approach to palliation to supplement the pharmacological measures (Myskja, & Lindbaek, 2000; McClean, Bunt, & Daykin, 2012; Huang, Good, & Zauszniewski, 2010). Similar studies had been carried out in the U.S. and UK and it was, therefore, important to extend the same in India where people are influenced by different cultural, economic, and social factors. 

Methodology

The study design for this research article is a quantitative study that entailed a comparative study of fourteen cancer patients who were on pain relief therapy. The patients were selected through the use of convenience sampling but randomly allocated to either test group or control group. The patients under the test category were placed under music therapy for 20 minutes while the control group was addressed for 20 minutes. The NRS scale was used to assess pain scores while Hamilton anxiety rating scale was used to establish anxiety scores before and after the study. 

Analysis

The study results were analyzed using student’s t-test. The use of student’s t-test allowed for comparison between the pre- and post-intervention data. A two-sample t-test was further used to make a comparison for the data acquired from the control and study groups

Researchers’ Conclusion

The authors of this article reached the conclusion that music therapy was observed to reduce the pain score of a patient who was on a normal palliative care reduction plan. It was also observed that the use of music therapy was more effective than normal talking to reduce the pain score. The article thereby, concludes that music therapy can be used as a non-pharmacological method to minimize cancer pain. 

The conclusion discussed above can be supported by other sections of the paper. In the background, the article had indicated the need to develop an approach of a therapy that could improve the condition of the cancer patients. In the section of the literature review, the article indicated that there was a common belief that music can be used to reduce pain and anxiety. The section on methods supports the conclusion reached by the researcher as it provided a comparative study to analyze the data. The student t-test used facilitated the conclusion that pain reduction was better achieved with music therapy. 

Protection and Consideration 

The researchers, in this case, have considered an ethical principle on informed consent. It was indicated that the researcher had acquired an informed consent from the subjects. It was only after gaining the informed consent that the subjects of the study were allocated into either the test group and control group. Another ethical principle the 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 may choose. The study period was another limitation since the number of therapy sessions was limited. 

Strengths and Limitations 

A major strength of this study was the study design, which involved a comparative analysis between a control group and a test group. This allowed making of a conclusion that the differences experienced were due to the intervention of music therapy. A key limitation facing 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. The sampling methods used during this research was convenience sampling, which affected the randomization of the selection of the respondent to be engaged in the research. 

Evidence Application 

The evidence presented in this research can be applied in the management of pain among cancer patients. It is revealed that a single session of music therapy is effective in significantly minimizing cancer pain when incorporated with standard palliative care for cancer patients with moderate to severe pain. The study findings inform the healthcare practitioners that music therapy can be considered as a nonpharmacological method of minimizing cancer pain.

“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 taking place 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 & health5(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 studies47(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 care22(3), 307-311.

Kaliyaperumal, R., & Subash, J. G. (2010). Effect of music therapy for patients with cancer pain. Int J Biol Med Res1(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 medicine18(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 raekke120(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 medicine9(6), 70.

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