"Song of Life": Results of a multicenter randomized trial on the effects of biographical music therapy in palliative care

Abstract

Background: Awareness for the importance of psychological and spiritual needs in patients with terminal diseases has increased in recent years, but randomized trials on the effects of psychosocial interventions are still rare.

Aim: To investigate the efficacy of the "Song of Life" music therapy intervention regarding the emotional and psycho-spiritual dimensions of quality of life.

Design: Patients were randomly assigned to either "Song of Life" or a relaxation intervention. "Song of Life" is a novel three-session music therapy intervention working with a biographically meaningful song. Primary outcome was the improvement in psychological quality of life. Secondary outcomes included spiritual well-being, ego-integrity, momentary distress, and global quality of life and the explorative assessment of treatment satisfaction (patient and family member version). Intention-to-treat analysis was conducted including adjustment for multiple testing in secondary outcomes.

Setting/participants: Between December 2018 and August 2020, 104 patients receiving specialized palliative care were recruited from two palliative care wards.

Results: No significant differences were found regarding psychological and global quality of life, but "Song of Life" participants reported significantly higher spiritual well-being (p = 0.04) and ego-integrity (p < 0.01), as well as lower distress (p = 0.05) than patients in the control group. Both patients' and family members' treatment satisfaction was higher after "Song of Life" with large between-group effect sizes on items asking for meaningfulness (d = 0.96) and importance (d = 1.00).

Conclusions: Our findings provide evidence that "Song of Life" is an effective and meaningful biographical music therapy intervention to facilitate psycho-spiritual integration in terminally ill patients.

Trial registration: German Clinical Trials Register (DRKS)-DRKS00015308 (date of registration: September 7th 2018).

Keywords: Music therapy; cancer; distress; ego-integrity; end-of-life; palliative care; quality of life; randomized controlled trial; spiritual well-being.

Figure 1.

Figure 2 SPIRIT figure: schedule of enrolment, interventions and assessments. SPIRIT: standard protocol items: recommendations for interventional trials; SOL: “Song of Life” music therapy; RELAX: relaxation intervention; MQOL-R: McGill quality of life questionnaire–revised); BMGE: brief measure of generativity and ego-integrity; FACIT-Sp: functional assessment of chronic illness therapy-spiritual well-being; NCCN: national comprehensive cancer network; FQ: feedback questionnaire. ^aDeviations from the schedule were possible.

Figure 2.

Patient flow chart. SOL: “Song of Life” music therapy; RELAX: relaxation intervention.

Figure 3.

Effect sizes and 95% confidence intervals for primary and secondary outcomes. QOL: quality of life; d: effect size according to Morris; positive effect size indicates higher increase in SOL than in RELAX.