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PATIENT STORY

A 72-year-old woman is being cared for at home at the end of life. She is dying from metastatic breast cancer. She is a social worker and planned meticulously for her end of life, including choosing home hospice, designating her medical power of attorney, and completing her last will and testament. The home hospice nurse visits daily and helps with many aspects of comfort care during her remaining days. In between visits, her family helps her stay clean and comfortable as she is now bedbound. They bring her water to sip, and soft food and medications as needed. Her doctor in conjunction with the hospice program has provided liquid morphine and a liquid benzodiazepine that helps tremendously with her pain and anxiety. The family members are able to administer these medications according to the schedule provided by the hospice nurse. The metastatic cancer has spread to many bones and leg muscles, and in the last weeks the morphine and benzodiazepine have truly contributed to her comfort. The hospice program has provided a music thanatologist to play the harp for her now that it is clear that her death is imminent (Figure 5-1). In the last hours of her life, the family plays her favorite music as she peacefully passes away with her two sons on either side of the bed, each holding a hand.

FIGURE 5-1

Music thanatologist playing the harp at the bedside of a dying woman on home hospice. Her family members are also listening as the woman both plays the harp and sings to comfort the patient. (Reproduced with permission from Richard P. Usatine, MD.)

Music thanatology uses harp and voice at the bedside to provide live music that attempts to respond to the patient's physiologic needs. Authors of a before-and-after study of 65 patients found that patients had decreased levels of agitation and wakefulness, and breathing was slower and deeper after the music vigil.1 In another paper, family members reported benefits for both themselves and their loved one, with perceived improvement in the patient's breathing, relaxation, pain, and ability to sleep.2

INTRODUCTION

End-of-life care is care delivered to patients of all ages who have a very short life expectancy (Figure 5-2). This care is focused on meeting the patient's emotional and physical needs for symptom relief and general comfort care and offering patient and family support. Patients at the end of life are fragile and require complex care and, therefore, are at higher risk of compromised safety, medical complications, and medical errors. Addressing these issues requires different approaches—patient and family preferences and quality of life are key factors in the balance between safety and quality of life. Early referral to palliative care, along with concurrent treatment, is vital to optimizing ...

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