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Exploring the role of music therapy in medical decisions

By Ilima Loomis

From the album you listened to on repeat as a teenager to the first song you slow-danced to with your spouse, the music you love is more than just the soundtrack to your life; it’s part of who you are.

That’s the theory behind a new interdisciplinary study by ���ϳԹ��� researchers that investigates whether music therapy can help family members make life-or-death decisions for patients in the intensive care unit (ICU). The team hopes to use music to reduce family members’ distress, help them connect  with their loved one and enable them to reflect on the patient’s wishes.

“These surrogate decision-makers often feel overwhelmed. They’re lost, and they can’t ask their loved one what to do,” said Grant Pignatiello, PhD, RN (NUR ’13; GRS ’18, nursing), assistant professor and KL2 scholar at Frances Payne Bolton School of Nursing, who was recently awarded an Impact Research Grant from the American Association of Critical-Care Nurses for the project. “Maybe we can leverage music as a means to facilitate this connection so the surrogate can tap into the values of the patient and better understand the decisions they should make for them.”

Even with decades of interventions aimed at easing medical decision-making for family members of ICU patients, many of these “surrogate decision-makers” still feel inadequately supported, noted Pignatiello, who serves as the project’s principal investigator.

They are often grieving, sleep-deprived and reeling from their loved one’s sudden medical crisis. In this state, many end up making decisions that don’t align with the patient’s values, such as signing off on invasive treatments that extend life at the cost of prioritizing the patient’s desire for a palliative-oriented plan of care.

The experience can also be devastating for patients’ family members, Pignatiello added. Studies have found around one-third of these decision-makers report symptoms consistent with post-traumatic stress disorder six months later.

“This experience can be very traumatizing, so the hope is music therapy will help them process the experience and improve their long-term psychological health,” Pignatiello said.

Leading the way in music therapy research

University Hospitals, where many ���ϳԹ��� nursing students get clinical experience, has one of the oldest and largest hospital-based music therapy programs in the country, noted Seneca Block, PhD, the Lauren Rich Fine Endowed Director of Expressive Therapies and a board-certified music therapist at University Hospitals Connor Whole Health. But while many studies have shown that music therapy can reduce stress, anxiety and even pain in patients, much less research has been done on how it affects caregivers.

“What’s exciting to me about this project is thinking about how music has this diffuse clinical impact,” said Block, who serves as the project’s music therapist. “We think so much about treating the patient, but how else are we impacting the individuals related to the care plan? That’s something that’s often overlooked.”

The study will take place in the neurological ICU at University Hospitals and will compare results for 20 surrogate decision-makers who receive music therapy, with a control group of the same size. For the project, a music therapist will first meet with participating family members to reminisce about their loved ones and discuss the person’s favorite music. A follow-up session will involve passive listening or active music-making, Block said. Therapists may also guide family members through mindfulness and meditation techniques during the experience.

Researchers will then measure quantitative data and conduct follow-up interviews covering topics including the decision-makers’ emotional symptoms, sleep and quality of communication with the healthcare team.

Tapping “musical identities” for insights

Music can be a way to connect not just with other people but with their beliefs, thoughts and values, said Nathan Kruse, PhD, associate professor of music at ���ϳԹ���’s College of Arts and Sciences. Kruse, an expert who conducts sociological research on music and music education, helped create the framework for the study, designed the interview questions, and will analyze the interview transcripts for qualitative findings.

“Music itself is a powerful vehicle through which individuals construct their personal identities, starting when they’re very young,” he said.

He noted that people turn to music to understand and process their earliest experiences with independence, authority, love, belonging and loss. Over a person’s lifetime, their “musical identity” continues to evolve, with influences from music they hear at home, in various communities they belong to and at places of worship, he added.

S. Alan Hoffer, MD, a professor of neurosurgery at ���ϳԹ��� School of Medicine and a neurosurgeon at University Hospitals Cleveland Medical Center, said when he learned about the premise of the project, he was excited to participate as co-investigator.

The neurological ICU specializes in caring for patients with stroke, aneurysm and other acute problems that affect their cognitive function; even when they are conscious, they are often confused and not capable of making decisions for themselves, he said. In this situation, the medical team must turn to family members for insights into their wishes.

“One of our most important roles as physicians is to help patients via their decision-makers, so we ask the family members to put aside their own feelings and speak for their loved one: If the patient could talk, what would they be telling us to do?” he said. “If we can use music to help decision-makers reflect on that person’s true self and wishes, then we are helping that patient be treated the way they want to be treated.”

This article appears in the print edition of Forefront magazine, summer 2024. Find more stories from Forefront at case.edu/nursing/news-events/forefront-magazine.