Home Uncategorized A musical Rx for palliative care

A musical Rx for palliative care

November 2008

Published in the November 2008 issue of Today’s Hospitalist

When the Cleveland Clinic decided to establish the Harry R. Horvitz Center for Palliative Medicine 14 years ago, administrators were fortunate to have the financial support of a relative of a former patient. One of that donor’s first acts in launching the new ward was to buy a baby grand piano.

The hospital was also fortunate to have one of the country’s largest music therapy programs “at the Cleveland Music School Settlement “right in its backyard. The clinic contracted with the school to provide music therapy, and Lisa Gallagher, MA, MT-BC, one of the school’s board-certified music therapists, has been with the clinic’s palliative care program from the start.

“We find that the therapy is invaluable in helping patients deal with pain, anxiety and depression,” Ms. Gallagher says.

Ms. Gallagher set out to develop a program specifically designed for this population. The program initially provided 12 hours a week of music therapy to patients on the ward. Since then, the program has received grant funding to expand to 23 hours per week.

Cleveland Clinic has also extended the program to other areas of patient care. Those include hospice care and neurology, where a specialized music therapist works on gait training and aphasia therapy. “Many patients with aphasia,” Ms. Gallagher says, “can sing before they can speak.”

Quantifying benefits
The palliative care center is a 23-bed unit where patients typically spend between seven and 14 days. To take part in music therapy, patients have to be referred to the program by an admitting physician, palliative care specialist, social worker, nurse or family member.

“We try to make the process as easy as possible,” Ms. Gallagher says. “We have a physician order form, and patients and families get a brochure describing the program in their admission packet.”

The idea that music therapy may alleviate pain and distress related to medical illness is not new. But Ms. Gallagher was able to quantify the benefits of the program in a study published in the August 2006 issue of Supportive Care in Cancer.

In what she calls “the largest study to objectively assess music therapy in palliative care,” Ms. Gallagher and her colleagues studied 200 patients and 68 family members who took part in the center’s program. Patient-related scores for anxiety, mood, pain and shortness of breath showed significant improvement with therapy, as did facial expression, movement and verbalizations.

Interestingly, there was no difference in outcomes between patients who had a musical background and those who did not. Family members also benefited from the therapy, with mood scores improving significantly.

Since publishing that study, Ms. Gallagher has gathered data on more than 1,000 patients and is planning to publish a follow-up study comparing results at the palliative care program to those at Cleveland Clinic’s hospice program.

How it works
Ms. Gallagher starts her day at the center by attending the morning report. At those meetings, doctors tell her what symptoms or problems patients are having that music therapy may help. Common symptoms or problems include physical or emotional pain, anxiety, depression, shortness of breath, and the need for better coping skills or relaxation.

Typically Ms. Gallagher, who works in the unit three days a week, sees between three and eight patients a day. (Family members are encouraged to participate in sessions.) She begins therapy with an initial evaluation, where she discusses what kinds of music a patient prefers. “Each program is individualized for that specific patient,” she notes.

Once she has established the type of music and musical interaction, Ms. Gallagher assesses the patient’s mood, pain score, anxiety, depression and shortness of breath prior to starting. “Then we identify what we are going to do for the day,” she says.

“For some patients, it is just listening to live music because they are so fatigued or ill. Others may sing along, play a simple instrument, write songs or participate in music-assisted relaxation.” She typically brings an electric keyboard into patients’ rooms, but also has a guitar, drum machine and small percussion instruments.

“Amazing Grace” is probably the most requested song, she says. “Gospel is the No. 1 choice of music, but big band and country are close behind. The perennial favorites constantly change based on the age of our patients.”

After about 25 minutes, Ms. Gallagher reassesses patients’ scores for pain, anxiety, depression and shortness of breadth. She reports before-and-after figures to referring physicians, using scores to help guide follow-up. She also writes brief summaries of outcomes in the electronic medical record.

In addition to seeing patients at the center, she supervises an intern and two staff members, and works on research.

Where to look for funding
According to Ms. Gallagher, the major obstacles in setting up a music therapy program are getting funding and convincing hospital administration that it is a worthwhile venture. That is one reason Ms. Gallagher continues to do research.

“Once you have the program in place,” she says, “it is not that hard to get converts because they can see the benefits to the patients.”

To establish a program, you need to find a board certified music therapist who knows how to use music appropriately with this population, she adds. And because music therapy is not routinely covered by private or public insurance, “the biggest piece after that is finding the funding, either through grants or private donors.”

Locally, she has received funding from the Cleveland- based Kulas Foundation. Grants for music therapy programs are also available from the National Institutes of Health and the American Cancer Society.

Cornelia Kean is a freelance health care writer based in Montclair, N.J.