How Music Therapy can affect, heal, and transform oncology experiences

Panelist: SarahRose Black, MA, MMTMusic Therapist, University Health Network and Kensington Health

Wednesday March 12th, 2014: A Room 217 Webinar Presentation

Overview and Learning Objectives

Attendees will learn about:

The role of music therapy in: hospice palliative care

Acute/palliative inpatient oncology

outpatient oncology

The four facets of music therapy used in clinical practice at the University Health Network & Kensington Health

How music therapy can affect the experience of inpatient/outpatient oncology and end of life care

Origins of Music Therapy in Oncology

Deforia Lane

Deborah Salmon

Amy Clements-Cortes

Clare O’Callaghan

Susan Munro

Lucanne Magill

What is Music Therapy? 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. Music has nonverbal, creative, structural, and emotional qualities. These are used in the therapeutic relationship to facilitate contact, interaction, self-awareness, learning, self-expression, communication, and personal development.”

Canadian Association for Music Therapy / Association de Musicothérapie du Canada Annual General Meeting, Vancouver, British Columbia, May 6, 1994

What is Oncology?

Oncology (a branch of medicine that deals with cancer) may involve diagnosis, treatment plans, ongoing assessments, palliative care, symptom management, and early detection/screening

The experience of oncology for the patient, family/friends of the patient, and the health care team is varied, multi-faceted, complex, and often full of unknowns, not to mention frightening and difficult at times (Grassi & Riba, 2012)

What is Music Therapy in oncology? Music therapy in cancer care is the creative and

professionally informed use of music in a therapeutic relationship with people identified as needing physical, psychosocial, or spiritual help, or with people aspiring to experience further self-awareness, enabling increased life satisfaction and quality. (O’Callaghan, 2004)

Clinical Goals in MT Oncology

Music therapy can support goals that the health care team has established (e.g. pain/symptom management)

Music therapy can create NEW goals e.g. creating a living legacy for patient’s families, or supporting a deeper exploration of the existential questions that arise during treatment and/or palliative care

An Overview of MT Clinical Goals Collaborative triad process of goal setting:

Patient ~ Therapist ~ Health Care Team

• Clinical goals are a defining feature of music therapy

• Goals may focus on physical, emotional, psychosocial, or spiritual well being, depending on several factors (patient’s requests/needs, health care team’s needs, family’s needs etc.)

Examples of MT Clinical Goals: Evidence – Based Work Pain/symptom management (Magill, 1993, O’Callaghan, 2012)

Anxiety relief (Hilliard, 2001; O‟Callaghan, 2001)

Creating legacies for family and friends (Clements-Cortes, 2009)

Relaxation (Hilliard, 2003)

Support for families (Hogan, 1999)

Support (physical- breathing, emotional-comforting) at end of life (Salmon, 2003)

Providing a positive distraction from treatment/symptoms

Providing a non-verbal space for communication

The Four Facets Clinical Improvisation

Client and therapist improvise together

Inter-Active Listening Therapist plays and client listens to music

Song-writing Client and therapist write music together

Active Playing Client and therapist play music (often pre-composed) together

Clinical Improvisation

Defined as: the spontaneous creation of music between therapist and client using instruments and/or voice (Lee, 2003)

Clinical example: Mazi and the ukulele

Inter-Active Listening Defined as: A music therapy methodology that

involves the therapist playing, singing, or providing music in some form while the client listens; therapist and client may interact non-verbally or verbally; further interventions may be based on potential client response. (Black, 2013).

Clinical example: Anna and the Singing Bowl

Song-writing Defined as: the creation of a song (either with or

without lyrics) by therapist and client that may reflect the client’s experiences. Song-writing is often done as legacy work for a client’s family.

Clinical example: Angela’s Song

Active Playing Defined as: client and therapist playing (generally

pre-composed music) either together or separately

Clinical example: Teresa and the Beatles

The Referral Process: who and why A standard referral form has been created and

implemented at UHN

Referrals are made for a variety of reasons e.g.: Patient requests/enjoys music/plays an instrument/sings

Patient is experiencing distress and needs psychosocial support

Patient is anxious/depressed/struggling with symptoms/treatments

Patient is actively dying and family requests support at bedside

Referrals come from a broad spectrum of health care professionals including: Physicians, nurses, occupational & physiotherapists

Psychiatrists, social workers, psychologists

Patients and family members can self-refer

Inpatient Oncology Common goals:

Supporting the patient (and family/friends) through treatment and related psychosocial issues

Providing a non-verbal outlet for patients to express themselves

Supporting symptom management

Common interventions: Patient listens to live music

Patient sings meaningful songs

Patient plays an instrument which provides distraction/enjoyment/sonic vibro-acoustic experience

Inpatient Palliative Care Common goals:

Supporting symptom management at end of life

Supporting team discussions and expressions of relationship completion (Clements-Cortes, 2009)

Supporting families through anticipatory grief

Common interventions:

Inter-Active listening for pain management, relaxation

Breathing entrainment (breath matching through music)

Song-writing with patients/families

Outpatient Sessions Aims and objectives:

Helping patients transition (reintegrate back into their activities of daily life OR integrate a palliative care plan)

Reasons for referral:

Difficulty coping with treatment and symptoms

Legacy work for family members and loved ones

Examples of interventions

Connecting meaningful pre-and-post cancer moments through improvisation, song-writing

Joint sessions with psychiatry

Evolution and Expansion at UHN Origins of the program (CAMT Internship and

academic connection with Kensington Hospice)

Liaising with Psychosocial Oncology and Palliative Care, Dr. Gary Rodin, Interdisciplinary Health Care Team

Pilot project at Toronto General Hospital

Qualitative study at Princess Margaret

Blending research and clinical practice

Music Therapy and Hospice Care

What is Hospice?

Primary diagnoses are cancer

Goals of Care: comfort measures, psychosocial support

Role of Music Therapy in grief and bereavement

Kensington Hospice

Music Therapy with Staff Joint sessions

Collaborations in Care/Joint Sessions Occupational therapy

Psychiatry

Nursing

Pharmacy

Spiritual Care

Staff wellness Physicians and nurses

Pharmacists

CONCERTS!

The Stories The Bells of Ward 14B- song-writing

Shawn’s Legacy- active playing

Jason’s Saxophone- active playing

Diana’s Voice- inter-active listening

“The Bells of Ward 14B” Creating meaning during a

difficult time

Engaging in activity

Engaging in singing

Having an emotional outlet

Sharing the experience with the staff

Shawn’s Legacy Creating a living legacy for his

family

Engaging his health care community in a musical experience

Expressing gratitude to his health care team

Encouraging his community to experience song together as a celebration of life and hospice care

Jason’s Saxophone Creating meaning in the

moment

Embracing a defining part of his life

“I want to go out with a squawk”

Diana’s Voice

“This is my mom’s voice, she’ll always be alive in it”

Grief and bereavement support through the meaningful musical moments

MT & Oncology: A Summary How can music therapy affect the experience of

oncology?

Creating meaningful moments through a musical relationship incorporating clinical goals

Creating legacies & providing emotional outlets

Engaging staff

Supporting grief

Possibilities are endless…!

Thank you!

Questions?

Comments?

Contact:

Sarahrose.black@uhn.ca