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BackgroundWhile studies in palliative care use measures of spirituality and religious belief, there have been few validation studies of a screening tool that identifies unmet spiritual needs.MethodsA multidisciplinary research team developed and examined the usefulness, reliability and validity of a 17-item Spiritual Concerns Checklist (SCC) as a screening tool for unmet spiritual needs. A cohort of patients recruited from three palliative care services in Sydney and Melbourne, Australia completed anonymous questionnaires. Factor structure and item response theory were used to examine its properties; concurrent validity employed the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp-12).ResultsAmong 261 patients, while only 15% directly sought spiritual care, nearly 62% identified at least one spiritual concern. Existential needs (fear of the dying process 32%; loss of control 31%), regret (20%), need for forgiveness (17%), guilt (13%), loss of hope (13%) and meaning (15%) were prominent concerns. Eleven concerns were present for more than 10% of the participants and 25% of religiously orientated participants expressed >4 concerns. The 17-item SCC was unidimensional, with satisfactory reliability. Concurrent validity was evident in the reduced sense of meaning and peace on the FACIT-Sp-12.ConclusionThis preliminary Rasch analysis of the newly developed SCC has demonstrated its usefulness, reliability and validity. Our findings encourage refinement and ongoing development of the SCC with further investigation of its psychometric properties in varying populations.

Eating disorders (EDs) can be life-threatening and cause long-term adverse biopsychosocial effects. Treatment options are limited and treatment seeking barriers exist. The objective of this systematic review was to examine the therapeutic impacts of music-based intervention (MBIs) for people with diagnosed EDs. Five bibliographic databases (PsycInfo, MEDLINE, CINAHL, CENTRAL, Open Dissertations) were searched. Eligible studies examined therapeutic outcomes of MBIs in people with EDs, using quantitative and/or qualitative methods. From 939 studies identified, 16 met the inclusion criteria (N= 349; age:12–65-years-old), and were categorized as: music therapy (5 studies), music medicine (4 studies), and “other MBIs” (7 studies), that is, the intervention included music and was delivered by a non-music therapist health worker and/or musician. A narrative synthesis of the studies was undertaken. Participants were diagnosed with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder otherwise not specified, or mixed symptoms. MBIs varied widely and were associated with improved mood regulation, emotional well-being, and management of meal-related distress. Vodcast (video podcast) interventions were associated with healthful eating in non-inpatient populations. Studies were assessed using critical appraisal tools. Generalizability of findings is limited due to small samples and suboptimal description of MBIs. Longitudinal research is warranted with larger samples and informed by frameworks for quality reporting of complex MBIs. Review findings may encourage music therapists to further develop and examine how music therapy can help people with EDs to live healthier lives.

BackgroundSpiritual care allows palliative care patients to gain a sense of purpose, meaning and connectedness to the sacred or important while experiencing a serious illness. This study examined how Australian patients conceptualise their spirituality/religiosity, the associations between diagnosis and spiritual/religious activities, and views on the amount of spiritual support received.MethodsThis mixed-methods study used anonymous semistructured questionnaires, which included the Functional Assessment of Chronic Illness Therapy-Spiritual Scale-12 (FACIT-SP-12) and adapted and developed questions examining religion/spirituality’s role and support.ResultsParticipants numbered 261, with a 50.9% response rate. Sixty-two per cent were affiliated with Christianity and 24.2% with no religion. The mean total FACIT-SP-12 score was 31.9 (SD 8.6). Patients with Christian affiliation reported a higher total FACIT-SP-12 score compared with no religious affiliation (p=0.003). Those with Christian and Buddhist affiliations had higher faith subscale scores compared with those with no religious affiliation (p<0.001). Spirituality was very important to 39.9% and religiosity to 31.7% of patients, and unimportant to 30.6% and 39.5%, respectively. Following diagnosis, patients prayed (p<0.001) and meditated (p<0.001) more, seeking more time, strength and acceptance. Attendance at religious services decreased with frailty (p<0.001), while engagement in other religious activities increased (p=0.017). Patients who received some level of spiritual/religious support from external religious/faith communities and moderate to complete spiritual/religious needs met by the hospitals reported greater total FACIT-SP-12 spirituality scores (p<0.001).ConclusionRespectful inquiry into patients spiritual/religious needs in hospitals allows for an attuned approach to addressing such care needs while considerately accommodating those disinterested in such support.

To examine how the coronavirus (COVID‐19) pandemic and its consequences may have influenced suicide in Victoria, Australia.

Objective: To examine how the coronavirus (COVID‐19) pandemic and its consequences may have influenced suicide in Victoria, Australia. Methods: A mixed methods study of consecutive Victorian suicide cases spanning 1 January 2015 to 31 January 2021. Interrupted time series analysis examined whether suicide frequency changed following the pandemic onset. Thematic analysis was undertaken of police reports in suicides linked with COVID‐19 to try to understand how COVID‐19 acted as a stressor. Results: The frequency of Victorian suicides did not change following the onset of COVID‐19. Sixty COVID‐linked suicides were identified, featuring three recurring themes: COVID‐19 as a disturbance in the self, in relationships with others and institutions. Conclusions: While COVID‐19 has not led to an increase in Victorian suicide frequency to date, it is an important background stressor that can erode one's wellbeing, sense of agency and connectedness to others. Implications for public health: Clinical interventions that serve to reconnect people with a sense of agency and seek to re‐establish contact with significant others are indicated. Clinicians should ensure they are familiar with pathways for their patients to access government social and economic supports. A better understanding of how government interventions may be lessening psychological distress is needed.

ObjectiveGiven preliminary evidence for positive health outcomes related to contact with nature for cancer populations, research is warranted to ascertain possible strategies for incorporating nature-based care opportunities into oncology contexts as additional strategies for addressing multidimensional aspects of cancer patients’ health and recovery needs. The objective of this study was to consolidate existing research related to nature-based supportive care opportunities and generate a conceptual framework for discerning relevant applications in the supportive care setting.MethodsDrawing on research investigating nature-based engagement in oncology contexts, a two-step analytic process was used to construct a conceptual framework for guiding nature-based supportive care design and future research. Concept analysis methodology generated new representations of understanding by extracting and synthesising salient concepts. Newly formulated concepts were transposed to findings from related research about patient-reported and healthcare expert-developed recommendations for nature-based supportive care in oncology.ResultsFive theoretical concepts (themes) were formulated describing patients’ reasons for engaging with nature and the underlying needs these interactions address. These included: connecting with what is genuinely valued, distancing from the cancer experience, meaning-making and reframing the cancer experience, finding comfort and safety, and vital nurturance. Eight shared patient and expert recommendations were compiled, which address the identified needs through nature-based initiatives. Eleven additional patient-reported recommendations attend to beneficial and adverse experiential qualities of patients’ nature-based engagement and complete the framework.ConclusionsThe framework outlines salient findings about helpful nature-based supportive care opportunities for ready access by healthcare practitioners, designers, researchers and patients themselves.

Objectives: To explore cancer patients’ recommendations for nature engagement based on their subjective nature experiences and observations in the cancer setting. The rationale was to gain practical insight for delineating relevant and translatable nature-based care and design opportunities in oncology contexts.Background: Innovative cancer care services are needed to respond to growing demand and shifting healthcare needs. Engagement with nature has shown multiple health benefits and presents a promising opportunity for application in healthcare to improve outcomes.Method: Qualitative research design using content analysis was used. Eligible adults with any cancer diagnosis participated in semistructured and audio-recorded interviews. Transcribed textual data included responses to two open-ended questions querying about participants’ recommendations related to nature-based opportunities in the cancer setting. Deductive analysis used three predetermined categories: “recommendation: features,” “recommendation: functions,” and “cautions.”Results: Twenty patients with cancer (nine female) participated. Broad recommendations incorporated (1) using nature for vital sensory stimulation and engagement, (2) using nature for personal space and freedom to enable private and social exploration, (3) using views to nature for distraction and comfort, and (4) accessing nature for physical activity and movement. Three critical factors were determined for avoiding adverse experiences: determining appropriate expenditure and resourcing, selection of appropriate nature-based design materials, and exercising caution around demanding nature engagement and harsh weather conditions.Conclusions: Cancer patients’ recommendations reveal the importance of engaging with nature in their experiences of health and recovery. The findings can inform planning appropriate and safe integration of beneficial nature engagement in cancer settings and support services.

Objective: To investigate patient, staff, and carer responses to an environmental intervention in an oncology clinic waiting room and evaluate the acceptability of artificial plant materials.Design Postintervention: Cross-sectional survey study.Setting: Oncology outpatient clinic waiting room located in a metropolitan comprehensive cancer center in Australia.Main Outcome Measure: Observer ratings of perceived qualities and effects of lifelike (fake) plants while spending time in the waiting room.Participants: Convenience sample (N= 143) consisted of 73 cancer patients, 13 staff, 52 carers, and 5 “others” aged between 24 and 89 years (M= 56, SD= 14.5).Intervention: Artificial plant arrangements, hanging installations, two movable green walls, and one rock garden on wheels placed throughout the outpatients’ clinic waiting room.Results: Eighty-one percent (115/142) of respondents noticed the green features when first entering the waiting room and 67% (90/134) noticed they were artificial. Eighty-one percent (115/142) indicated “like/like a lot” when reporting their first reaction to the green features. Forty-eight percent (68/143) were positively affected and 23% (33/143) were very positively affected. Eighty-one percent (110/135) agreed/strongly agreed that “The greenery brightens the waiting room,” 62% (80/130) agreed/strongly agreed that they “prefer living plants,” and 76% (101/133) agreed/strongly agreed that “‘lifelike’ plants are better than no plants.” Comments included mostly positive appraisals and occasional adverse reactions to artificial plants. No significant differences were found between patients’, staff, and carers’ reactions.Conclusions: The environmental intervention positively impacted patients’, staff, and carers’ perceptions of the oncology waiting room environment. Patients, staff, and carers mostly accepted artificial plants as an alternative design solution to real plants.

Legacies encompass treasured memories and items such as wills, publications, and songs, which help to validate lives. Legacy creation is encouraged by palliative care staff to help patients deal with loss and find personal meaning; the legacy works may also support the bereaved. Within the literature, however, there is no consideration of how staff deal with patients’ incomplete legacies when patients relocate, deteriorate, or die. Our research focuses on this question: What experiences did four music therapists have with palliative care patients’ incomplete tangible music therapy legacies? Data included transcripts from the therapists’ discussions about patients’ incomplete legacies in three reflexive group supervision sessions and further reflections written during transcript verification. Inductive thematic analysis yielded five themes: the nature of incomplete music therapy legacies; reasons for and feelings about these legacies; factors determining what music therapists do with them; considerations about their future “life”; and the ways therapists’ shared reflections can support their future legacy work.

Philosophical perspectives, clinical experiences, and research findings grounded in cancer care, offer clarification of therapeutic components of “musical re–play”, that is, a client and music therapist relationship that is focused on playing with known music from the client's life. Addis' (1999) theory of mind and music and Winnicott's (1971) theory of “playing” as a means to attain growth and health are included, to inform the perspective that musical re–play can provide a multisensorial “human musical mirror” able to penetrate one's entire consciousness, including consciousness states that do not involve language. Consequently, it is the author's belief that when cancer patients are involved in musical re–play they may powerfully experience identity affirmation, creative self–discoveries, and a heightened sense of feeling and experiencing one's “real” and “alive” self. While it has been proposed that prior association with known, precomposed music thwarts creative awareness development (Aigen, 1991; Pavlicevic, 1997), consideration is given to the idea that playing with known music is a foundation for offering opportunities for creative responses and therapeutic change: changes which are evident and comparable in improvisational as well as re–played music therapy methods.

A music therapy research study aimed at understanding patients’, visitors’ and staff members’ experiences of a music therapy program in a cancer hospital over a three-month period is described. Respondents’ answers to brief open-ended questions, as well as the music therapist researcher's interpretations of the program's relevance, were examined using thematic analysis based on grounded theory. ATLAS.ti software supported data management and analysis. Themes encapsulating 128 patients’ reflections about music therapy were delineated and substantiate how music therapy can support palliative care aims throughout the cancer illness trajectory.

An analysis of the music therapy literature yields numerous reports to support the role of music in the alleviation of pain in palliative care. Four theoretical perspectives that support why many patients report reduced pain sensation after music therapy include: the psychological relationship between music and pain; the psychophysiological theory; spinal mechanisms involved in pain modulation; and the role of endorphins. Considerations significant to the use of music in pain relief include how music, used in appropriately, can aggravate pain sensation. Case studies, which include the use of creative music therapy techniques, point to the efficacy of music therapy in alleviating the pain experiences of both palliative care patients and their significant others.

Language is mainly a function of the left hemisphere of the brain; music is mainly a function of the right hemisphere. Using language and music together therapeutically with brain-impaired patients offers a greater chance of activating intact neurological pathway than using language alone. Music therapy also offers an alternate and creative way of communicating with these patients.

BackgroundDespite increasing evidence that Advance Care Planning (ACP) can improve end-of-life care, the majority of cancer patients do not engage in this initiative. A key barrier to this isAimTo develop a multifaceted programme of service development, education, and research to meet specific organisational needs as well as national and accreditation requirements on ACP in Australia.MethodResultsWe will present the successes and challenges of various interventions undertaken including: Electronic enhancement of current Health Information Services to ensure visibility of information and to allow for a more dynamic system to document ongoing conversationsDesign of ACP documents to reflect the complex nature of decision making in the cancer populationDesign of appropriate information materials and interventions to allow for healthcare decisions to be documented throughout the cancer trajectoryMethods to identify and target learning needs for staff in a cancer centrePolicy development and identification of key performance indicators for the cancer populations.Utilisation of a comprehensive research programme to inform and evaluate the above strategiesConclusionThe implementation of a cancer specific model of ACP is a complex intervention requiring the development of an organised clinical microsystem. Challenges which emerge throughout the implementation process will be delineated. Lessons learned will guide ongoing development of the disease specific ACP model in the cancer centre and its feasibility will be examined in a Phase II study of patients with advanced cancer.

Background: Grounded theory is one of the most common methodologies used in constructivist (qualitative) music therapy research. Researchers use the term “grounded theory” when denoting varying research designs and theoretical outcomes. This may he challenging for novice researchers when considering whether grounded theory is appropriate for their research phenomena. Objective: This paper examines grounded theory within music therapy research. Methods: Grounded theory is briefly described, including some of its “contested” ideas. A literature search was conducted using the descriptor “music therapy and grounded theory” in Pubmed, CINAHL PsychINFO, SCOPUS, ERIC (CSA), Web of Science databases, and a music therapy monograph series. A descriptive analysis was performed on the uncovered studies to examine researched phenomena, grounded theory methods used, and how findings were presented. Results: Thirty music therapy research projects were found in refereed journals and monographs from 1993 to “in press.” The Strauss and Corbin approach to grounded theory dominates the field. Descriptors to signify grounded theory components in the studies greatly varied. Researchers have used partial or complete grounded theory methods to examine clients', family members', staff, music therapy “overhearers,” music therapists', and students' experiences, as well as music therapy creative products and professional views, issues, and literature. Seven grounded theories were offered. Conclusions: It is suggested that grounded theory researchers clarify what and who inspired their design, why partial grounded theory methods were used (when relevant), and their ontology. By elucidating assumptions underpinning the data collection, analysis, and findings' contribution, researchers will continue to improve music therapy research using grounded theory methods.

Many references to time or temporality are located within music therapy literature, however little research has been completed regarding this phenomenon. Findings from a modified grounded theory study about clients' experiences and descriptions of time within the context of music therapy are presented here. The study was informed by the constructivist-interpretive paradigm and a grounded-descriptive statement finding resulted. A 2-staged research methodology was used, comprising a deductive-inductive content analysis of information from the public domain, followed by data-mining of information from a minimum of 160 clients and analysis of data from at least 43 of these 160 clients. Information regarding memory experiences, the duration of music therapy effects, recall and retrieval, and experiences of time are identified. Implications for practice are emphasized, in particular the following is stressed (a) the importance of time orientation and temporal connectedness in relation to identity development, (b) temporal strategies within music experience to assist integration, recall, and retrieval of information, and (c) the importance of and the elements involved in time modification. New explanations for music therapy phenomena are shared, and areas for research highlighted. Benefits of using time dynamically to aid therapeutic process are proposed and it is concluded that temporal experience within the context of music therapy is important in relation to both practice and research.

A mixed methods research design was used to investigate the effects of a music therapy CD (MTCD) creation intervention on pediatric oncology patients' distress and coping during their first radiation therapy treatment. The music therapy method involved children creating a music CD using interactive computer-based music software, which was “remixed” by the music therapist-researcher to extend the musical material. Eleven pediatric radiation therapy outpatients aged 6 to 13 years were randomly assigned to either an experimental group, in which they could create a music CD prior to their initial treatment to listen to during radiation therapy, or to a standard care group. Quantitative and qualitative analyses generated multiple perceptions from the pediatric patients, parents, radiation therapy staff, and music therapist-researcher. Ratings of distress during initial radiation therapy treatment were low for all children. The comparison between the two groups found that 67% of the children in the standard care group used social withdrawal as a coping strategy, compared to 0% of the children in the music therapy group; this trend approached significance (p = 0.076). MTCD creation was a fun, engaging, and developmentally appropriate intervention for pediatric patients, which offered a positive experience and aided their use of effective coping strategies to meet the demands of their initial radiation therapy treatment.

Following an investigation into oncologic patients' experiences of the helpfulness of music therapy (O'Callaghan & McDermott, 2004), it was considered that examining relationships between specific patient characteristics and their responses could yield further interesting understandings. “Interpretative subgroup analysis” is introduced, which adapts principles of subgroup analysis in quantitative research to textual data analysis. Anonymous written responses from 128 oncologic patients were analyzed to compare responses from (a) those that had one music therapy session with those who had more than one session, (b) males and females, and (c) middle and older aged respondents. The number of music therapy sessions had scant effect on reported music therapy experiences, and males were much more likely to return questionnaires but much less likely to participate. Unlike some females, males always described positive affective responses when experiencing both sad and positive memories. Variations in the middle and older aged subgroups were evident in type of affective response, and emphases in descriptions of memories and music therapy's effect. Implications of these findings for music therapy practice are considered. Interpretive subgroup analysis is recommended for extending understanding of subjective within group experiences in music therapy research incorporating a grounded theory approach and large enough samples.

The constructivist research paradigm informed a research investigation on the relevance of music therapy in a cancer hospital that is, what did the music therapy do and did it help? Over 3 months, criterion sampling was used to elicit interpretations in 5 studies from 5 sources: 128 patients who participated, 27 patients who overheard or witnessed music therapy, 41 visitors, 61 staff, and the music therapist-researcher. Fifty-seven percent of the patients who participated had advanced or end stage cancer. The music therapist's interpretations were recorded in a reflexive clinical journal and the respondents' interpretations were written on anonymous open-ended questionnaires. Thematic and content analyses were performed on the 5 groups of data with the support of qualitative data management software. Findings from the 5 data groups were contrasted and compared. Many patients', visitors' and staff members' affective, contemplative, and imagined moments in music therapy affirmed their “aliveness,” resonating with an expanded consciousness, in a context where life's vulnerability is constantly apparent. Philosophical depictions about the relevance of music in human life, including theories by Addis and Winnicott, substantiated the therapeutic reactions.

This study examines the use of song writing in palliative care. Modified grounded theory and content analysis approaches were used to investigate the lyrical themes and categories (groups of concepts) in 64 songs written by 39 palliative care patients. The eight themes that emerged in the songs were: self-reflections, compliments, memories, reflections upon significant others (including pets), self-expression of adversity, imagery, and prayers. The seven most frequently recurring categories were: compliments to family members, staff, other patients and friends about their personal qualities and their impact upon the patients' lives; messages of positive feelings for and experiences with people, including love, care and that one needs people; memories of relationships with people, both living and deceased; existing in the future; expressions of the adverse experiences resulting from living with the illnesses of multiple sclerosis and cancer descriptions of stories and nature imagery scenes; and gratitude to family members, staff, and God. The author argues that song writing is a worthwhile technique for some palliative care patients because the Iyrical themes suggest that the process may aid in meeting their physical, psycho-social, and spiritual needs. The song writing paradigm that facilitated the palliative care patients' song writing is also presented.