Patients undergoing Blood and Marrow Transplantation (BMT) are particularly susceptible to psychological distress due to the demanding nature of BMT procedures. Hope is a malleable (Weis & Speridakos, 2011) and multidimensional construct (Kim, Schwartz-Barcott, & Zucker, 2006) that can impact a patient’s psychological health. Extant research on hope with cancer patients has promoted psychological interventions to foster and maintain hope, but has been conducted almost exclusively within the field of oncology nursing.
While research supports music therapy interventions that address pain, anxiety, depression, isolation, mood disturbance, motivation, and fatigue in BMT patients (Boldt, 1996; Cassileth, Vickers, & Magill, 2003; Fredenburg & Silverman, 2014a, 2014b; Rosenow & Silverman, 2014; Sahler, Hunter, & Liesveld, 2003), little attention has been given to interventions that enhance patient resources in ways that may offset or mitigate psychological distress. Hope-based music therapy interventions might broaden findings within the oncology nursing literature linking levels of hope with improved psychological functioning, coping skills, and quality of life (Felder, 2004; Herth, 1989, 1992, 2001; Molassiotis, Van Den Akker, Milligan, Goldman, & Boughton, 1996).
The purpose of this convergent parallel mixed-methods pilot study was to target hope by adapting an existing hope intervention to music therapy treatment with patients on a BMT unit. The research questions guiding this study were: Are there between-group differences in patient hope resultant of a two-dose hope-based music therapy intervention in adult patients on a BMT unit? How do adult patients on a BMT unit perceive hope and psychological health impacted by the hope-based music therapy intervention?
Patients (N = 10) were randomly assigned to experimental or wait-list control conditions, and all patients completed the Herth Hope Index (Herth, 1992) supplemented with an 11-point Likert-Type Pain Scale at pre- and posttest. Experimental participants engaged in a two-session individualized music therapy treatment consisting of patient-preferred live music chosen from a hope-based song menu coupled with therapeutic dialogue that was adapted from the Hope Intervention Program (Herth, 2001). At the conclusion of the intervention, experimental participants also took part in an individual semi-structured interview in an attempt to understand their experiences and perceptions of how music therapy may have impacted hope. Thematic analysis, following the six-step procedure identified by Braun and Clarke (2006), was used to analyze qualitative data.
There was no significant between-group difference in hope or pain at pretest. Posttest analyses utilizing Mann-Whitney U tests revealed a significant between-group difference (p = .035) in measures of hope, with participants in the experimental condition (M = 44.00, SD = 2.12) demonstrating higher hope than participants in the control condition (M = 38.90, SD = 3.71). Although not statistically significant, there was a slight tendency for a decrease in pre- to posttest pain for the experimental condition but not for the control condition. Qualitative analyses resulted in three emerging themes: 1. Hope-based music therapy provides opportunities for positive experiences, including comfort and interpersonal connection; 2. Hope-based music therapy facilitates personal depth though self-awareness and self-identity; and 3. Hope-based music therapy provides a platform to discuss and confront hope, including motivations for and obstacles to hope.
Although generalization is limited by a small sample, preliminary evidence supports that hope-based music therapy can be a beneficial intervention for patients undergoing BMT. Qualitative data reinforced and provided depth to these quantitative results, revealing that hope-based music therapy elicited positive experiences, comfort, and interpersonal connection; acted as a platform to discuss hope; and supported self-awareness and self-identity.
Implications for clinical practice include integration of hope-based treatment goals and objectives in care of BMT and oncology patients, with additional clinical work warranted to inform hope-based treatments with other hospitalized medical patients. Patients were able to exercise repertoire choices within their individual sessions from a hope-based song menu, with some patients choosing to hear the same song in sessions on both days one and two. As patients verbalized that supplying a song menu was helpful for them, song menus may facilitate choice and coping in music therapy sessions based upon patient-preferred live music.
Suggestions for future research include measuring maintenance of hope gains, exploring hope in a longitudinal context, examining levels of hope at various stages of illness and treatment, and investigating larger dosages of music therapy treatment and the subsequent impact on patient hope. As behavior synchrony can result from emotional contagion (Hatfield, Cacioppo, & Rapson, 1994), future research might explore such contagion in a context of hope as it occurs between patients, their care supporters, and hospital roommates in various adult medical settings. Such inquiry may also include structuring sessions to focus not only on patients, but also on care partners. Additionally, future researchers may examine application of hope-based music therapy with procedures outside BMT, including solid organ transplantation.