Choirs in end-of-life care: a thematic literature review
Colleen Ryan, Margaret McAllister and Jennifer Mulvogue
Background: Choirs are an important source of wellbeing for people experiencing palliative and end-of-life care. Threshold choirs are an innovation that could be more widely introduced, as hospital and palliative care settings have become more open to community input. Aims: Before such choirs are recommended and encouraged, evidence for their effectiveness and implementation barriers need to be known. Methods: A literature review was undertaken in 2019 and 2020 using CINAHL, PUBMED, Medline, ProQuest, Google Scholar and an internet manual search. Findings : The review identified a total of 26 research and discussion papers relevant to the topic of choir in palliative care settings. Conclusion: Following the review, guidelines were developed that may be useful to assist choirs and service providers to effectively introduce this valuable initiative. Choirs may be a creative, and uplifting arts-based activity to augment and enrich the culture of person-centred care during palliative care processes.
Key words: l arts l hospice l palliative care l choir l wellbeing
Colleen Ryan Head of Professional Practice, School of Nursing Midwifery and Social Sciences, Central Queensland University, Australia Margaret McAllister Emeritus Professor, School of Nursing Midwifery and Social Sciences, Central Queensland University, Australia Jennifer Mulvogue Lecturer, School of Nursing Midwifery and Social Sciences, Central Queensland University, Australia Correspondence to: firstname.lastname@example.org
Many forms of music have been used to create a comforting environment in palliative and end-of-life care (Vesel and Dave, 2018). When patients participate in music, by either playing, singing or listening, positive emotions and a reduction in negative experiences, such as anxiety and depression, often occur (Daykin et al, 2018). Music thanatology has an evidence base to support harpists playing at the bedside of patients in their end-of-life stage (Ganzini et al, 2015). Such interventions have been reported to be low in risk and cost, and facilitate peacefulness, transcendence and appreciation for beauty at the end of life. In a memoir about music thanatology (Cox and Roberts, 2013), it was reported that musicians can find the experience fulfilling, though they find it challenging to secure ongoing funding to support such artistic interventions. Singing to patients is another example of the compassionate use of music in palliation. There are many choirs that exist globally, which use gentle singing, often with harmonies and canons, to bring comfort and enjoyment. Threshold choirs, which were developed in the US in the 1990s, have proliferated widely and exist within Australia—where this study took place. This paper reports the findings of a literature review that explored the challenges and benefits of choirs—particularly choirs that sing to patients at the end of their life—and to discuss the issues relevant for those wishing to establish such a choir for their service.
For people experiencing the end of their life, dying in comfort and with dignity should always be the focus of any intervention used in palliative care settings (World Health Organization, 2020). Provision of comfort is a key concept in nursing. As Kolcaba’s (1991) comfort theory explains, there are three types of comfort: provision of relief, ease and transcendence. Relief comes when a specific comfort need is met; ease, a state of calm or contentment and transcendence are situations in which a patient can rise above the current distressing situation. Kolcaba (2013) has further explained that comfort is a status that goes beyond physical homeostasis. It includes provision of environmental comfort where temperature, light, sense of space, sense of familiarity and ease of movement, as well as human connection, are facilitated. Environmental comfort may also relate to noise and sound, such that there is no sensory overload, but rather sensory enrichment. Such comfort is paramount in palliative care environments where patients and visitors may spend extended periods of time and be experiencing varying levels of anxiety, fear and foreboding. In reality, some palliative care settings can be austere, colourless, sombre and silent (Worpole, 2009). On the other hand,
International Journal of Palliative Nursing August 2022 Vol 28, No 8