Personal Means of Evidence in End-of-Life Care

As I addressed previously in this blog post, there are a variety of ways that music can be used to enhance a person’s sense of health and well-being. Likewise, the practice of music therapy itself is incredibly diverse, with music therapists working from different orientations including: humanistic, psychodynamic, and music-centered, in addition to behavioral, medical, and neurological. Therefore, the current understanding of Evidence Based Practice (EBP) in western medicine, wherein Randomized Control Trials (RCT) are held as the gold standard, may not be the most conducive means for determining the efficacy of music therapy because not every music therapist works from a medical or behavioral perspective. Because of this, the structure and results of RCT aren’t always relevant to music therapists who work from a more relational perspective, such as myself.

Up until recently, I hadn’t really questioned taking the above approach towards music therapy research. Like many music therapists, I see on a daily basis the ways in which people benefit from music therapy, but I’m also aware of the need for increased education to the public and other health care professionals about what music therapy is. As such, I had believed that the best way for music therapy to get recognized as a valid healthcare profession was to be able to demonstrate evidence of its efficacy through research which strove to meet the RCT gold standard.

Recently my thoughts started changing after I read an article in the latest Music Therapy Perspectives, one of the music therapy journals published through the American Music Therapy Association. This article by Kenneth Aigen, DA, MT-BC provided a thoughtful critique of evidence-based practice in music therapy. As a music therapist who works relationally, and who has also worked as a member of an interdisciplinary team in the hospice setting, this article resonated with me in that it hints at needing a new way to view, and measure, health- especially in the field of music therapy.

The specialized medical fields of hospice and palliative care provide new models for healthcare in which quality of life is emphasized. The ways in which one can experience enhanced quality of life are holistic and varied. The efficacy of the interventions provided by members of the interdisciplinary team are largely determined by the personal, subjective experience of the person receiving them.

Because hospice and palliative care strives to meet the diverse needs of an individual with a chronic or life-limiting illness, care is provided by an interdisciplinary team that can address specific areas of need. For example, in addition to a MD, RN, and social worker, other members of the interdisciplinary team may include a chaplain or spiritual advisor to provide spiritual care, or a music therapist to address a person’s physical, emotional, mental, social, or spiritual needs through the use of music and therapeutic relationship.

This team approach means that each member may see things about a person that other team members don’t see, which helps provide a greater snapshot of how the person is coping and managing their disease process. (It has been my experience that this is especially true for music therapists working in hospice and palliative care). Due to a variety of factors, such as disease and comorbidities, genetics, life experiences, environmental factors, social support, and financial resources, just to name a few, each person’s experience of hospice or palliative care is unique. As such, it would seem that RCT wouldn’t necessarily be the best way to measure the efficacy of interventions used in a person’s treatment and care.


Resource:

Aigen, K. (2015). A critique of evidenced-based practice in music therapy. Music Therapy Perspectives, 33(1), 12-24.

 

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