1. Running Head: MUSIC TERAPY IN END OF LIFE CARE LITERATURE REVIEW
Music Therapy in End of Life Care Literature Review
Kimberly J. Miller
MJHS Hospice

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Abstract
In the last forty years, there has been a growth in music therapy in hospice programs. Music
therapy in end of life care is beneficial for terminally ill patients, their family and friends, and the
interdisciplinary care team. This paper gives an overview of the literature discussing music
therapy in end of life care. Music therapy’s history in end of life care is fairly recent, beginning
in the 1970’s in the United States. Goals treated in music therapy throughout the dying process
include the physical, emotional, spiritual, familial, and bereavement support. There are various
music therapy interventions used to treat these goals, such as, song writing, lyric analysis,
improvisation, singing, instrument playing, and listening. Music therapy aims to provide
comfort and overall quality of life as a patient is going through the dying process. Additionally,
music therapy offers added support to family and colleagues.

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History of Music Therapy in End of Life Care
End of Life Care gives hope for a peaceful and meaningful death. Hospice is important
to patients and families alike; when one dies, many are affected. This is what Dame Cicely
Saunders knew as she began the first official hospice, St. Christopher’s Hospice, in 1948 in
London (History of Hospice Care, 2012). Hospice is known for its comfort and care for patients
and families, aiming to provide the best support as a loved one goes through the dying process.
In 1974, the first United States hospice program began at Connecticut Hospice (History of
Hospice Care, 2012). Around the late 1970’s and early 1980’s, music therapy started appearing
in end-of-life care (Munro & Mount, 1978 & Hogan, 2003).
Music has been used therapeutically all throughout the ages, even dating back to David
using music to help King Saul in the Bible. During WWI and WWII, musicians aided soldiers in
their recovery and played music at their bedsides. Since that time, the introduction of music
therapy as an academic program in colleges and universities, as well as profession, came into
fruition. Music therapists became integral members in the end of life care team not too long after
hospice care was introduced to the United States. Today music therapy is continuing to expand in
End of Life Care, being a part of many hospice and palliative care agencies around the country
and around the world.
Nearing the end of life, patients and their families have many needs. Changes are
occurring in the patient’s physical body, emotional state, and cognitive and spiritual well-being,
necessitating the use of music therapy to help reduce negative symptoms and provide comfort
and peace. A music therapist treats the patient by first assessing physical, emotional, and
spiritual conditions of the patient and family members (Horne-Thompson, 2008). The goals and

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objectives are then formed based on the music therapist’s observations and evaluation of the
patient.
Goals Addressed by Music Therapy in End of Life Care
The first goal that is addressed and treated by the music therapist is physical comfort
(Krout, 2003). “When patients present as physically distressed, the initial aim of the music
therapy is to provide a minimally stimulating environment that is predictable, relaxing, and
reassuring” (Hogan, 2003). Pain management or control is important in hospice and palliative
care to facilitate physical comfort. Gallagher, et. al (2001), listed physical goals for patients in
their study including the following: “physical pain, restlessness, respiratory difficulties, sleep
disorders, nausea, pain perception, agitation, and stress” (p. 158). Overall comfort is provided,
families are more at ease, and the dying process is more peaceful when these goals are treated
and met.
An additional goal treated by a music therapist is emotional needs. This can include
psychological, social and relational, and communication goals as well. Emotional goals listed by
Clements-Cortés (2004) for patients are to “decrease depressive symptoms and social isolation,
increase communication and self-expression, stimulate reminiscence and life review. …
Facilitate the expression and exploration of feelings, thoughts, hopes, fears, etc., regarding
hospitalization, illness, death, and any other area of concern… decreasing confusion, reducing
anxiety” (p. 255, p. 258).
On a spiritual level, patients and families may have many unanswered questions. The
dying process often leads one to question their faith and belief, as well as seek answers and find
peace. Aldridge (2003) stated that everyone is faced with the “great questions of life” which

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leads to concern about existence and identity, “fundamental questions of all spiritual traditions.”
Spiritual goals include the need to “maintain personal relationships and relationship to a higher
authority, God or life force (as defined by that individual), identify meaning and purpose in life
and transcend a given moment.” Aldridge claimed that spiritual elements of a person’s health
are as important as medical health, classifying these elements as “patience, grace, prayer,
meditation, hope, forgiveness and fellowship.” (p. 103-105).
In addition to assisting in transitioning the patient physically, emotionally, and spiritually,
music therapy helps to transition the family in this process. Families are welcomed to engage in
the music therapy interventions and encouraged to sing along, give music suggestions, and
openly discuss with everyone else in the room. Their goals may be to have their attention and
focus on the patient, share stories and memories about the loved one, communicate with and
support the patient and other family members, be actively involved in the sessions, and find
meaning in the process.
The overall goal of music therapy in end of life care is to improve the patient’s quality of
life (physically, emotionally, and spiritually); music has a wide range of options for creating
interventions to improve patients’ quality of life. Among other factors, music therapists think
about the specific needs and goals of a particular patient when creating interventions. This
approach used by music therapists and other disciplines provides a unique experience for every
patient. Individual goals are formed and interventions are tailored for the particular patient. The
same song could be used with two patients in different ways, for different purposes, and eliciting
different responses. Factors such as the patient or family’s musical preference, mobility,
cognitive awareness, speech capability, age, musical experiences, and prognosis all play a part in
creating an individual-based intervention.

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Because family is so important in end of life care, music therapy often continues
providing support after the loved one has died. Family members and close friends are with the
patient through the dying process, and their loss can be very difficult to cope with. Music
therapy goals in bereavement can include expressing feelings and emotions. Through
songwriting, lyric analysis, and other music therapy interventions, family members may have
more ease in communication and find it to be a cathartic release. (Schwantes, et. al., 2011;
McFerran, Roberts, and O’Grady, 2010)
Music Therapy Interventions in End of Life Care
Because music therapy interventions are patient-centered, there are many types of
interventions a music therapist can use. Interventions can be live or recorded music,
instrumental alone or with lyrics, and interactive or passive. In one of his studies, Hilliard
(2003) said, “…most music therapists utilized one or more of the following music therapy
techniques: song choice, music-prompted reminiscence, singing, live music listening, lyric
analysis, instrument playing, song parody, singing with accompaniment using the iso-principle,
planning of funerals or memorial services, song gifts, and music-assisted supportive counseling”
(p. 123).
One intervention that music therapists use in end-of-life care is songwriting. Songwriting
is diverse because it can range from the patient or family writing their own lyrics to a song, to
them creating their own melody or musical structure to a song, or the patient filling in blanks
with original words where the music therapist leaves blanks (fill in the blank activity can also be
used to work on memory of the song). Songwriting can be an effective way for families to

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express their love to the patient or an outlet for patients to communicate their feelings in a more
creative way than just speaking. (Clements-Cortés, 2004)
Another intervention that music therapists utilize is lyric analysis and discussion. This
activity often provides an outlet for patients and/or their families to express emotions and
feelings otherwise kept inside. The lyrics may also more adequately articulate one’s feelings,
especially if one is having a difficult time opening up or if one’s speech is affected by the
disease. The music therapist offers time after playing or listening to a song where the lyrics can
be discussed. The lyrics can be a “springboard for discussion” which is less threatening than
asking directly how someone feels. Each person may find different meaning in the song which
offers opportunity to discuss the dying, loss, and grieving processes. (Clements-Cortés, 2004)
Through improvisation, music therapy can create an opportunity for growth in a powerful
way. O’Kelly & Koffman (2007) explained that patients felt that this creative expression was
‘satisfying and fulfilling’, ‘exciting’, ‘transformative’ and ‘confidence building’ (p. 238).
Improvisation is the spontaneous (no sheet music) playing of an instrument, whether by music
therapist or patient. The music therapy session provides a safe space for a patient to creatively
express him/herself through unwritten music without fear of judgment, critique, or criticism.
This creative outlet allows a patient to use music instead of words if it is difficult to verbalize
one’s feelings and thoughts. A musical dialogue may occur between therapist and patient while
improvising on the same or different instrument. This dialogue may be a bridge for words,
fostering a trustworthy relationship in which the patient may eventually open up with the
therapist musically or verbally. The music therapist may reflect or mirror the patient’s
improvisation with music therapy techniques while also giving verbal and musical support to the
patient. Moreover, improvisation can likely aid a patient in increasing confidence in oneself and

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give the patient a sense of control over the environment, as the music therapist supports and
validates what the patient is improvising and experiencing.
Instrument playing itself can help build confidence. It is part of many interventions to
“promote participation, provide an alternate vehicle for self-expression, encourage choice
making, and focus attention” (Clements-Cortés, 2004, p. 257). Playing instruments may also
improve motor coordination; keeping a patient moving even if the patient is bed-bound. Having
family members play instruments (such as small percussive instruments) is an effective way to
get them involved in the patient’s therapy and improve family relationships with a fun, musical
experience.
Similarly, singing may be an effective way to have patients and family members be
involved in the music therapy interventions, helping build relationships in a non-obtrusive way.
Singing, like instrument playing, can help increase self confidence and expression of one’s
feelings. Physically, singing may help breathing and speech (Clements-Cortés, 2004). It may
also bring back past memories or create new memories with a loved one. Astonishingly, some
patients may not be able to speak, but find it possible to sing.
A music therapy intervention that is much more passive in nature is the act of listening to
music. The music therapist may choose to play live music in order to change the tempo,
dynamics, and other qualities; or use recorded music for the authenticity of the original
instrument/voice sound, look, and feel. The recorded music may bring back memories from the
patient’s past, allowing for life review and discussion. The patient may be comforted by hearing
a song they enjoy, put into a restful state by listening to calming music, decrease agitation by
focusing on a soft melody, be distracted from painful symptoms by putting their attention on the
music, or feel open to talking about their feelings after listening to a particular song.

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Music therapists plan particular interventions very purposefully. They have in mind who
the patient is, what the goals for the patient are, and what the patient’s preferences are. Each
intervention is well thought-out and given space for impromptu changes. Music therapists are
flexible, keeping in mind and observing the patient’s responses to the music. Music therapists
are also keen in knowing when to start, stop, and elicit certain techniques; going with the flow of
the session and noticing the relationship dynamics in the room. The patient’s participation could
be any of the following or more: “singing, playing instruments, choosing songs, humming,
dancing, clapping, discussing music” (Gallagher, et al., 2001, p. 157). The music therapist is
mindful of the patient’s limitations while choosing interventions; they also challenge the patient
or family members when necessary.
Music therapy is part of end of life care that families and patients may enjoy the most.
This is because of the qualities of music that relate to one’s well-being. Music can be fun and
exciting, and it is able to reach every member of a family in one way or another. Music can
bring back memories of the past and create new memories for future days, such as writing a song
for the loved one that the family holds onto after the death. Music can include one person or a
whole room filled with people. It is something that is seen in many, if not all, cultures around
the world; it is an element in religious traditions and practices. Music is non-obtrusive and its
qualities are versatile and easy to change. Furthermore, music therapy is a discipline that can be
easily combined with others (O’Kelly & Koffman 2007). Music therapy reaches to not only the
whole person, but the whole team behind the person. Music therapy provides support to all those
who support the patient in creative ways that may go unnoticed until you open up the
possibilities musically.

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Works Cited
Aldridge, D. (2003, February). Music therapy and spirituality; A transcendental understanding of
suffering. Music Therapy Today, 22(2), 1-28.
Clements-Cortés, A. (2004, July). The use of music in facilitating emotional. American Journal
of Hospice & Palliative Medicine, 21(4), 255-260.
Gallagher, L. M., Huston, M. J., Nelson, K. A., Walsh, D., & Steele, A. l. (2001). Music therapy
in palliative medicine. Support Care Cancer, 9, 156-161.
Hilliard, R. E. (2003). The effects of music therapy on the quality and length of life of people
diagnosed with terminal cancer. Journal of Music Therapy, XL(2), 113-137.
History of Hospice Care (2012, May 17). In National Hospice and Palliative Care Organization.
Retrieved July 12, 2012, from http://www.nhpco.org/i4a/pages/index.cfm?pageid=3285
Hogan, B. E. (2003, August 10). Soul music in the twilight years: Music therapy and the dying
process. Topics in Geriatric Rhabilitation, 19(4), 275-281.
Horne-Thompson, A., & Grocke, D. (2008). The Effect of Music Therapy on Anxiety in Patients
who are Terminally Ill. Journal of Palliative Medicine, 11(4), 582-590.
Krout, R. E. (2003, March). Music therapy with imminently dying hospice patients and their
families: Facilitating release near the time of death. American Journal of Hospice &
Palliative Care, 20(2), 129-134.
McFerran, K., Roberts, M., O’Grady, L. (2010). Music therapy with bereaved teenagers: A
mixed methods perspective. Death Studies, 34, 541-565.
Munro, S., & Mount, B. (1978). Music therapy in palliative care. CMA Journal, 119, 1029-1034.
O'Kelly, J., & Koffman, J. (2007). Multidisciplinary perspectives of music therapy in adult
palliative care. Palliative Medicine, 21, 235-241.

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Schwantes, M., Wigram, T., McKinney, C., Lipscomb, A., Richards, C. (2011). The Mexican
corridor and its use in a music therapy bereavement group. The Australian Journal of
Music Therapy, 22, 2-20.