Clare O'Callaghan

Objectivist and Constructivist Music Therapy Research in Oncology and Palliative Care: An Overview and Reflection

Objectivist and constructivist music therapy research in oncology and palliative care since 1983 is detailed, and the meaningfulness of evidence gathered is consid- ered. Objectivist approaches are informed by positivism and commonly use experimental, hypothetically driven methodologies incorporating researcher-designed measures. Constructivist approaches are informed by varied theoretical frameworks (e.g., postmodernism, phenomenology) and commonly aim to understand participants’ subjective experiences. Methodologies include grounded theory, ethnography, and discourse analysis. Both research approaches have uncovered varied and evolutionary understandings about how music therapy can help people deal with loss and main- tain life quality when affected by life-threatening and end-stage illnesses. Furthermore, constructivism and palliative care are compatible in that both focus on understanding individualized and multiple interpreta- tions of experience. It is contended that objectivist and constructivist research will never be able to capture an absolute ‘‘truth’’ about music therapy’s effectiveness; however, findings from both approaches can be con- ceptually generalized to comparable clinical contexts.

Sound Continuing Bonds with the Deceased: The Relevance of Music, Including Preloss Music Therapy, for Eight Bereaved Caregivers

This study examines musics relevance, including preloss music therapy, for 8 informal caregivers of people who died from cancer. The design was informed by constructivist grounded theory and included semistructured interviews. Bereaved caregivers were supported or occasionally challenged as their musical lives enabled a connection with the deceased. Music was often still used to improve mood and sometimes used to confront grief. Specific music, however, was sometimes avoided to minimize sadness. Continuing bonds theorys focus on connecting with the deceased through memory and imagery engagement may expand to encompass musical memories, reworking the meaning of familiar music, and discovering new music related to the deceased. Preloss music involvement, including music therapy, between dying patients and families can help in bereavement.

“A quiet still voice that just touches”: music’s relevance for adults living with life-threatening cancer diagnoses

PurposeMusic has historically aided health and loss-adaptation, however, cancer patients’ experience of music for self-care is not well understood. This study examines adult cancer patients’ views about music’s role before and after diagnosis.MethodsConstructivist approach, with grounded theory informed design using convenience, snowball and theoretical sampling. Patients from Australian metropolitan cancer and hospice settings completed demographic questionnaires and participated in semi-structured interviews. Qualitative inter-rater reliability was applied.ResultsFifty-two patients reported comparable time spent experiencing music pre-post diagnosis. Music may remain incidental; however, many patients adapt music usage to ameliorate cancer’s aversive effects. Patients often draw from their musical lives and explore unfamiliar music to: remain connected with pre-illness identities; strengthen capacity for enduring treatment, ongoing survival (even when knowing “you’re going to die”), or facing death; reframe upended worlds; and live enriched lives. Patients can ascribe human or physical properties to music when describing its transformative effects. Familiar lyrics maybe reinterpreted, and patients’ intensified emotional reactions to music can reflect their threatened mortality. Sometimes music becomes inaccessible, elusive, and/or intensifies distress and is avoided. Families’, friends’ and professionals’ recognition of patients’ altered musical lives and music-based suggestions can extend patients’ use of music for self-care.ConclusionHealth professionals can support patients by inquiring about their music behaviours and recognising that altered music usage may signify vulnerability. Although commonly recommended, hospital concerts and music broadcasts need sensitive delivery. Patients’ preferred music should be available in diagnostic, treatment and palliative settings because it can promote endurance and life enrichment.

Music among family carers of people with life-threatening cancer

Family caregivers of people with cancer may struggle as they observe the effects of the illnesses and experience the demands of caregiving amid potential loss. In order to provide beneficial support, health care professionals need to understand factors that promote caregivers’ resilience. This research explored the role of music. Twelve caregivers were recruited and data were collected through questionnaires and semi-structured interviews. Data analysis was informed by grounded theory. Six thematic findings emerged: caregivers’ music backgrounds affect their cancer experiences; caregivers’ use or nonuse of music is associated with how they cope with the patients’ illnesses; music can help improve biopsychosocial and spiritual well-being; music can be used in caring; music may intrude; and music is recommended. Recommendations are that health care organizations providing suppor- tive cancer care might consider offering music-based care and that health professionals may consider inquiring about caregivers’ musical lives to increase their understanding about caregivers’ resilience or vulnerability. Keywords cancer, family caregivers, music, self-care

Audit-guided action can improve the compliance with thromboembolic prophylaxis prescribing to hospitalized, acutely ill older adults

We read with interest the articles by Minno and Tufano (2004) and Zakai et al. (2004), which serve to highlight the need for prevention of venous thromboembolism (VTE) in at-risk patients. We recently audited our use of prophylactic low molecular weight heparin (LMWH) in hospitalized older adults (65 years or older) over a 6-week period. Patients were included if they had an indication for thromboembolic prophylaxis as defined by our departmental guidelines (severe heart failure; acute myocardial infarction; respiratory failure; past history of thromboembolic disease; hypercoagulable state; nephrotic syndrome; acute illness with dehydration). Patients were excluded if they received therapeutic LMWH for suspected myocardial infarction or VTE, were already receiving longterm warfarin therapy, or died or were discharged within 48 h of admission. To comply with departmental guidelines, a patient had to be prescribed subcutaneous tinzaparin, 3500 units once a day, within 2 days of admission. There were three predetermined exceptions to this standard: (a) a documented contraindication to LMWH; (b) the patient had suffered a stroke, in which case they had to be either prescribed compression stockings or have a documented contraindication to these; and (c) inappropriateness of thromboembolic prophylaxis due to the patient’s overall condition (i.e. patient was moribund or terminally ill). There were 120 acute admissions to the ward during the audit period, with 16 of these cases excluded (six received therapeutic LMWH, five were taking warfarin and five died or were discharged within 48 h). Of the remaining 104 patients, 27 (26%) had an indication for thromboembolic prophylaxis. Of these, six cases (22%) met the prescribing standard, four cases were inappropriate for prophylaxis and three cases had a contraindication to LMWH. Thus, in total, only 48% of those eligible for thromboembolic prophylaxis met the prescribing standard or an exception. (No case failed because of a missing drug prescription sheet, suboptimal dose of tinzaparin or the prescription of an alternative LMWH). Following discussion of the baseline audit results, a program of medical staff education on the content of the departmental guidelines, including those for VTE prevention, was initiated. In addition, a specific prompt for thromboembolic prophylaxis was inserted into the ward admission form. Data collection was subsequently repeated. On this occasion, 20 patients had an indication for thromboembolic prophylaxis. Of these, 17 received prophylaxis (85%), and one patient met a prescribing exception (receiving palliative care). Thus, there was a 90% compliance with, or exception to, the prescribing standard on this occasion, in comparison with 48% on the first occasion, a significant improvement (P < 0.02, Fisher’s exact test). It has been previously reported that hospitalized patients at risk of VTE are underprescribed thromboembolic prophylaxis [3–5]. A study of medical patients at Kings hospital, London, found that only 23% of those at high risk, and none of those at moderate risk of VTE, received prophylaxis [6]. In Italy, only 46% of patients who met the American College of Chest Physicians consensus statement criteria received thromboembolic prophylaxis [7]. It is known that education can increase prophylaxis prescribing – Anderson described an increase from 29% to 52% [8]. Our audit cycle clearly demonstrates that thromboembolic prophylaxis prescribing can be significantly improved, at least in the short term, by a combination of education and written prompting.

Music, Intelligence, and the Neurocognitive Effects of Childhood Cancer Treatment

Improved childhood cancer survival rates are associated with increasing numbers of patients with neurocognitive impairment. Detrimental cancer treatment effects include declines in IQ, attention, executive function, processing speed, memory, visuos- patial, and visuomotor skills, reducing patients’ quality of life and the potential to achieve key life milestones. Music training can improve intelligence, attention, and memory as well as provide a medium for interaction, coping, stress reduction, and improved self-esteem. Given the crossover between the domains impaired by childhood cancer treatment, and improved through music training, there is potential for music-based interventions to minimize detrimental treatment effects. This article reviews the neurocognitive effects of childhood cancer and its treatment, provides a theoretical rationale for offering children with cancer music-based interventions, and suggests strategies that carers may use to extend their intellectual potential and quality of life.

A music therapy educator and undergraduate students’ perceptions of their music project's relevance for Sichuan earthquake survivors

Following the earthquake in Sichuan, China, in May 2008, which killed approximately 70,000 people, a music therapy educator led three teams, totalling 41 music therapy students, who provided music performances and activities to survivors and relief workers for three 30-day periods from June–August 2008. This constructivist research examines the educators and five music therapy student volunteers’ perceptions of their music projects relevance during a stabilization-through-music phase in June–July 2008. The educators narrative stance provides some context for the students’ presence in the earthquake aftermath and his views about the music program’s outcomes. The volunteers’ interview transcripts were inductively, comparatively, and recursively analyzed. Emergent themes encompassed descriptions of the volunteers’ arrivals; aims for improving survivors’ wellbeing; music activities, and their beneficial outcomes; personal enrichment and challenges; and helpful coping strategies and recommendations. In the early months following an earthquake disaster, survivors of all ages may benefit from experiencing music performances or small music activity groups provided by music therapy students. Benefits may include nurturance, relaxation, reflection, emoting, learning, diversion, socialization, family resilience, and community building. It is suggested that musical options provided by musicians and music therapists following a disaster can support survivors and relief workers, and remind them about the potential aesthetic of existence and hope for improved lives.

Book Review Summaries

? Users may download and print one copy of any publication from the public portal for the purpose of private study or research. ? You may not further distribute the material or use it for any profit-making activity or commercial gain ? You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access to the work immediately and investigate your claim.This book offers exemplarily guidance for how therapists and researchers can work together, or therapists can work as researchers, to develop research knowledge highly relevant to practice, with data already existing in workplaces. Through clinical data-mining (CDM), music therapists can do low or no cost research which can make work-life more satisfying, interesting, accountable, and professional. Concerned about the ‘‘practice research divide’’, Prof. Epstein focused on engaging practitioners in research through CDM studies.

A website supporting sensitive religious and cultural advance care planning (ACPTalk): Formative and summative evaluation

Background Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources. Objective The purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk. Methods The CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey. Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey. Results Context: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content. Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29). Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. Conclusions The CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study.