The Art of Music Therapy in Palliative Care
By Devon Phillips and Deborah Salmon
Music, with its intrinsic capacity for beauty and expression, has been employed
throughout time to convey the gamut of human emotion and experience, to
soothe and stimulate, and to speak directly to our hearts and souls.1
Christos, a patient at the Montreal General Hospital (MGH) palliative care unit,
has appreciated music all his life. He and his wife Ginette loved to go dancing.
Ginette describes the importance of music therapy as part of her husband’s endof-life of care.
“My husband likes it when the music therapists come because he likes music a
lot and he knows almost all the songs – oh yes! It’s very good therapy for
patients and for me too. Sometimes I become emotional, to hear him sing like
that but I know it makes him happy. He is at the end of his life and it feels good
when he sings. It brings back memories, nice times, nice songs, and the old
songs are the best. When the music therapist plays the guitar, you know he sings
with her, that’s joy. Yesterday the music therapist came with the flute – this music
is so lovely – it is like you are on a cloud and you are floating or you are flying.
The music helps him forget why is here. It makes him happy and that is the
important thing.”
The music therapist takes out her guitar and together she and Christos quietly
sing one of his favourite Simon and Garfunkel tunes, Mrs. Robinson. Although
Christos is weak and bedridden, the music lights up his face and he and his wife
are visibly transported by the music. In a whisper Christos says: “I like to sing
with her. The music is beautiful. I feel the music, I really feel it. Music gives me
chills”.
Music therapy has been an integral part of the McGill University Health Centre’s
Supportive and Palliative Care Service since the inception of palliative care at the
Royal Victoria Hospital in 1975. The Canadian Association for Music Therapy
defines music therapy as “the skillful use of music and musical elements by an
accredited music therapist to promote, maintain, and restore mental, physical,
emotional, and spiritual health.” 2
At the end of life, music therapy works well within a whole person care
philosophy, promoting a move from suffering toward wellness in the context of
dying. More specifically, music is employed to address various overlapping
areas of personhood - physical, psychological, spiritual and social.
The music therapist assesses each patient, first by attending team meetings and
reviewing patient charts to learn as much as possible about each patient,
including medical status, cognitive state, mood, and ability to cope. Then a music
therapy assessment is conducted with the patient: establishing rapport and
determining the patient’s musical preferences, musical history, and receptiveness
to music therapy. Where possible the therapist includes live music based on the
patient’s preferences, carefully observing the patient’s response. This allows the
music therapist, along with the patient, to determine if and how music could be
beneficial, and to tailor the therapy to the needs and wishes of each patient.
The benefits of music as a therapeutic tool are multiple and include pain and
anxiety control, relaxation, improved mood and coping, self-expression,
enhanced interaction and communication with loved ones, reduced isolation, life
review, and spiritual expression.
Music therapists draw on the remarkable flexibility of music to meet the needs
and preferences of individuals. After 30 years of work on the Palliative Care unit
of the Montreal General Hospital, music therapist Deborah Salmon describes
how she has seen first-hand how music enhances end-of-life care:
“Used well by a trained therapist, music can do many things including helping
people cope with pain. We use a lot of music-relaxation for pain and anxiety.
Music supports relationships between patients and families; it can really bring a
whole group together in a way that might otherwise be difficult. It also decreases
isolation for someone who is alone and provides shared pleasure for patients and
families at a difficult time. In music therapy, patients often choose songs that
express what might be difficult to put into words. The music may match or lift
one’s mood and support morale. And, of course, music promotes life review as it
evokes memories from other times and places...”
The MGH palliative care unit boasts a wide collection of CDS of music of every
genre from classical to country, and from around the world. Each room has a CD
player. A recording device, for patients who wish to record their music and/or
words, is available on the unit. Instruments used include guitar, piano and flute,
as well as small percussion instruments, and an ocean drum which simulates
soothing ocean sounds.
Musical elements (e.g. rhythm, melody, harmony, timbre and tempo) can be
manipulated to produce different sensations, designed to address the patient’s
needs at the time.
“When we are creating the music, we can make it fast, slow, lively, gentle. If we
want something with a rocking sensation, like a lullaby, we can choose music in
6/8 or 3/4 time so it has that rocking feeling. If someone is in pain, I might start
with a little more intensity and then slow down the tempo to help them relax, so
that’s where the live musician can play with the elements of music...and play the
music that is significant to that patient.”
Music and imagery is also employed to help patients access a sense, or a place,
of well-being. Deborah relates how music therapy helped a young, dying man
escape from the hospital environment to a happier time: “I asked, “if you could go
anywhere, now, what would be the most nourishing place you can imagine?
Sometimes the music helps us go somewhere more beautiful.” So he said, “Oh, I
would go to the beach and my sister would be there”. So I got the ocean drum
out, and I said let’s go, and there we are making ocean sounds. And so now he’s
on the beach with his sister and the kids and the dog so it’s a good memory, it’s
nourishing ..”
Music therapy is also employed to create legacy work. Patients can compose
their own music and they or the music therapist can perform and record the
music. Some patients select songs and record stories or anecdotes about their
life for loved ones, such as children and grandchildren, to keep after their
passing.
Music can also be used in very specific ways to help control pain and reduce
anxiety in what can be very distressing or painful circumstances. For example,
the music therapist worked with a patient undergoing a painful dressing change.
The patient engaged in singing and breathing to his preferred music to help direct
his focus away from the procedure and remain calm. It also allowed the nurse to
relax and complete her work quickly, knowing that her patient’s emotional needs
were being met.
Music can thus underscore people’s experience, add to the preciousness of this
special time, and help patients and those close to them create meaning at the
end of life.
Music therapy is an important part of the palliative care program at multiple
Palliative Care McGill sites including the Montreal General, Jewish General, St.
Mary’s and Mount Sinai hospitals as well as the West island Palliative Care
Residence.
References
1. Salmon, D. Endnotes: Music Therapy in Palliative Care. La Scena Musicale;
1994:10(1).
2. The Canadian Association of Music Therapy (CAMT).
http://www.musictherapy.ca
Resources
1. Dileo C, Lowey J, editors. Music therapy at the end of life. Cherry Hill, NJ:
Jeffrey Books; 2005.
2. Gutgsell KJ, Schluchter M, Margevicius S, DeGolia PA, McLaughlin B, Harris
M, et al. Music therapy reduces pain in palliative care patients: A randomized
controlled trial. J Pain Symptom Manage.2013;45(5):822-831.
3. O'Callaghan C. The contribution of music therapy to palliative medicine. In:
Hanks G, Cherny N, Christakis N, Fallon M, Kaasa S, Portenoy R, editors. The
Oxford textbook of palliative medicine, 4th edition. Oxford: Oxford University
Press; 2010. p. 214-221.
4. Garry Beitel G, director. On wings of song [DVD]. Montreal: Beitel/Lazar
Productions;1999.
5. Munro S. Music therapy in palliative/hospice care. New York: Gustav Fischer
Verlag Stuttgart; 1974.
6. Munro S, Mount B. Music therapy in palliative Care. CMAJ;1978;119:10291034.
7. Salmon D. Endnotes: music therapy in palliative care. La Scena Musicale;
1994:10(1).
8. The Canadian Association of Music Therapy (CAMT) [website].
http://www.musictherapy.ca