Stories: Hospice

Music therapy in hospice care can help to serve the emotional, social, physical, spiritual, and cognitive needs of the hospice patient and benefit the patient’s family and staff as well. Here are several vignettes describing music therapy in this setting.

Jack: Family support

Age: mid-50s

Diagnosis: Lung cancer

Facility: Hospice house

Primary reason for referral: Jack was young, with a wife and three children, aged high school and younger, preparing for his death.

Jack started hospice services very near to the end of his life, so music therapy began when Jack was already actively dying. His wife and three children were in his room with him, the wife perched on the edge of the bed with her arms around Jack, and the children sitting side by side on the couch by the bed. The music therapist offered to sing a song for Jack and asked the family members to choose Jack’s favorite songs from a Top 40 songbook. Each of the family members chose a song, reminiscing about each one, talking to each other and to Jack, and changing the mood of the room as they did so.

Joseph: Dementia

Age: early 90s

Diagnoses: Alzheimer’s Disease, Major Depressive Disorder

Location: Assisted living facility

Primary reasons for referral: Had stopped communicating with staff or family following recent death of his wife, was resistive to staff care, daughter said he had “lost the will to live”

Music therapy began with the introduction of familiar songs sung by the therapist and played on guitar. Joseph had been a prominent professional oboist, so the therapist also played oboe selections for Joseph while he coached her on how to play, just as an oboe teacher does. Joseph began communicating verbally with his family again and began accepting help from nursing and rehabilitation staff members, regaining some of his abilities to complete activities of daily living.

Marilyn: Emotional needs

Age: late 60s

Diagnosis: Lung cancer

Facility: Patient’s home

Primary reason for referral: Marilyn was in the end stage of her disease but was not ready to accept it. She refused to speak to a social worker or chaplain but had been involved in music in her church for many years.

Music therapy sessions with Marilyn at first focused just on music. Marilyn and the therapist discussed their involvement in music, sang and played on Marilyn’s piano many of her favorite hymns and popular songs. As Marilyn became more comfortable with the music therapist, she began talking more about what she would miss, reminiscing through the songs she selected and sharing with the therapist her fears about death and leaving her family alone.

David: Caregiver support

Age: late 80s

Diagnosis: End-stage cardiac disease

Location: Patient’s home

Primary reasons for referral: David lived alone with his wife Jane. The two were socially isolated, with few visitors and their children living some distance away.

When the music therapist visited David, Jane sometimes left the house and sometimes stayed to participate. In either case, music therapy provided Jane with a break from caregiving. The music therapist used singing, songwriting, and movement or dancing experiences to help the couple reminisce in a fun, lighthearted way, and in later stages of therapy, the music therapist used relaxation experiences to help both husband and wife calm down.

Maria: Pain management

Age: early 60s

Diagnosis: Stomach cancer

Location: Skilled nursing facility with acute-care hospice beds

Primary reasons for referral: Maria’s pain that was not being managed well enough in her home. When the music therapist arrived at the facility, Maria was groaning, holding her hand over her stomach, and writhing back and forth in her bed.

For Maria, the music therapist provided soft, soothing vocal and guitar music interspersed with music-assisted relaxation exercises, including deep breathing, positive affirmations, and imagery. Maria fell asleep briefly during the session and reported a decrease in pain from at 10 to a 7 on a 1-10 scale, a significant decrease for her.

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