Music Therapy to Facilitate Relationship Completion for Patients and Families at the End of Life: A Mixed Methods Study

Abstract

Under the influence of Confucianism, Taiwanese people have always emphasized family values as an essential culture. The concept of relationship completion (Byock, 1996) was embodied as the core belief for end-of-life care in Taiwan, known as the Four Expressions in Life: Love, Gratitude, Forgiveness, and Farewell. The palliative care team in Taiwan advocates the Four Expressions in Life to help patients at the end of life strengthen bonds with their families. However, the traditional and conservative culture in Taiwan often impedes relationship completion. The purpose of this study was to examine the effects of music therapy to facilitate relationship completion for patients at the end of life and their families, and to understand the perceptions of patients at the end of life and families about their relationship completion during music therapy. This study took a further step in exploring how the perceptions of patients at the end of life, and their families about their relationship completion during music therapy helped to explain the effects of music therapy intervention.This study employed a convergent mixed methods design in which qualitative and quantitative data were collected in parallel stages, analyzed separately, and then the findings were merged. For the quantitative phase, a convenience sample of 34 patients at end-of-life care at a large teaching hospital in southern Taiwan and 36 of their family members were recruited in a single music therapy intervention with a one-group pretest-posttest design. Measures included the “Life Completion” subscales of the Quality of Life at the End of Life (QUAL–E) survey and a single-item global QoL indicator for patients as well as the QUAL-E (Fam) survey and a question of Overall Quality of Life for family members. In the qualitative phase, a nested sample of five patients and nine family members completed the semi-structured interviews about their experiences of the music therapy sessions. There were significant differences (p<.001) between the pre and post session scores for the Life Completion subscale of the QUAL-E and between pre-post scores for the global QoL Indicator for patient participants. The results also showed a significant difference (p<.001) in the scores for the Completion subscale of the QUAL-E (family) and a significant difference (p<.001) in the scores for Overall Quality of Life for families from before music therapy session to after music therapy session. Four themes emerged from the qualitative results: music therapy provides the opportunity for exploration, music therapy provides the opportunity for connection, music therapy provides the opportunity for expression, and music therapy provides the opportunity for healing. The integrated findings suggested that music therapy facilitated relationship completion and improved quality of life for both patients and their families. The use of songs in music psychotherapy had a significant contribution to relationship completion. Song interventions can accommodate a patient's physical weakness and life-limiting obstacles at the very end of life to achieve the ultimate goal to improve quality of life, by assisting relationship completion. The results suggested that the transformative level of music therapy within a single session for end-of-life care in Taiwan is both feasible and culturally acceptable.