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Bev Foster and her team at Room 217 have been producing music for the hospice and palliative care setting for over 15 years. This review is prompted by the release of two new (6-CD) collections of music (see Collections 3 & 4 below), but I thought it appropriate to include some comments from my reviews of Collections 1 & 2, as well as to say something about the other material they have made available.
In producing music for palliative care, the team at Room 217 have set laudable goals — to offer hope and comfort by producing therapeutic, research-informed music care products, to provide skills and training for integrating music into care, and to support innovative research in music care.
All their music is slow and gentle, soothing and comforting. The studies they cite show music therapy may alleviate fear and anxiety, promote relaxation, facilitate anticipatory grief, reinforce identity and self-concept, give access to spiritual connection, and facilitate communication. And, lastly, they note the role of music in our own (professionals’) self-care, which I would strongly endorse.
Collection 1: SOUL COMFORT
[6 CDs: Spirit Wings - Gentle Waters - Celtic Whisperings - Hugs & Kisses - Warm Breezes - Classic Comfort]
I particularly liked the instrument-only Gentle Waters, which combines Bev Foster’s piano with the beautiful warm sound of a solo cello. Classic Comfort is comprised of some of the greatest piano music ever written, from J.S. Bach to Tchaikovsky; skilfully and tenderly performed, these melodies are both calming and refreshing. Hugs and Kisses is designed for children. I enjoyed the Boomer tunes in Warm Breezes; little did I know there was much more to come this year!
Collection 2: MEMORABLE MOMENTS
[6 CDs: Peaceful Presence - Country Road - Old Chestnuts - Broadway Melodies - Forever Love - Healing Light]
Peaceful Presence is a collection of Christian hymns and songs that, the cover says, represent the sounds of hope, peace and promise. Country Road presents classic country tunes played on a guitar and a fiddle that are peaceful and comforting. Old Chestnuts is a collection of World War II songs and jazz standards, gently and tastefully presented. Forever Love presents some of the greatest love songs of all time. Healing Light is a collection of traditional Jewish music.
Collection 3: DIVERSE SOUNDS
[6 CDs: Lotus Blossom - Good Medicine - Song Weaver - Tranquil Oasis - Heart Beat - Bamboo Garden]
This differs from the first two Collections, in that rather than familiar songs, it employs familiar and iconic cultural sounds from around the globe, presented in the usual soothing and healing manner. I recognised sounds from a range of areas around the world including Asia, Africa, the Middle East, and South America. Listening to these tracks, I felt that they were soothing and calming, but I did not identify with the sounds. This simply reflects my personal background (a Boomer brought up in the UK, the USA, and Australia), but it made me realise that many of our patients, particularly those of different ethnic backgrounds, may not identify with the music that appeals to me. This Collection will be particularly useful if your service deals with significant numbers of non-Western patients and their families.
Collection 4: BOOMER TRACKS
[6 CDs: Road Trip - Jukebox Junkies - Folkie Folk - Soul City - Not Afraid - British Invasion]
As named, this showcases the music from the ‘50s, ‘60s and ‘70s, the music I grew up with. The arrangements are slow and restful. Many of the melodies were recognisable and I didn’t need to be given the words. It certainly brought back memories — glued to your transistor to hear the latest from the Beatles or The Mamas and The Papas, hoping that your parents wouldn’t hear it. Listening to songs that meant so much in adolescence and early adulthood — the Big O, the Beach Boys, Bob Dylan, Simon and Garfunkel, Peter Paul and Mary, and Don McLean driving his Chevy to the levee — brought back floods of memories about what was happening back then. Memories of where you lived, your friends and relationships, your successes, the things that didn’t go so well, the things you enjoyed, as well as the burdens such as conscription for Vietnam. Songs that were originally loud and fast are the ones most changed in the (appropriate) arrangements presented here, but only occasionally did I feel a longing for the explosive opening bars from a band like the Stones or the Doors, on fire. I doubt that any Boomer can listen to this without a lot of memories and a tear or two.
The Collections may be purchased as CDs or digital downloads from the Room 217 website. They are also available on iTunes, and Spotify.
There are three 1-hour DVDs combining the gentle music from Collection 1 with some amazing photography. In keeping with the slower music, the images are also paced at a slower tempo. They are designed to be enjoyable and comforting, promoting reminiscence and review, storytelling and conversations. I thought they were stunning and had little doubt they would be useful in the palliative care setting. The DVDs are available on the Room 217 website.
Room 217 is offering four free infographics or charts, which you can access by completing a form here.
GUIDE FOR USING MUSIC IN HOSPICE PALLIATIVE CARE: Music Collections and More
Room 217 is also offering a free 64-page Guide for Using Music in Hospice Palliative Care: Music Collections and More, which you can access here. The guide provides a lot of relevant information, set out in a way that a non-musical person can understand and I thought it was impressive.
There is a range of other materials available at Room 217, including Music Care Conversation Cards, Pathways Singing Programs, and educational webinars.
My feeling is that music is probably underutilised in palliative care, except for the (relatively few) units that have a music therapist. I don’t think there is any doubt that music care may be of great value in palliative and end-of-life care, and Bev Foster and her team at Room 217 are making it easier by providing a range of suitable music plus some pointers about how to use it. And don’t forget the self-care for the professionals!
“Music is a powerful medium of comfort, communication and connection for the human spirit. In end-of-life situations it can be an invaluable support for the one in transition and for caregivers at the bedside. Timeless melodies can reassure troubled hearts and reach into the depth of souls.”
(Roger Woodruff, June 2020)
Mary Lynn McPherson
ASHP (American Society of Health-System Pharmacists), 2018
288 pp, softcover
Also available: e-book
RRP $US50.74 £60.95
The first edition of this book was reviewed in the November 2010 Newsletter. The format is similar to the previous edition, although expanded and updated. It provides a clear and practical description of the use of opioids, changing to different routes of administration, and changing from one opioid to another. Where conversions were concerned, I noted this edition emphasised the evidence from steady-state crossover trials, in contrast to the single-dose crossover trials. There are chapters on titrating opioid regimens, the use of methadone, patient-controlled analgesia and neuraxial therapy, using oral solutions and suspensions, and, finally, a discussion of the fentanyl derivatives, levorphanol and nalbuphine.
This edition is again written in an almost conversational manner, but one has to admire the setout and the attention to detail. Each chapter starts with an objectives summary, contains lots of clinical anecdotes as well as plenty of practical examples (for the reader to calculate the answers), and ends with a summary of the key points, the answers to the practice problems (including the arithmetic to go with them), and a list of references. The text is studded with little boxes variously containing Pearls, Pitfalls, or Fast Facts.
As with the first edition, I am not sure this book is concise enough for day-to-day use in the ward, but it would certainly be very useful for postgraduate courses in medical and nursing palliative care, where the finer detail of opioid therapy is sometimes overshadowed by matters related to psychosocial and spiritual concerns. I would also recommend it to any doctors or nurses working in palliative care who are regularly involved in opioid therapy, for whom it will provide a review of updated information, as well as advice on how to optimise the opioid therapy they prescribe.
Mary Lynn McPherson, PharmD, is professor and executive director of Advanced Post-Graduate Education in Palliative Care in the School of Pharmacy at the University of Maryland.
(Roger Woodruff, May 2020)
Anne C. Mosenthal and Geoffrey P. Dunn (eds)
Oxford University Press, 2019
384 pp, softcover
Also available: e-book
RRP $US77.99 £52.00
In the Foreword and the opening chapter we are very quietly told, as if it were a secret, that the term “palliative care” was coined by a surgeon. But no name and no details are given. Well, I shall pay tribute to Balfour Mount, the urologist surgeon from the Royal Victoria Hospital in Montreal who contributed so much to the development of palliative care, and who is credited with the introduction of the term “palliative care” (and soins palliatifs) in the early 1970s.
The book opens with a chapter on Principles of Surgical Palliative Care, which emphasizes the need for all surgeons to be aware of the basic principles of palliative care and to use them for many, if not all, of the patients under their care. I was interested in the discussion about models of care for when the palliative care needs are greater, which I believe remains a major stumbling block in meeting the needs of our patients. Except for a few exceptional individuals, it is probably unrealistic to expect a surgeon to oversee the multidisciplinary management of the palliative care needs of a patient and family. Then arises the question as to whether the palliative care team should be involved throughout the episode/illness or whether they are summoned urgently after the windows of surgical opportunity have closed and/or the patient is about to die, often accompanied by “we tried everything…” Obviously, the former is better, but it requires a lot of planning and diplomacy. There need to be agreed goals of care, or it may descend into acrimony and “that’s the last time we’ll ask them…” I’m not sure there is an easy fix, but if what’s written down here about principles and practice helps mould the next generation of surgeons, then I am all for it.
There are chapters on spiritual care, shared decision-making, communicating serious news, family conferencing, pain and symptom management, and transitions of care. There are also chapters on the palliative care needs of trauma, burns, and transplantation patients, as well as those having gastrointestinal, thoracic, head and neck, and cardiovascular surgery.
The material in this book suggests that significant advances are being made in the incorporation of palliative care into surgical practice, although I suspect it may only be the tip of the iceberg. I would recommend this book to any surgeon so that they might recognize the opportunities that exist to provide better (palliative care-inclusive) care for their patients. And I would make it compulsory reading for every surgical trainee and also those training to be palliative care specialists, the latter because they need insight into the surgeon’s position and difficulties when the referrals do come.
There are 42 contributors. Most are from the USA, with two from Canada.
(Roger Woodruff, March 2020)
Peter J. Adams
Oxford University Press, 2020
264 pp, softcover
Also available: e-book, Oxford Medicine Online
RRP £35.99 $US48.72
This book is about one’s own, personal mortality or “my-death,” as distinct from other topics in the field of death studies, such as the process of dying, responses to grief and bereavement, caring for the dying, cultural practices surrounding death, our ongoing fear of death, and how death beliefs relate to religious and philosophical perspectives.
Adams’ thesis is that one’s own mortality (“my-death,” as he calls it) has accompanied each of us throughout our lives. He admits that “my-death” may be difficult to separate from other aspects of death, which leads him to make two important distinctions. The first is to distinguish what we understand or mean by the terms dying and death: death is a possibility throughout life, whilst dying is an event at the end of life. The second distinction concerns the difference between one’s own death (“my-death") and other people’s deaths (“other-death”). Whilst we might imagine how things might be after our own death by observing what happened after “other-death,” “other-death” belongs to what is recognizable in life, whereas “my-death” connects us with something that lies beyond recognition.
The book is organized into a journey of five stages. Starting out “in the swamp of conceptual uncertainty that surrounds personal mortality,” the first stage explores in more detail the difference between “my-death” and “other-death.” The second focuses on the incomprehensibility of one’s own mortality, and explores the various ways we avoid thinking and talking about it. The third further explores the incomprehensibility of “my-death” and the possible solutions or “enabling frames” that might allow thinking and talking about it. The fourth discusses four enabling frames — essential structures, passionate suffusion, point-of-transition, and self-generative process — and their relative merits. The last focuses on the possible consequences of pursuing an on-going relationship with “my-death,” such as improving the quality of life, clarifying fundamental values, or preparing us better for our end of life.
Then there are the characters — Leo, Mandy, Stan, and Brenda — four people of different ages living in two adjacent houses, whose conversations form illustrative narratives around the key ideas discussed. Whilst Adams admits their conversations are contrived, it allows an exploration of the possibilities for “my-death” engagement across different ages and stages of life, across different life circumstances, and across varying levels of exposure to “other-death.” They do add a human heterogeneity to the discussion, although on occasions I found them a distraction.
I do not feel I am an expert when it comes to the deeper psychological and philosophical aspects of death and dying, and I found this book difficult to judge. However, if you have an interest in death studies or your clinical or teaching duties include these fields, you should consider this book.
Peter J. Adams, PhD, has a background in philosophy, social sciences, and health sciences. He is currently a professor of population health at the University of Auckland in New Zealand.
(Roger Woodruff, May 2020)
Roger Woodruff, MD (Australia)
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.
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