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The Effects of Music in Pain and Anxiety in Hospice Patients

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The Effects of Music in Pain and Anxiety in Hospice Patients Title Page THE EFFECTS OF MUSIC AND NATURE SOUNDS ON CANCER PAIN AND ANXIETY IN HOSPICE CANCER PATIENTS by LING-CHUN CHIANG Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Advisor: Marion Good, PhD, RN, FAAN Frances Payne Bolton School of Nursing CASE WESTERN RESERVE UNIVERSITY January, 2012 Committee Signature Page CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Ling-Chun Chiang Candidate for the Doctor of Philosophy degree*: Marion Good, PhD, RN, FAAN Barbara J. Daly, PhD, RN, FAAN Christopher J. Burant, PhD Deforia Lane, PhD, MT-BC August 29, 2011 *We also certify that written approval has been obtained for any proprietary material contained therein. ii Copyright © 2012 by Ling-Chun Chiang All rights reserved iii Dedication This dissertation is dedicated to those patients and their families who participated in my study by showing me their bravery and generosity to life. iv Table of Contents Title Page ............................................................................................................................. i Committee Signature Page .................................................................................................. ii Dedication .......................................................................................................................... iv Table of Contents ................................................................................................................ v List of Tables ...................................................................................................................... ix List of Figures ..................................................................................................................... x Acknowledgement ............................................................................................................. xi Abstract ............................................................................................................................ xiii Chapter One Introduction ................................................................................................... 1 Problem ........................................................................................................................... 3 Significance..................................................................................................................... 5 Intervention ..................................................................................................................... 6 Conceptual Framework ................................................................................................... 7 Summary of Literature .................................................................................................. 10 Assumptions .................................................................................................................. 11 Hypotheses .................................................................................................................... 11 Research Questions ....................................................................................................... 11 Conclusion .................................................................................................................... 12 Chapter Two Review of Literature .................................................................................... 13 Cancer Pain ................................................................................................................... 13 Pathophysiology and mechanisms of cancer pain. ................................................... 13 Cancer pain in hospice patients. ................................................................................ 21 Cultural issues. .......................................................................................................... 26 Anxiety .......................................................................................................................... 29 Pathophysiology and mechanisms of anxiety. .......................................................... 31 Anxiety in hospice cancer patients. .......................................................................... 32 Cultural issues. .......................................................................................................... 36 Cancer Pain and Anxiety ............................................................................................... 39 Music for Pain and Anxiety .......................................................................................... 40 Mechanisms of music for pain and anxiety. ............................................................. 41 Effects of music on pain. .......................................................................................... 42 Effects of music on pain in cancer and hospice patients........................................... 44 v Effects of music on anxiety. ...................................................................................... 45 Selection of music. .................................................................................................... 47 Nature Sounds ............................................................................................................... 49 Combination of Music and Nature Sounds ................................................................... 51 Threats to Internal Validity ........................................................................................... 53 Summary of Literature Review ..................................................................................... 57 Chapter Three Method ...................................................................................................... 58 Design ........................................................................................................................... 58 Sampling ....................................................................................................................... 61 Sample size estimation. ............................................................................................. 61 Inclusion and exclusion criteria. ............................................................................... 61 Setting ........................................................................................................................... 62 Experimental Interventions ........................................................................................... 64 Music......................................................................................................................... 64 Nature sounds............................................................................................................ 65 Combination of music and nature sounds. ................................................................ 66 Equipment. ................................................................................................................ 66 Measures ....................................................................................................................... 67 Cancer pain. .............................................................................................................. 67 Anxiety. ..................................................................................................................... 69 Demographic measures. ............................................................................................ 71 Types of music and nature sounds generally liked. .................................................. 71 Experience with complementary and alternative therapies. ..................................... 71 Length of time and reasons for independent listening. ............................................. 72 Potentially Confounding Variables ............................................................................... 73 Analgesic and anxiolytics intake. ............................................................................. 73 Environmental disturbances. ..................................................................................... 74 Religious chanting box. ............................................................................................ 74 Procedure ...................................................................................................................... 75 Protection of Human Subjects ...................................................................................... 80 Data Management ......................................................................................................... 81 Data Cleaning................................................................................................................ 82 Assumptions of Statistical Tests ................................................................................... 82 Data Analysis ................................................................................................................ 84 vi Hypotheses testing. ................................................................................................... 84 Research questions. ................................................................................................... 86 Summary ....................................................................................................................... 86 Chapter Four Results........................................................................................................
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