RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address (in block letters) / MR. ANJAN MARIAN LOBO
I YEAR M.Sc. NURSING
MASOOD COLLEGE OF NURSING
BIKARNAKATTE, MANGALORE
2. / Name of the Institution / MASOOD COLLEGE OF NURSING
BIKARNAKATTE, MANGALORE
3. / Course of Study and Subject / M.Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of Admission to the Course / 30.10.2011
5. / Title of the study
“EFFECTIVENESS OF MUSIC THERAPY ON LEVEL OF ANXIETY AMONG PATIENTS DIAGNOSED WITH CANCER ADMITTED IN A SELECTED HOSPITAL, MANGALORE”.
6. / Brief resume of the intended work
7.
8. / INTRODUCTION:
“It’s not the years in your life that count. It's the life in your years”.
-Abraham Lincoln
Life is a gift from God, how you use your life is God's gift. The hazards that surround the gift give rise to health problems. Cancer is a major health problem of present world, which has created challenging environment in modern health care system. Despite of advanced treatment modalities, it has made people to suffer a lot. Support and care given by health team members, especially nurses can result in alleviation of suffering. Patient diagnosed with cancer may have fear and many questions in their mind. Will I survive? Can I tolerate pain? What will be my family responsibilities? Threatening thoughts of disfigurement, changes in routine work, physical discomfort come in forefront. People with cancer usually experience a variety of symptoms; including pain, anxiety. Depression and other mood disturbances and these can fluctuate over time in response to remission and the diagnosis of refractory disease.1
Anxiety is considered as a normal emotion in all human beings. It acts as a way of protection from dangers and threat. When people become ill, they will be more anxious, frightened and depressed. It becomes worse when they get admitted; as hospital environment triggers their emotion. Anxiety is a state of nervousness to an impending threat. The threat is unpredictable with the expected events and can be associated with feelings of fear and uneasiness. Anxiety is a negative stimuli which can be dispelled by distractors like music.2
Music Therapy works on the person based on the principle that music relaxes the person by making his body to “harmonize his rhythm with the rhythm of vibrating bodies around the person.’’ Music is a therapeutic intervention developed largely in the mid-20th century; however it has existed in various forms in most cultures for many centuries. In recent years the use of music as an intervention has increased and this to extent may reflect the growing interest in complimentary therapies.3
6.1  Need for the study
Cancer is a class of disease characterized by out-of-control cell growth. There are over hundred different types of cancer, and each is classified by the type of cell that is initially affected. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors4 .
Everyone deals with their cancer diagnosis differently. Many concerns are raised aside from physical health, like how cancer will affect your mental health and quality of life. The emotional effects of cancer are not the same for everyone. For some people, this may mean stress, depression, anxiety, and fear. Others may feel a sense of relief and calmness with their diagnosis. All of these emotions are normal. Knowing how to cope with these emotional effects may make treatment less stressful and also increase your quality of life.5
Anxiety a major concern in cancer detected patients, can be described as an emotional state characterized by feelings of unpleasant anticipation and a sense of imminent danger. Anxiety has both physiological and psychological components. Autonomic hyper arousal with acceleration of heart rate and respiration, tremor, sweating, muscle tension and gastrointestinal changes are common physiological experiences. Apprehension, feeling powerless and fearing loss of control are psychological aspects. There are many types of anxiety disorders, and all are relatively common in the population, with prevalence data varying from 7% to 18%. Anxiety is a common, though not universal, symptom that affects 13–16% of patients with cancer.6
A study was done to assess the level of anxiety in terminally ill cancer in-patients receiving palliative care and patient-patient care. The results showed that 18.6% of patients had moderate level of anxiety and 12.4% had clinically significant anxiety symptoms. This shows that there is a greater level of anxiety problems in patient with cancer and serious action is needed to alleviate them.7
There have been many treatments for different anxiety related problems of cancer patients like music, guided imagery, muscle relaxation, aroma therapy, chemotherapy, counselling, Music is one of them, music not only nourishes the soul, it reduces the anxiety that cancer patients feel. According to a major international review of the effectiveness of music therapy. "The evidence suggests that music interventions may be useful as a complementary treatment to people with cancer,"8
Music and music therapy are used in a wide range of clinical settings. Treatments range from patients listening to pre-recorded music, to music therapists engaging patients in music experiences to improve psychological and physical well-being.9 Music therapy is the incorporation of music, whether through a trained therapist or technology, for the benefit of patients. It has historically been used to reduce anxiety and promote relaxation in the hospital setting. Music has proven therapeutic effectiveness in psychiatry, obstetrics, and paediatrics, promoting well-being, controlling pain, and neutralizing negative emotions10
Music has been demonstrated in the literature to reduce pain and anxiety in patients by as much as 50%. Some studies have investigated the physiological mechanism explaining music’s beneficial effects. Adrino cortico trophic hormone, DHEA, epinephrine, and IL-6 concentrations are all surrogate markers for healing that have been demonstrated to be significantly improved with music, specifically Mozart. IL-6, for example, is a cytokine that activates the adrenocortical and sympatho adrenal axes, which play an integral role in stress reduction. Such positive impacts of music on physiological mechanisms provide opportunities for adjunct healing.11
A study was conducted to evaluate the effectiveness of music therapy on pain and anxiety among cancer patients. Using purposive sampling technique a sample size of 30 cancer patients was taken result found that the level of anxiety in cancer patients before music therapy was high Mean=51.6 SD=7.40 but after music therapy it was found to be less Mean=55 SD=5.25. This study indicating music effective for reducing the level anxiety among cancer patients as suggested by the decrease in the SD values. Hence the researcher felt the need to assess the level of anxiety in cancer patients and to evaluate the effectiveness of music therapy on level of anxiety among cancer patients.12
6.2  Review of Literature
A study was conducted using music therapy to reduce anxiety among female breast cancer patients following radical mastectomy in China. A randomized controlled design was used and 120 female breast cancer patients participated in this study. The patients were randomly allocated to the experimental group (n = 60) received music therapy in addition to routine nursing care, and the control group (n = 60) only received routine nursing care. A standardized questionnaire and the State Anxiety Inventory were applied. The pre-test score revealed that the majority of the patients had a moderate level (77·5%) and 15% had severe level of state anxiety. The mean difference between the experimental and control group together with 95% confidence intervals were −4·57, −8·91 and −9·69 at the 1st post-test, 2nd post-test and 3rd post-test respectively. Thus music therapy was found to have positive effects on decreasing state anxiety score.13
A study was done to determine the effect of music therapy and verbal relaxation on state anxiety and anxiety-induced physiological manifestations among patients with cancer before and after chemotherapy in the outpatient chemotherapy clinic operated by a University medical centre in southern Taiwan. A randomised controlled trial and permuted block design were used and 98 patients were randomised into three groups: the music therapy group received one-hour single music session; the verbal relaxation group received 30minutes of guided relaxation; the control group received usual care. Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, three bio behavioural indicators: skin temperature, heart rate and consciousness level were measured during and after chemotherapy. The results showed that music therapy had a greater positive effect on post chemotherapy anxiety than verbal relaxation (p=2.03) and control groups (p= 5.1) and a significantly increase in skin temperature (mean= 99F). Patients with high state anxiety (p= 1.99) receiving music therapy had a greater drop in post chemotherapy anxiety than did the normal state anxiety (p=3.04) subsample. Thus it found that Thirty minutes of intervention initiates anxiety reduction. Patients with high state anxiety receiving chemotherapy obtain the most benefit from music or verbal relaxation.14
A study was conducted to find the effectiveness of single music therapy session in reducing anxiety for terminally ill patients in Melbourne, Australia. Twenty-five participants with end-stage terminal cancer took part and a randomised controlled design was used Edmonton Symptom Assessment System (ESAS) and heart rate were measured. In this, experimental group received a single music therapy intervention and the control group received a volunteer visit. The result revealed significant reduction in anxiety for the experimental group on the anxiety measurement of the ESAS (p=0.005). Post hoc analysis found significant reductions in other measurements on the ESAS in the experimental group, specifically pain (p=0.019), tiredness (p=0.024) and drowsiness(p=0.018). thus it is concluded that music therapy helps to manage anxiety in terminally ill cancer patients and suggested still more studies are required using music therapy over long time periods as well as addressing other symptom issues.15
A study was conducted to find the effectiveness of music therapy or music medicine interventions and standard care with standard care alone, or standard care and other interventions in patients with cancer for improving psychological and physical outcomes. A total of 1,891patients were included and randomized controlled trials (RCTs) and quasi-randomized trials of music interventions were used for improving psychological and physical outcomes in patients with cancer. The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 11.20 units (95% confidence interval (CI) -19.59 to -2.82, P = 0.009) on the STAI-S scale and -0.61 standardized units (95% CI -0.97 to -0.26, P = 0.0007) on other anxiety scales. Results also suggested a positive impact on mood (standardised mean difference (SMD) = 0.42, 95% CI 0.03 to 0.81, P = 0.03). Music interventions may lead to small reductions in heart rate, respiratory rate, and blood pressure. A moderate pain-reducing effect was found (SMD = -0.59, 95% CI -0.92 to -0.27, P = 0.0003), but no strong evidence was found for enhancement of fatigue or physical status. The pooled estimate of two trials suggested a beneficial effect of music therapy on patients’ quality of life (QoL) (SMD = 1.02, 95% CI 0.58 to 1.47, P = 0.00001). 16
A study conducted to determine the effectiveness of music therapy and quiet rest periods on pain and anxiety among patients who underwent total knee arthroplasty. A visual analogue scale was used to evaluate the pain and anxiety level among 56 postoperative patients who were randomly assigned to either music therapy or quiet rest group. Study revealed that there was a significant reduction in pain (p=0.01) and anxiety level (p=0.013).17
A study with controlled trials was performed on sixty children aged 9-12 years old, admitted to the main paediatric hospital of Gorgan city, by a team of trained nurses. The patients were categorized into the intervention (case) and the control groups by using a simple randomized method. There were 30 patients in each group. The data gathering instruments were questionnaires which included demographic information and the Spielberger test for the trait anxiety inventory in children, (STAIC). For the intervention group, two day, 20 minutes, the soothing rhythmic music of Johann Sebastian Bach was released through a tape recorder which was equipped with a headphone, and then, the Spielberger questionnaires were refilled by each patient. The control group did not receive any intervention; they rested only 20 minutes and also had minimum communication with the intervention group. The mean attitude anxiety score before the application of the music in the control group was 49.6±7.2 and in the intervention group, it was 49.1 ± 6.4. The test results showed that the anxiety scores between the control and intervention groups showed no significant difference before the application of the music. The mean anxiety after the application of the music in the control group was 49.4±7.2 and in the intervention group, it was 30.7±7.5. The results showed a significant difference in the mean anxiety between the control and intervention groups (p<0.05).18
6.3  Statement of the problem
“Effectiveness of music therapy on level of anxiety among patients diagnosed with cancer admitted in a selected hospital, Mangalore”.
6.4  Objectives of the study
Objectives of the study are:
1.  To assess the level of anxiety among patients with cancer in both experimental and control groups.
2.  To evaluate the effectiveness of music therapy on level of anxiety among patients diagnosed with cancer.
3.  To find the association between the level of anxiety and demographic variables among patients diagnosed with cancer in the experimental group.
6.5  Operational definitions.
1.  Effectiveness: In this study, effectiveness refers to the extent to which music therapy will achieve the desired result in decreasing the level of anxiety among patients with cancer measured in terms of difference in pre and post test level of anxiety.
2.  Music therapy: In this study music therapy refers to the violin based instrumental ragas played for 3 consecutive days in 2sessions a day morning and evening for about 30 minutes per session through the headphones to reduce the level of anxiety in cancer patients.
3.  Anxiety: In this study anxiety refers to the state of feeling of nervousness, worrying about prognosis of the treatment experienced by patients diagnosed with cancer. It is measured by straight trait anxiety inventory scale.