Informing Healthcare Providers
in Hospice and Palliative Care
of the
Pioneering Field
of Music-Thanatology
and the Benefit and Use of
Music in End-of-Life Care
Music-Thanatology Training
Lane Community College
Eugene, Oregon
Professional/Academic Research Paper
Jennifer Jones Nackowski
June 2009
Copyright © 2009 Jennifer Jones Nackowski
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ACKNOWLEDGEMENT
This paper is dedicated to the thousands of hospice and palliative care “givers” who
lovingly and graciously assist patients and their families with end-of-life care. Countless
hours of compassionate service are extended to the dying using available resources,
skills, talents and professional expertise in meeting the physical, emotional and spiritual
needs of the dying. As this specialized field grows and its value and benefits become
more visible it is my desire that music-thanatology be available to every person who
wants and needs the healing comfort and peaceful rest offered by a trained music-
thanatologist.
My deepest gratitude to my teachers, my mentor, my advisor and most especially my
classmates who have traveled this journey with me in preparation to become a Certified
Music-Thanatologist helping develop qualities I didn’t have before.
We have only just begun . . .
Sincere love and appreciation to my family: Peter, Ben and Dana, Nyla, Soni and
Lindsay, my sisters, my brother, my mother-in law and my amazing Mother, Lynn,
We all know, the tougher the journey the greater the joy!
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Informing Healthcare Providers in Hospice and Palliative Care of the Pioneering Field of
Music-Thanatology and the Benefit and Use of Music in End-of-Life Care
Over the past several decades, the hospice movement has evolved into an important treatment
option for the terminally ill. Hospice care has helped countless people deal in a more positive
way with death by making it more natural, visible and acceptable to the patient’s family, friends
and community. Music-thanatology is a recent and creative addition to the menu of palliative
care and hospice services offering dynamic, individualized and prescriptive music to the dying
and their families. Combining medicine and music, music-thanatologists bring physical,
emotional and spiritual support to dying patients, however, few providers in the field of hospice
and palliative care understand the healing power of music, when to use it or how to find someone
who practices music-thanatology.
Statement of Purpose
In order to inform healthcare professionals in the hospice and palliative care field about the use
and benefit of music-thanatology it is necessary to determine how much is really known and
understood by these practitioners. This paper will present a brief history of the hospice
movement in this country and introduce the pioneering field of music-thanatology, its value and
benefits for the dying. The essential elements of this paper, however, are the results of a survey
of healthcare providers measuring their individual understanding of music-thanatology. Finally,
an outline to aid in the presentation of music-thanatology is presented which can be used to teach
and inform professionals at any level about the use, value and benefits of music-thanatology.
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History of Hospice in the United States
“We live in a very peculiar, death-defying society. We isolate both the dying and the old, and it
serves a purpose, I guess. They are reminders of our own mortality.” Elisabeth Kubler-Ross
made this statement when she testified at the first national hearings on the subject of death with
dignity, which were conducted by the U.S. Senate Special Committee on Aging in 1972. Her
statement continues, “We should not institutionalize people. We can give families more help
with home care and visiting nurses, giving the families and the patients the spiritual, emotional
and financial help in order to facilitate the final care at home.”
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The hospice movement in the United States has its roots in the work of British Physician Dame
Cicely Saunders and Dr. Elisabeth Kubler-Ross, who brought the subject of dying into the open.
In the 1950’s Saunders envisioned a community of caring that would attend to the spiritual needs
of dying patients along with addressing their pain management and other medical needs.
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Kubler-Ross argued that homecare was preferable over institutional care and that patients should
be able to participate in decisions regarding their treatment. Since that time, attitudes have
evolved and the hospice philosophy that dying and death is a natural occurrence has begun to
alter American society’s technological view that dying and death are events that must be avoided
at all medical costs. This way of thinking is a return to an old and more traditional view of
dying.
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The first hospice in the United States opened in 1974 and today there are more than 3,200
hospices across the country – some are part of hospitals or health systems, others are
independent, some are nonprofit agencies, others are for-profit companies. In the year 2000,
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about one in every four Americans who died received hospice care at the end of life. In spite of
this, however, the numbers of dying patients who elect hospice care remain small – the vast
majority of people still die in nursing homes and hospitals where they are often invisible to
society, friends and families.
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“Dying of cancer without the help of a hospice program has been compared to undergoing
surgery without anesthesia.”
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Hospice programs offer unique benefits for patients who are
near
the end of life and their families, and growing evidence indicates that hospice provides high-
quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll
generally do so very late in the course of their illness.
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It can also be said that some hospice agencies require more understanding of services and related
elements of care that add to the quality of end-of-life care for patients and their families in
addition to medical intervention. While it is customary for palliative care to include symptom
control, emotional and spiritual support, there is a persistent attitude that spiritual care is an
“additional” service rather than intrinsic to end-of-life care. It remains a challenge, even with
changing attitudes toward death and dying, to help professional medical personnel address the
whole person not just the physical aspect.
Historical Background and Benefits of Music-Thanatology
The practice of using music as a way of comforting, calming and relieving suffering is an ancient
tradition dating back to the monastic infirmaries of the Middle Ages. “Thanatos” comes from
the Greek which means death and the word thanatology is the study of the effects of death and
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the needs of the terminally ill. Patterned after the 10
th
century monastery at Cluny, France the
tradition of monastic medicine, with the philosophy of creating a peaceful death, inspired the
current profession of music-thanatology.
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The term music-thanatology was coined by harpist Therese Schroeder-Sheker who founded the
present field of music-thanatology in the 1970’s. Today, it is recognized as a sub-specialty of
palliative care that unites music and medicine at the bedside of the dying. It is a contemplative
practice with clinical applications utilizing harp and voice focusing on the physical and spiritual
care of the dying with prescriptive music.
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Prescriptive music is live music that responds to the physiological needs of the patient moment
by moment. It is this element that distinguishes this work from other programs of music therapy.
The music-thanatologist observes vital signs such as heart rate, respiration and temperature and
then provides music that is tailored to each specific situation. The music is offered peacefully so
the patient can listen or sleep. “The music can help to ease physical symptoms such as pain,
restlessness, agitation, sleeplessness and labored breathing. It offers an atmosphere of serenity
and comfort that can be profoundly soothing for those present. Difficult emotions such as anger,
fear, sadness and grief can be relieved as listeners rest into a musical presence of beauty,
intimacy and compassion.”
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“The Certified Music-Thanatologist works to provide a musical
presence that draws together and responds to the various streams of diagnosis, prognosis,
personal, spiritual and social context, as well as the present and ever changing physiological
parameters of the patient.” The music is quiet, restful, and meditative and is chosen to address
the individual needs and symptoms of each patient.
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The music-thanatologist works with those who are actively dying or have received a terminal
diagnosis with a four-fold goal: 1) relief of acute and chronic physiological pain and/or spiritual
suffering; 2) the creation of the supportive conditions which can facilitate reconciliation and
meaning in the face of mortality and suffering; 3) a blessed or peaceful or conscious death
which is returned back into the fullness of life and the whole human life cycle; and, 4) the
transformation of the personal, familial, medical, cultural and community experiences of death.
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“Music-thanatology is not intended to entertain or distract the patient. Instead, this music allows
the patient to enter into the unbinding process of letting go in his or her own very personal way.
It affords families a chance to be with their loved one in a very intimate yet safe atmosphere
where words are not necessary and the words that are said can come from a deep place, aided by
the music”.
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The service at the bedside is called a “vigil” which means watchfulness. “A music
vigil is the time during which a music-thanatologist is present and offering prescriptive music
using harp and voice for the benefit of the patient and their loved ones. It is recognized that
family and caregivers are experiencing grief, loss, change and a desire to support the patient.
They are encouraged to be present for the vigil.”
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”The music is delivered to support the process that is taking place within and around the patient.
Musical elements such as rhythm, pacing, volume and tone are tailored, or prescribed, live at the
bedside, and the delivery changes constantly in attentive response to the patient. For example,
the length and shape of a musical phrase can correspond to the rise and fall of the patient’s
breath. Fluctuations in dynamics can reflect variations from restless to calm or from effort to
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ease. Rhythm may be an avenue to achieve a close synchronization, and letting go of that
rhythm may support the possibility of inner and outer movement. This is not to say there is a
particular formula to be followed, only that live music at the bedside provides a broad spectrum
of choices for the trained practitioner to employ in seeking to accompany patients, families and
caregivers as they work through the end-of-life process.”
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One of the tools a music-thanatolgist uses to evaluate their work at the bedside is a “narrative”
which documents the clinical observations of the patient before and after the vigil as well as
listing the music played and its prescriptive qualities. It documents what actually was
experienced by the patient, loved ones and music-thanatologist during the vigil. “No
interpretation is necessary. The event is simply observed and recorded as the truth of the
patient’s experience at the time the music is offered.”
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For example, the following excerpt from
a vigil narrative describes the experience as follows: “We sit in silence for a few moments,
preparing a still, sacred container. The music begins. . . played antiphonally, wafting gently
from each side of the bed. The long, melismatic phrases in major modality are offered with the
intent of providing a cradling blanket of beauty and comfort. The patient stills within a couple
minutes. Her eyes close, and her mouth drops open slightly, revealing a thick tongue. By the
end. . .the patient’s pulse drops to 80 and her respirations decrease to 16.
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Survey Findings
To ascertain the level of understanding about music-thanatology a survey of 20 hospices was
conducted in Salt Lake City, Utah. Hospice teams, consisting of physicians, social workers,
nurses, aides, chaplains, volunteers and office support staff, were asked to answer nine questions
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and make comments relating to their knowledge about music-thanatology. (See Appendix 1 –
Questionnaire) An explanation of the questionnaire follows including two tables showing
percentages of certain responses.
The first section of the questionnaire asked qualifying information regarding current position,
years worked in hospice and knowledge of music-thanatology. In the first column of Table 1 the
position of those responding to the survey is listed. Column two shows the percent of the total
respondents from a particular position, and column three shows the percent of those respondents
who have knowledge of music-thanatology. Of the total respondents, 88% said they had heard
about music-thanatology and 12% said they had no knowledge.
Table 1. Position on Hospice Team – Percentage with Knowledge of Music-Thanatology
Position on
Hospice Team
Percent of Total
Respondents
Knowledge of Music-
Thanatology
Yes No
Nurse 52% 86% 14%
Social Worker 16% 89% 11%
Chaplain 7% 100%
Volunteer 7% 100%
Administration 6% 100%
CNA (Aide) 7% 75% 25%
Other 3% 50% 50%
Physician 2% 100%
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Table 2 following, breaks down respondents into years of service which shows there is no trend
indicating that long-time employees have a better understanding of music-thanatology that those
who are new to the profession. Of respondents who have worked in hospice for six months or
less, 100% indicated they know about music-thanatology and only 65% of respondents who have
worked in the field for one to three years know about music-thanatology. However, for those
respondents who have worked for over three years in the hospice 97% reported they had
knowledge about music-thanatology.
Table 2. Percentage of Music-Thanatology Knowledge and Years Worked in Hospice
Less than 6
months 15%
Worked 1-3 years
30%
Worked over 3 years
55%
Know Don’t Know Don’t Know Don’t
100% 65% 35% 97% 3%
The second part of the questionnaire asked respondents to describe their understanding of music-
thanatology and the qualifications required of a music-thanatologist. Almost two-thirds of the
respondents believed training and qualifications beyond musical ability are required to be a
music-thanatologist with comments from 12% which suggest “master’s degree required” to 31%
believing that some musical training is required. Two respondents indicated their understanding
of qualifications as “musical talent” and being a “trained volunteer”.
The third section of the questionnaire asked about personal experience and opinions regarding
the value and benefits of music for the dying. The majority of the respondents, 76%, indicated
they believed hospice care providers value music as an important part of care for the dying,
however, they expressed some concern that administration does not place value on it and that it
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is not utilized as much as it could be. One comment from the group that did not understand the
value of music indicated there is a “…perception that dying patients are hypersensitive to
stimulation”. While few of the respondents commented about the value hospice care providers
place on music for the dying, one respondent expressed concern about the future saying, “I think
that as we get more and more clinically driven, we forget these wonder techniques we can use to
provide care and comfort for our patients.” A question requesting a music-thanatology vigil for a
patient was asked and 23% indicated they know who to call, however, the music services they
utilize are from staff members or volunteers who play a variety of instruments or sing. “If we
had this service at our hospice we would request it through our volunteer program.” None of the
respondents indicated they had made a referral to a Certified Music-Thanatologist.
The final question on the survey was asked specifically to determine if healthcare professionals
who responded to this questionnaire agreed on what they believe contributes most to the patient
and family on hospice care. The comments were surprising – there were over 40 separate
categories listed. Some responses were duplicated or worded differently but the range of
opinions indicate healthcare providers do not agree on what is of most value to a dying patient
and family.
Twenty-five percent of respondents indicated the most important contribution to a patient and
family on hospice care was hospice team support, including education, on-call team response and
24-hour care. Comfort care, including compassion, physical, social and emotional comfort and
communication was indicated as the second highest category contributing to hospice care with
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14%. The third most important contribution to patient and family care was pain and symptom
management at home with 13% of responses.
Other categories mentioned, which received less than 11% were supportive care, including
listening, respite care and companionship. Patient and family needs such as physical and mental
patient care and a serene setting were next followed by family and friend support, education and
communication. Spiritual support and grief support were at the bottom of the list receiving less
than 4% of responses. (See Appendix 2 – Survey Results, for listed responses to each question)
Presentation Outline for Introduction to Music-Thanatology
There are many opportunities in the hospice arena to introduce music-thanatology to health care
providers, such as: in-service training for hospice agencies, Skilled Nursing Facilities, Assisted
Living Facilities, Hospitals and University’s schools of Nursing and Social Work. There are
opportunities for community education in churches and senior centers as well as service
organizations and auxiliaries. In addition, information about music-thanatology and its benefits
for the dying can be distributed in brochures and flyers as well as articles submitted to area
newspapers, professional magazines and journals to carry forth the message of the value of
music for the dying. The following outline can be adapted for use in training and teaching
professionals and the community about music-thanatology.
WHAT IS MUSIC-THANATOLOGY:
• Music and medicine have a long, ancient tradition associated with healing.
o Music-thanatology is the contemporary component of palliative care rooted in the
monastic tradition of creating a peaceful death by uniting music and medicine at the
end-of-life
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o Music-thanatology brings the beauty of harp and voice to the bedside of the dying
meeting anxiety, grief and suffering with the therapeutic qualities of music
• The word “thanatology” comes from the Greek word for death, “Thanatos”
o Thanatology is the study of death and dying
o Music-thanatology means music for the dying
• The service at the bedside is called a music “vigil”
• Music-thanagologists are clinically trained in an extensive two-year program involving
musicianship and areas of study including physiology and anatomy, disease and the aging
process, cultures and religions and contemplative practices
WHAT IS THE PURPOSE OF MUSIC-THANATOLOGY:
• The purpose of Music-thanatology is to lovingly serve the physical, emotional and spiritual
needs of the dying with “prescriptive” or individualized music.
o Blending science and art, a range of music is played based upon patient symptoms at
the time music is offered easing symptoms caused by physical, emotional or spiritual
pain
o The delivery of the music changes constantly in loving, attentive response to the
patient offering relief from anxiety, discomfort and suffering
o The thematic material draws primarily on traditions of sacred song and lullabies.
o The prescriptive qualities within the music support the work of “letting go.” These
unbinding elements can free the patient to move toward acceptance, release and
peaceful death.
HOW CAN MUSIC-THANATOLOGY BENEFIT YOUR PATIENTS
• In situations where everyone is doing their best, the dying person may still have significant
physical, emotional or spiritual pain. A music vigil at the bedside is almost always beneficial
for both patient and loved ones.
• The vigil conveys a sense of serenity and consolation that can be profoundly soothing to
those present. Difficult emotions such as anger, fear, sadness and grief can find unspoken
comfort as listeners rest into a musical presence of beauty, intimacy, and reverence.
• Together with the diagnosis of the patient we assess –
o Respiration
o Pulse
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o Body Temperature and color
o Level of pain
• With this information we determine what music will be played during a vigil and which
techniques, like harmony, rhythm, melody or volume will be used to meet the patient’s
needs.
What does music do? How is it done?
• The music used in a vigil is contemplative music played with harp and voice
• Vibrational energy of music can relieve physical, emotional and spiritual symptoms such as:
o Pain, restlessness, agitation, sleeplessness, labored breathing, fear, sadness, grief
• The instrument capable of reaching this core most profoundly is the harp, especially when
played by someone with the awareness of healing intent and the clinical training to address
the physical, emotional and spiritual needs of a patient
• Only the harp has the capability of producing the wide range of tones used in the prescriptive
music applied during a vigil.
o Volume, rhythm and change of keys provide a variety of musical choices
o Lever Harp for portability
o The resonant tones and vibrations of the harp reveal the therapeutic value to the
patient.
2 The resonant qualities and overtones of the harp linger in the body even after
the sound is no longer heard.
2 Even patients who are hard of hearing, or are in that unconscious place often
associated with death, can still benefit from the vibrational energy of the harp.
o Voice is the other instrument that can be used in a variety of ways using words and
harmony to achieve a prescriptive quality or benefit.
WHEN AND HOW TO USE THE SERVICES OF A MUSIC-THANATO LOGIST
How are potential patients informed?
• In most hospice agencies, within 24-48 hours after admission the patient and family are
visited by a nurse, a social worker and chaplain. These professionals should be aware of the
benefits of live music at the bedside and can educate the patient and family about the
availability of a music vigil
• The music-thanatologist calls the patient, family or caregiver and makes arrangements for a
30-60 minute vigil appointment.
When to make a referral for Music-Thanatology:
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There are three referral categories:
• Imminency: Actively dying – highest level of acuity
• Processing: Patients who are terminally ill and receiving palliative care
• Intervention: May not be at end of life but experiencing pain, anxiety, sleeplessness.
EXPERIENCE HARP MUSIC:
• 5-20 minutes to have audience experience the sound and quality of the harp
Discussion and Conclusion
This paper presented a brief history of hospice in the United States revealing that over the past
several decades hospice treatment has helped thousands of people deal with death by making it a
natural part of life. The pioneering field of music-thanatology was also described explaining the
value and benefits of music at the bedside of the dying. The results of a questionnaire given to
healthcare professionals measuring their knowledge and understanding of music-thanatology
indicated that most hospice and palliative care providers surveyed do not have an accurate
understanding of what music-thanatology is and how the application of music at the bedside of
the dying benefits patient and family.
As the results of the survey indicated, everyone believes music is beautiful, it can make people
feel good and some even understand that music can be played in response to body rhythms but
few of the respondents really understand what music-thanatology is and how it benefits the
dying. The percentage of respondents that said they had some knowledge of music-thanatology
had a limited understanding of the specialty or how it is applied to the dying. Many comments
were made about the benefit of music, for instance: “Music is used (harp & singing) to
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assist/facilitate in making the actual death peaceful.” “Calms people when dying – slows heart
rate.” “Music played to body rhythms” and, “Specific music designed to assist the patient
through the dying process.” The most insightful comment was: “I am aware of the service. I
understand that some individuals (thanatologists) are able to discern which type of music to play
based on the reaction of the patient even though they are no longer able to respond verbally.”
And another comment, “A quality means of spirituality. Brings spiritual peace to patients.
Opening door or window of opportunity to release spiritual stress.” Although the majority of
comments to this question showed some knowledge that music is beneficial to the dying, a
number of responses showed a lack of complete understanding with comments indicating that
music is performed to entertain and that familiar tunes are used for a calming and comforting
effect.
From section two, the questions about understanding music-thanatology and required training,
the following comment shows some professionals understand the necessary educational
requirement. The respondent writes, “Specifically, I think one to two years training to provide
the specific music and environment to facilitate dying. I have seen a small in-service by a music-
thanatologist and it was wonderful.” The survey results show that even though healthcare
professionals don’t have direct knowledge of training and certification requirements of a music-
thanatologist, most believe specialized training is necessary.
In the third section of the questionnaire regarding the value and benefits of music at the bedside,
the conclusion could be drawn that hospice and palliative care providers do not fully understand
the value of music-thanatology at the bedside of the dying and based on the information in Table
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2, there is no trend indicating that long-time employees have a better understanding of music-
thanatology than those who are new to the profession.
The most interesting results of the survey, however, were the variety of responses to the last
question about what contributes most to the patient and family on hospice care. The wide range
of opinions could indicate a general lack of training in and understanding of the hospice
philosophy, an inadequate knowledge of the dying process and the important aspects of not just
physical care of the dying but that emotional and spiritual issues need to be addressed at end-of-
life. The only physician who responded to the questionnaire indicated hearing about music-
thanatology but responded with the words, “little or none” to every other question except the last
one about what contributes most to the patient and family on hospice care. The physician’s
response was 1) “Relief of physical suffering”, 2) “Relief of emotional suffering” and 3) “Relief
of spiritual suffering”. Clearly, as medical technology becomes even more advanced,
practitioners must recognize that there is suffering that eludes even the most sophisticated
medical treatment.
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Emotional and spiritual needs of the dying can be eased as music vigils
become an integral form of care offering an opportunity for relieving suffering and bringing
comfort to the dying.
The results of the 20 local hospice agencies surveyed clearly indicate music as a physical,
emotional and spiritual benefit for the dying is not fully understood. There are misconceptions
about music-thanatology, required training, the value to the dying and it is inadequately used in
care of the dying in this area this survey was conducted. As previously stated, while it is
customary for palliative care to include symptom control, emotional and spiritual support, there
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is a persistent attitude that spiritual care is an “additional” service rather than intrinsic to end-of-
life care. It remains a challenge, even with changing attitudes toward death and dying, to help
professional medical personnel address the whole person not just the physical aspect. Education,
information and training are required to make the profession of music-thanatology a viable
consideration to accompany patients and families through the end-of-life process. The most
effective way to impart the value and benefit of prescriptive music at the bedside of the dying is
best accomplished by a music-thanatologist who embodies the necessary background, education
and skill to influence and change the attitude that spiritual care is not an additional service but a
required and necessary service intrinsic to end-of-life care. The outline included in this paper is
designed to aid in the presentation of music-thanatology to professionals at any level. The
responsibility of informing and developing the field of music-thanatology belongs to music-
thanatologists.
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Music has no value or morals. Music does not think. When music replaces our thoughts we are
in a trance and are open to suggestion. There is no longer a question of thinking. We are in
motion. We are merged as one with the music. Our thoughts, emotions, and physical bodies are
moving with the elemental qualities of the sound. Later, the self remembers. Music is always a
participatory and energetic event. The difference between what is secular and what is divine in
music is only a matter of focus. The divine is always present.
John Beaulieu
Music and Sound in the Healing Arts
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Appendix 1 – QUESTIONNAIRE
What do you know about Music-Thanatology?
I am writing a research paper as part of my training to become a Certified Music-Thanatologist.
A music-thanatologist offers harp and voice at the bedside of the dying meeting anxiety,
discomfort and suffering with the therapeutic qualities of music. This brief questionnaire is
designed to determine how much professionals in the homecare and hospice field know and
understand about music-thanatology.
Please take a few minutes and answer the questions listed below by circling the answer that
applies, making a short list or writing a brief statement. Please feel free to comment on any
question. Thank you!
1. What is your current position/responsibility on the Hospice Team?
a. Physician b. Nurse c. Certified Nursing As sistant-CNA
d. Social Worker e. Chaplain f. Volunteer
g. Administration h. Finance/Billing i. Other (please indicate)
2. How long have you worked in hospice?
a. 0-6 months b. 6 months – 3 years c. More than 3 years
3. Have you heard about music-thanatology? Yes _____ No _____
4. Please describe your understanding of music-thanatology.
5. Please describe your understanding of the training and qualifications of a music-
thanatologist.
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6. In your experience, do you believe hospice care providers value music as an important
part of care for the dying?
Yes _____ No _____ Comments:
7. In your experience, do you know or understand the benefits of music at the bedside of
the dying?
Yes _____ No _____ Comments:
8. Do you know how a hospice team member makes a request for music-thanatology for a
patient?
Yes _____ No _____ Explain:
9. In your experience, what are three things you believe contribute most to the patient and
family on hospice care?
1.
2.
3.
Additional Comments:
THANKS for your time! Jennifer J. Nackowski, Music-Thanatologist Intern
435-669-8359
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Appendix 2 – SURVEY RESULTS
1. What is your current position/responsibility on the Hospice Team?
a. Physician – 2%
b. Nurse – 52%
c. Certified Nursing Assistant-CNA (Aide) – 7%
d. Social Worker – 16%
e. Chaplain – 7%
f. Volunteer – 7%
g. Administration / Finance/Billing – 6%
i. Other – 3%
2. How long have you worked in hospice?
a. 0-6 months – 15% (100% Know of MTh)
b. 1-3 years – 30% (65% Know of MTh, 35% Don’t Know )
c. More than 3 years – 55% (97% Know of MTh, 3% Don’t Know)
3. Have you heard about music-thanatology?
Yes – 88%
No – 12%
a. Physician – 100% Yes
b. Nurse – 86% Yes, 14% No
c. Certified Nursing Assistant-CNA (Aide) 75% Yes, 25% No
d. Social Worker – 89% Yes, 11% No
e. Chaplain – 100% Yes
f. Volunteer – 100% Yes
g. Administration / Finance/Billing – 100% Yes
i. Other – 50% Yes, 50% No
4. Please describe your understanding of music-thanatology.
• Specific music designed to assist the patient through the dying process
• Music played to body rhythms
• Music that is performed to promote comfort, peace, entertainment, etc. to person’s with a
chronic or terminal illness
• Music is used (harp & singing) to assist/facilitate in making the actual death peaceful
• Calms people when dying – slows heart rate
• I worked with a thanatologist and have a good understanding of it. I also have many
wonderful experiences that were shared with her.
• I am aware of the service. I understand that some individuals (thanatologists) are able to
discern which type of music to play based on the reaction of the patient even though they
are no longer able to respond verbally
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• Music to calm patient and family and provide serenity during the final stage of the dying
process
• It creates a soothing atmosphere
• Helps in many ways; decrease anxiety, help patient relax and decrease pain
• Music or singing often together played at the bedside
• I have a good friend who is a music thanatologist. If you want to talk to her, please call
me
• Therapist attends patient. Quite a bit of the time is a vigil music thanatology.
Thanatologist assesses patient’s heart rate and respirations. Uses music in time to heart
rate and respirations. Will also play familiar tunes that have calming and comforting
effect.
• I know that it involves the concept of music therapy to help hospice patients.
• Using familiar music for comfort using tones and particular rhythm for comfort
• Return patient peacefulness. Can decrease pain and alleviate some physical symptoms
• Utilize/access energy vibrations to promote healing/wellness
• Music to comfort dying
• Soothing music by any artist at the patient’s bedside
• I have utilized harpist in the past as well as singing at the bedside
• Music therapy at the end-of-life
• Therapy through musical notes. Especially harp that reduces anxiety and helps people
relax and brings into a more spiritual state
• Music, usually the harp that is used when patient is actively dying. Music mimics the
breathing and heart rate to assist patient with relaxation and have more comfortable death
• Using music to help the dying and their families with the transition
• A quality means of spirituality. Bring spiritual peace to patients. Opening door or
window of opportunity to release spiritual stress
• I have seen music-thanatology bring huge benefits to patients and families
• Music comforts – helps anxiety –calming
• Music-thanatology provides relaxation for people suffering a terminal condition. In the
active dying process patients can experience lowered heart rate and respirations with
music.
• Is relaxation for terminally ill patient. Is a form of therapy (I think)
• Music-thanatology has a way of calming patients as they enter their dying process and
helps relieve stress and anxiety for the patient and family.
• It provides calm, comforting atmosphere and allows patients to relax and reduces
symptoms of anxiety and restlessness.
• Playing music at the bedside
• Music is soothing to dying
• Playing music to help people achieve a calm peaceful state
5. Please describe your understanding of the training and qualifications of a music-
thanatologist.
• Have musical training
24
• Specifically, I think one to two years training to provide the specific music and
environment to facilitate dying. I have seen a small in-service by a music-thanatologist
and it was wonderful.
• There are specific trainings and a license or certification that is required. I have no idea if
it is post-graduate training or the number of hours to be licensed.
• Bachelors degree – license in music-thanatologist
• I understanding there is a certification program through Utah State University
• I do not know what training/qualifications are required
• My experience has been with people who are music majors and enjoy doing volunteer
work with their talent.
• It is a degree program
• Focus on patient and patient needs, varies music with patient’s breathing, etc.
• Currently a nurse and a social worker or our hospice team provide this together. I do not
know specifics of education.
• Well, I know they don’t just take anyone off the street. My understanding is it takes 11/2
years of education at least, and certification.
• I don’t know. I have never personally worked anywhere that offers this service to
hospice patients. My awareness is limited to information I received at a hospice
conference about one of the course offerings that I didn’t end up attending.
• Master’s Degree with mental health focus
• Assume some formalized required training but unsure of what that is.
• I understood that a musician trains for hospice through a hospice program.
• Just know they have schooling related to this field
• No understanding other than musical training
• Certification, formal education, internship
• Music-thanatologist’s go through formal musical training on their instrument as well as
end-of-life therapy.
• I think they have a degree in music and then a specialization in thanatology – not sure
though
• Proficient with instrument and certified through training
• Understanding of music background – bring harp or voice. Sometimes utilizing only one
tone or note, depending upon where patient is in the dying process.
• Masters in music
• Background of music as well as lessons in music or instruments. Understanding of
comfort and healing.
• I presume there is a degree program or a certification.
• I believe you can now get a degree or advanced certificate in music-thanatology
• Not aware of the training or qualifications of a music thanatologist
• I really don’t know, but apparently there is a certification
• Must have a Master’s Degree
• I am not clear on what is involved
• I am not familiar with the extent of training
• Trained volunteer
25
• Someone who can play music
6. In your experience, do you believe hospice care providers value music as an important
part of care for the dying?
Yes – 75%
• Sometimes but not often
• In our Layton office our Chaplain plays the guitar and sings for the patients and they love
it a lot.
• As a volunteer coordinator, I do know patients request to listen to music. I know the
patient values music as comfort and relaxation. I don’t know how much the staff knows.
• I don’t think administrators grasp its importance at all!
• In many cases
• We have many staff members who are musically talented and share this with ding and
demented patients.
• But don’t utilize as much as needed
• Can be very soothing
• I have experience with it. I personally think it would be valuable.
• It offers a quality experience to the dying process
• Primarily for people who have been involved in music
• It’s also important while our patients are alive. Music can even alleviate pain
• I have seen music calm patients that are actively dying
• I think it certainly is for some patients and as the team we know that usually and think it’s
important as well
• However, it needs to be used more as does hospice
• I don’t know about other providers but I have a strong belief in the ability of music to
help people achieve peaceful, pain free states
• I think it is valued when it is available
No – 25%
• Not enough or hospice companies do not provide this
• Perception that dying patients are hypersensitive to stimulation
• No, but I do!
• Our company is the exception and really takes a holistic approach to hospice care
• Rarely used
• I think that as we get more and more clinically driven, we forget these wonder techniques
we can use to provide care and comfort for our patients.
7. In your experience, do you know or understand the benefits of music at the bedside of
the dying?
Yes – 71%
• Somewhat
26
• It allows for a peaceful transition
• But I would like to know more
• Most people use a CD player
• I have had a few patients who have used music to help them be calm and relax during
stressful times.
• Perhaps – but maybe not as much as I should
• I majored in music therapy for a time and understand the benefits of music – especially to
reduce anxiety and assist patient breathing /heart rate to slow
• I have seen it bring peace into a room that has allowed spiritual care to happen and has
helped suffering people let go and die
• I have seen many patients with decreased pain and anxiety through use of music
• I know some – probably not the full benefit. I have seen positive results.
No – 29%
• No, but I believe it would be beneficial to many dying patients
• No firsthand experience
• Not directly but am open to learning
8. Do you know how a hospice team member makes a request for music-thanatology for a
patient?
Yes – 27%
• I ask all
the time
• We have several resources including our medical doctor
• Usually a team member makes a request to case manager
• Look on internet / University of Utah
• Needs to be approved by administration
• Unfortunately we don’t have a volunteer to provide this service at this time
• I have networked
• If we had this service at our hospice we would request it through our volunteer program
• I know this process in the hospital, but am not sure of the process in the home.
No – 73%
• Don’t know the process
• I have had no experience with music-thanatology with any of my patients
• We don’t have that service available
• I would love to do this – but if it is an additional cost our company may not agree to it.
Can you do it pro bono?
• I turn this request over to our social worker who plays or will have contacts for other
musicians
27
9. In your experience, what are three things you believe contribute most to the patient and
family on hospice care?
Hospice Team Support
• Hospice team support with education
• Good team – team response
• On-Call Staff – Frequent contact – 24-hour nursing care/support
• Social Work
• Nurse
• Social worker and volunteers
• Extra help – providing the extras i.e, volunteers
• Chaplain
• Psycho/social support and end of life planning
Comfort
• Comfort
• Compassion
• Comfort physically, socially
• Communication
• Honesty and trust
• Love
• Hope
Pain and Symptom Management
• Pain management / relief
• Symptom management at home
Supportive Care
• Supportive Care
• Listening
• Respite Care
• Companionship
• Emotional support
• Sincerity and care
• Asking not assuming
Patient Needs
• Taking care of patient and family needs
• Physical and mental patient care
• Serene setting
• Being able to make own decisions regarding end-of-life
• Wishes being met including music
• Mental preparation
• Patient-centered goals
• Client needs first
28
Family / Friend Support
• Family Support
• Being surrounded by family and friends
• Caregiver support
Education and Communication
• Communication
• Knowledge of dying process
• Understanding of prognosis and acceptance of death
Spiritual Support
• Spiritual Support
Grief Support
• Bereavement / Grief Support and anticipatory grief counseling
ADDITIONAL COMMENTS
• Many factors contributing to a peaceful hospice death do not involve the hospice team
• Hospice is about quality not quantity
• What a gift to individual and community
• Would love more info on Thanatology
• While individual and families may choose to include music in end-of-life care, offering
music-thanatology is beyond my competence at the present
• Music would add another dimension to making the death process a positive experience
for both patient and family
• Is music-thanatology something that is provided through the individual agency, is it a part
of volunteer services? I’m just not sure where and how it is accessed.
• Music is such a great addition and value to patient at end-of-life
• Music-thanatology should be used more to facilitate peaceful dying
29
END NOTES
1
Hospice Association of America, Hospice: An HAA/NAHC Historical Perspective,
Congressional Record (1972). Death with Dignity
. Washington, DC.
2
Meador, Keith G. MD, ThM, MPH,“Spiritual Care at the End of Life: What Is It and Who
Does It”, North Carolina Medical Journal, July/August 2004, Volume 65, Number 4 Dame
Cicely Saunders founded the first modern hospice, St. Christophers, in London in 1967
3
History of Hospice Care, National Hospice and Palliative Care Organization (NHPCO),
www.nhpco.org
4
Daugherty, Christopher K., David P. Steensma, “Overcoming Obstacles to Hospice Care: An
Ethical Examination of Inertia and Inaction, Journal of Clinical Oncology, Vol 20, Issue 11
(June), 2002
5
Cassarett,David J., MD,MA, and Timothy E. Quill, MD, “I’m Not Ready for Hospice”:
Strategies for Timely and Effective Hospice Discussion, Annals of Internal Medicine, Volume
146 Issue 6, Pages 443-449, March 20, 2007
6
Paxton, Frederick S., A Medieval Latin Death Ritual: The Monastic Customaries of Bernard
and Ulrich of Cluny, Studies in Music-Thanatology 1, Missoula; St. Dunstan’s Press 1993
(originally published as a Master’s Thesis)
7
Schroeder-Sheker, Therese, “Music for the Dying: A Personal Account of the New Field of
Music-Thanatology – History, Theories, and Clinical Narratives”, Advances, The Journal of
Mind-Body Health, Vol. 9, No 1, Winter, 1993
8
Music-Thanatology Association International,(MTAI) What is Music-Thanatology? September
22, 2008,
www.mtai.org
9
Schroeder-Sheker, Therese, “In Brief: What is Music-Thanatology?”, 1996. Web Page
10
MTAI
30
11
MTAI
12
MTAI
13
“Feature: Music Thanatology As Narrative Practice” by Suzanne Cerddue, The Journal of the
Music-Thanatology Association International, February 2009
14
Clinical Narrative #32 by Music-Thanatologist Intern, Cyd Dudgeon, Submitted February 3,
2009
15
MTAI
31
BIBLIOGRAPHY
Articles/Papers
Cerddue, Suzanne, “Feature: Music Thanatology As Narrative Practice”, The Journal of the
Music-Thanatology Association International, February 2009
Clinical Narrative #32 by Music-Thanatologist Intern, Cyd Dudgeon, Submitted February 3,
2009
“Physicians Speak Out On ‘MusicMedicine’”, Article #77 Musical Inspirations
Books
Kubler-Ross, Elisabeth, On Death and Dying
. New York: Macmillan Co., 1969
Paxton, Frederick S., A Medieval Latin Death Ritual: The Monastic Customaries of Bernard and
Ulrich of Cluny, Studies in Music-Thanatology 1, Missoula; St. Dunstan’s Press 1993 (originally
published as a Master’s Thesis)
Haley, James, Editor, Death and Dying: Opposing Viewpoints. Greenhaven Press, 2003
Kubler-Ross, Elisabeth, On Death and Dying: What the dying have to teach doctors, nurses,
clergy and their own families. Collier Books, Macmillian Publishing Company, New York,1969
Lattanzi-Licht, Marcia, with John J. Mahoney and Galen W. Miller, The Hospice Choice: In
Pursuit of a Peaceful Death, A Fireside Book Published by Simon & Schuster, Copyright 1998
by The National Hospice Organization
Encyclopedia
The World Book Encyclopedia 2007
Fundamentals of Nursing – Concepts and Procedures, Third Edition, Barbara Kozier, Glenora
Erb, 1987
Journals
Aldridge, David, Ph.D, The Music of the Body: Music Therapy in Medical Settings, Advances,
The Journal of Mind-Body Health Vol. 9, No.1 Winter 1993
Cassarett,David J., MD,MA, and Timothy E. Quill, MD, “I’m Not Ready for Hospice”:
Strategies for Timely and Effective Hospice Discussion, Annals of Internal Medicine, Volume
146 Issue 6, Pages 443-449, March 20, 2007
32
Daugherty, Christopher K., David P. Steensma, “Overcoming Obstacles to Hospice Care: An
Ethical Examination of Inertia and Inaction, Journal of Clinical Oncology, Vol 20, Issue 11
(June), 2002
Gazelle, Gail, M.D. “Understanding Hospice – An Underutilized Option for Life’s Final
Chapter” The New England Journal of Medicine, July 26, 2007
“Hospice and Palliative Care Education Programs” National Institute of Health Guide, Volume
23, Number 13, April 1, 1994
“Institute Information”, Hospice Institute for Education, Training and Research, Inc.
Krout, Robert E. EdD, MT-BC, RMTh, Music therapy with imminently dying hospice patients
and their families: Facilitating release near the time of death. American Journal of Hospice and
Palliative Medicine, Vol. 20, No. 2, 129-134 (2003)
Meador, Keith G. MD, ThM, MPH,
“Spiritual Care at the End of Life: What Is It and Who
Does It”, North Carolina Medical Journal, July/August 2004, Volume 65, Number 4 Dame
Cicely Saunders founded the first modern hospice, St. Christophers, in London in 1967
Schroeder-Sheker, Therese, “Music for the Dying: A Personal Account of the New Field of
Music-Thanatology – History, Theories, and Clinical Narratives”, Advances, The Journal of
Mind-Body Health, Vol. 9, No 1, Winter, 1993
“Talking about Hospice: Tips for Physicians”, The American Hospice Foundation
Website
Chalice or Repose, 1996, Schroeder-Sheker, Therese, “In Brief: What is Music-Thanatology?”
1996. www.chaliceofrepose.org
“History of Hospice Care”, The National Hospice and Palliative Care Organization,
www.nhpco.org
Hospice Association of America, Hospice: An HAA/NAHC Historical Perspective,
Congressional Record (1972). Death with Dignity
. Washington, DC. www.nahc.org
Music-Thanatology Association International, What is Music-Thanatology? September 22, 2008,
www.mtai.org
Sacred Flight, A Palliative Music Practice for End of Life Care, May 5, 2007,
www.sacredflight.org
33
Interviews
Appendix 1 – Questionnaire
Appendix 2 – Survey Results
