Journal of Pediatric Oncology

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Music Therapy Services in Pediatric Oncology: A National Clinical Practice Review

Belinda Tucquet and Maggie Leung
Journal of Pediatric Oncology Nursing 2014 31: 327 originally published online 15 July 2014
DOI: 10.1177/1043454214533424

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research-article2014
JPOXXX10.1177/1043454214533424Journal of Pediatric Oncology NursingTucquet and Leung

Article
Journal of Pediatric Oncology Nursing

Music Therapy Services in Pediatric

2014, Vol. 31(6) 327338
2014 by Association of Pediatric
Hematology/Oncology Nurses
Oncology: A National Clinical Practice Reprints and permissions:
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Review DOI: 10.1177/1043454214533424

jpo.sagepub.com

Belinda Tucquet, BComm, MMusThrpy, RMT1 and

Maggie Leung, BMus, GDipMusThy, RMT, NMT1

Abstract
This article presents the results of a national clinical practice review conducted in Australia of music therapy services
in pediatric oncology hospitals. Literature specifically related to music therapy and symptom management in pediatric
oncology is reviewed. The results from a national benchmarking survey distributed to all music therapists working
with children with cancer in Australian pediatric hospitals are discussed. Patient and family feedback provided from a
quality improvement activity conducted at a major pediatric tertiary hospital is summarized, and considerations for
future growth as a profession and further research is proposed.

Keywords
pediatric, music therapy, oncology, cancer, children

Music therapy is a growing profession in Australia, with
431 music therapists currently registered with the
Australian Music Therapy Association Inc (AMTA). In
the acute pediatric setting, there are 25 therapists provid-
ing music therapy services across a broad range of clini-
cal areas. Pediatric oncology music therapy services are
provided by 12 therapists across 8 pediatric hospitals,
each with a dedicated oncology unit.
The platform for networking and sharing of informa-
tion among pediatric music therapists in Australia takes
place through the AMTA Pediatric Health Reference
Group (PHRG). Members of the PHRG consist of
Australian registered music therapists working as clini-
cians or researchers with infants, children, and young
people in hospital. The objectives of the group, as per its
terms of reference, are to provide professional network-
ing regarding common and emerging issues and innova-
tive practice, such as service development, resource
sharing, professional development, clinical education,
project development and research.
The purpose of this review was to provide an opportu-
nity for clinical service development in Australian pediat-
ric oncology music therapy. Current practice was
determined by the distribution of a national benchmark-
ing survey, the results of which were disseminated
through the PHRG. Patient and family feedback regard-
ing music therapy services received was evaluated via a
quality improvement activity conducted at 1 of the 8
Australian pediatric hospital sites.
Music Therapy in the Pediatric Oncology
Hospital Environment
Music therapy services are commonly included as part of
the multidisciplinary team model approach adopted by
pediatric oncology health settings. In Australia, this is
evidenced by each of the pediatric hospitals providing
oncology care having a registered music therapist as part
of the allied health team. A nonpharmacological approach
to symptom management is often addressed in music
therapy, and several studies have focused on pain, anxi-
ety, depression, distress, and emotional support, includ-
ing music therapys ability to enhance motivation
(Barrera, Rykov, & Doyle, 2002; Barry, OCallaghan, &
Wheeler, 2010; Kennelly, 2001; Nguyen, Nilsson,
Hellstrom, & Bengtson, 2010; OCallaghan, Baron,
Barry, & Dun, 2011; Robb & Ebberts, 2003a; Robb et al.,
2008; Walworth, Rumana, Nguyun, & Jarred, 2008;
Willis & Barry, 2010).
1
Royal Childrens Hospital and Health Services District, Brisbane,
Queensland, Australia
Corresponding Author:
Belinda Tucquet, BComm, MMusThrpy, RMT, Royal Childrens
Hospital and Health Services District, Music Therapy Department,
Level 3, Coles Building, Herston Rd, Herston, Queensland 4029,
Australia.
Email: Belinda.Tucquet@health.qld.gov.au

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328 Journal of Pediatric Oncology Nursing 31(6)
Children with cancer respond and react to treatment
and the hospital environment in varying degrees, with
some experiencing pain and anxiety. Nguyen et al. (2010)
found that music therapy can help reduce these symp-
toms, measured via self-report and physiological status
before, during, and after a lumbar puncture procedure.
Children in the music group spoke of being able to focus
on the music, a decrease in anxiety about what would
happen next, and an association of feeling calm and
relaxed as a result of the music. Pain scores reported by
children were significantly lower during the procedure
(P < .001) for the music group (mean = 2.35, standard
deviation [SD] = 1.9) compared with the control group
(mean = 5.65, SD = 2.5), and after the procedure (P <
.003) for the music group (mean = 1.2, SD = 1.36), com-
pared with the control group (mean = 3, SD = 2). Anxiety
levels after music listening but before the lumbar punc-
ture were also significantly lower (P < .001) for children
in the music group (mean = 8.6, SD = 2.78) than for chil-
dren in the control group (mean = 13.25, SD = 3.73).
These reductions in anxiety were also significant after the
procedure for children in the music group (mean = 8.1,
SD = 2.22) compared with the control group (mean =
13.0, SD = 4.17). Heart rate and respiratory rate were sig-
nificantly lower during the procedure (P = .012, P = .009)
in the music group (mean = 102.7, SD = 9.24, and mean
= 25.1, SD = 3.60) compared with the control group
(mean = 117.7, SD = 19.49, and mean = 28.5, SD = 3.86).
Respiratory rates were also significantly lower after the
procedure (P = .003) for children in the music group
(mean = 24.45, SD = 3.49) compared with the control
group (mean = 28.1, SD = 3.72). There was no significant
difference in blood pressure (Nguyen et al., 2010).
Music therapy has also been found to be effective in
supporting children experiencing anxiety during radia-
tion treatment. Patients undergoing radiation therapy at a
major oncology hospital site (N = 24) were found to have
a 92% success rate without general anesthesia when live
music therapy sessions were conducted during the proce-
dure through closed-circuit television (Willis & Barry,
2010).
Pediatric patients undergoing active cancer treatment
may also experience depression and anxiety, of which
levels of both have been found to be reduced by music
therapy (Robb & Ebberts, 2003a; Walworth et al., 2008).
Robb and Ebberts (2003a) discovered that depression
levels in children undergoing bone marrow transplanta-
tion vary according to phase of treatment, with lower
anxiety levels in the music group compared with patients
receiving standard care. Furthermore, analysis of patients
songs showed themes of hope, positive coping, apprecia-
tion, mental status, and control. Walworth et al. (2008)
examined the effects of live interactive music sessions for
patients undergoing brain surgery (N = 27), and they
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found statistically significant differences in levels of anx-
iety (P = .03), perception of hospitalization (P = .03),
relaxation (P = .001), and stress (P = .001; Walworth et al.,
2008).
Music therapy has also been found to assist with chil-
drens decreased ability to cope during procedures and
associated distress. Barry et al. (2010) explored the
effect of creating a personalized music therapy CD
(MTCD) for children undergoing radiation procedure
(N = 11); the authors found that this aided the use of
effective coping strategies, with a significant difference
in total distress (P = .024). These findings are further
supported by a multiresearch project conducted by 3
major pediatric oncology hospital sites in Australia. A
range of music therapy interventions were reported to
help children through aversive cancer experiences; par-
ents recommendations included the provision of a more
supportive musical and sound environment (OCallaghan
et al., 2011).
Children with cancer who are required to spend a sig-
nificant amount of time in hospital are often separated
from their familiar environment and sometimes isolated
from their peers, which may adversely affect their level
of motivation. Participation in music therapy has been
found to have a significant effect on positive facial
affect and active engagement (P < .001) and initiation
(P < 005; Robb et al., 2008). These behavioral outcomes
are noted as being consistent with Skinner and
Wellborns motivational theory of coping, and suggest
that active music engagement as an intervention can be
used to assist hospitalized children to positively engage
with their environment, an important first step in learn-
ing and using effective coping strategies (Robb et al.,
2008). The interactive use of music therapy on hospital-
ized children with cancer has been found to have signifi-
cant improvements in not only patients feelings and
level of engagement, F(1, 59) = 8.11, P < .01, but also
reduction in parents anxiety, F(1, 57) = 8.02, P < .01
(Barrera et al., 2002).
Several music therapists have shared their experience
of working with pediatric oncology patients and the
capacity of music therapy to provide emotional support.
The recurring themes of these publications highlight that
music therapy has a positive effect in reducing feelings of
isolation, enhancing quality of life, and increasing
patients participation in treatment (Abad, 2003; Daveson,
2001; Daveson & Kennelly, 1999; Kennelly, 2001;
Ledger, 2001).
In a series of case studies, Abad (2003) illustrates the
efficacy of music therapy with adolescents on a pediatric
hospital ward. Music therapy interventions included song
parody and performance, music relaxation and imagery,
and instrument learning. Song parody and performance
can provide adolescents with freedom and flexibility to
Tucquet and Leung 329
Table 1. Benchmarking Outcome: Referral Source.
Frequency of referral (1 = most common, 5 = least common)
Referral source 1 2
Medical staff 0% 13%
Nursing staff 25% 25%
Allied health 38% 38%
Families/parents 0% 25%
Self-referral 38% 0%
express personal words and feelings they may have previ-
ously been uncomfortable in discussing, and increased
social interaction through sharing their creation with oth-
ers (Abad, 2003). Music relaxation and imagery may help
cancer patients perceive less pain, discomfort and nausea,
and reduce perceived anxiety (Abad, 2003). Instrument
learning can provide a motivating and age-appropriate
way to engage adolescents and, through mastery, may
assist with increased control over the hospital environ-
ment (Abad, 2003).
Similarly, Daveson (2001) suggests music therapy can
facilitate opportunities for self-expression, connection
with the outside world, and help children to learn, rein-
force, extend, and use new coping strategies.
National Benchmarking
In Australia, there are currently 25 music therapists work-
ing in the pediatric hospital setting. Eleven music thera-
pists work in pediatric oncology (44%) across 8 hospital
sites, with 3 of these sites having full-time positions.
Practicing music therapists must be registered with the
AMTA and are bound by its code of ethics.
Australian music therapy clinical services provided in
the pediatric oncology setting were evaluated via the dis-
tribution of a national benchmarking survey. The purpose
of this benchmarking survey was to provide a platform to
share knowledge regarding varied models of care and
compare clinical practice with current evidence and con-
sumer feedback, specifically, to establish the correlation
between clinical service delivery and symptom manage-
ment, as determined by the literature reviewed. The
benchmarking survey was necessary in order to confirm
current practice with the literature and avoid assumptions
being made by the authors with regard to national clinical
service delivery.
The benchmarking survey was descriptive in design,
given the population was a specific cohort and informa-
tion sought related to specific aspects of music therapy
clinical service delivery. Questions were associated with
seeking data related to referral source, therapeutic goals,
program structure, assessment tools, and evaluation (see
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3 4 5
0% 25% 63%
25% 25% 0%
25% 0% 0%
25% 38% 13%
25% 13% 25%
Appendix A). During the period of March to October
2010, it was distributed via email to all music therapy
departments (N = 8) that provide pediatric oncology ser-
vices in Australia, with a 100% response rate.
Survey respondents were identified and contacted
via the AMTA PHRG. A deadline was provided to
return the survey via email, with minimal follow-up
email reminders required. One sites music therapy
position was vacant at the time of initial data collection.
This survey was completed once the position was filled,
and the respondent was contacted via telephone and
email to explain the purpose of the survey and obtain
consent to participate.
Respondents were informed of the purpose of the sur-
vey via cover letter and that the results would be made
public via conference presentation and redistribution to
the group. All information was de-identified prior to
being shared publicly.
Referral Source
Using a scale of 1 to 5 (1 = most common, 5 = least com-
mon), each site was asked to rank referrals based on their
source (medical staff, nursing staff, allied health staff,
families/parents, and self-referral). Varied responses were
received, with no indication of a particular referral source
consistently reported across sites as being most or least
common, except for medical staff heavily weighted
toward least common (see Table 1).
As Table 1 indicates, allied health professionals and
self-referral were highlighted as being the most common
referral source (38%), followed by nursing staff (25%).
Least most common sources of referral were indicated as
medical staff (63%), self-referral (25%), and families/
parents (13%).
Music Therapy Program Goals
The benchmarking survey asked music therapists to indi-
cate program goals, as well as those most commonly
used. A clear correspondence between current evidence
and symptom management in pediatric oncology was
330 Journal of Pediatric Oncology Nursing 31(6)
Figure 1. Benchmarking outcome: Music therapy program
goals.
reflected in program goals integrated into clinical music
therapy practice. As Figure 1 indicates, emotional support
and parent/child bonding is incorporated into all music
therapy programs, followed by rehabilitation (88%), anx-
iety and pain management (71%), and procedural support
(63%). There were some similarities and differences
between sites regarding most common program goals;
however, these were still in accordance with current evi-
dence. Anxiety management, adjustment to illness, devel-
opmental stimulation, emotional support, sensory
stimulation, and socialization were indicated. Some sites
chose not to indicate ranking of program goals.
Program Structure
Data were also collected with regards to the structure of
the music therapy program. Music therapists were asked
to indicate whether services are provided to inpatients
and/or outpatients, via group and/or individual sessions,
and whether or not music therapy sessions are sometimes
combined with other allied health services.
Seventy-five percent of respondents reported provid-
ing music therapy as an inpatient and outpatient service,
with 25% providing inpatient services only. Eighty-seven
percent provide group and individual sessions, and 13%
individual sessions only. Regarding combined sessions
with other allied health professionals, 63% report provid-
ing joint sessions with some variance of professions,
including physiotherapy, speech pathology, occupational
therapy, and psychology.
Assessment
Music therapists were asked to indicate whether any for-
mal written assessment tools are used in the development
of music therapy programs. This question was very brief
and did not allow space to describe the frequency of use,
or other forms of assessment. Several sites report the use
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of an assessment tool developed specifically by their site,
whereas one site reported using a modified version of a
published assessment tool.
Evaluation
There were differences reported in the evaluation pro-
cess; however, all sites reported using either formal or
informal evaluation. In accordance with the evidence-
based model of practice, these included patient and fam-
ily feedback surveys, staff surveys, a multisite research
project, quality activities, formal reporting to funding
bodies, and statistical data collection.
Research
At the time of data collection, 4 music therapists across 3
sites were participating in a multisite research project.
Using a qualitative clinical data mining design, the 4
researchers adopted a music-therapist-researcher role
to collectively examine their beliefs about music, includ-
ing music therapys relevance for pediatric cancer patients
(OCallaghan et al., 2011). Data collection involved 4
phases: (a) a transcript of therapists audio recorded ini-
tial discussion; (b) therapists additional reflections, writ-
ten when privately reading and validating the transcript;
(c) a transcript of the therapists second discussion; and
(d) therapists additional reflections of second discussion
(OCallaghan et al., 2011).
Quality Activity
A quality activity was conducted at the Royal Childrens
Hospital (RCH) Brisbane to collect data from patients
and families within Queensland Childrens Cancer Centre
(QCCC) in relation to music therapy services received.
Quality activities are defined by RCH Brisbane as activi-
ties that measure performance, identify opportunities for
improvement in the delivery of care and service, and
include action and follow-up. Participation in quality
activities is considered general practice and is a job
description requirement for all allied health
professionals.
History of Music Therapy Services
The RCH Brisbane was established in 1878 and is now
the largest specialist childrens hospital in Queensland,
Australia. It is a 168-bed, public specialist teaching
hospital providing services across most health special-
ties for children and young people aged 0 to 14 years
living in Queensland, northern New South Wales, the
nearby Pacific Islands, New Zealand, and Japan (RCH,
2011).
Tucquet and Leung 331

Table 2. Brief Description of Some QCCC Music Therapy Programs.

Music therapy program Brief description

Developmental stimulation
Rehabilitation
Emotional support
Pain and anxiety
Palliative care
Aims to support childrens developmental milestones
Focuses on maximizing patients motivation, physical and emotional potential, to achieve
functional goals
Allows patients, especially adolescents, the space to voice their feelings through songwriting or
simply making music together
Provides nonpharmacological strategies (in conjunction with pharmacological treatment) to
maximize therapeutic outcomes as well as patient and family empowerment and independence
Plays a significant role in enhancing patients quality of life. By facilitating the process for patients
and families in music creation, a sense of community and comfort can be induced as well as an
opportunity to share experiences, feelings and build positive memories

Note. QCCC = Queensland Childrens Cancer Centre.

The Queensland Childrens Cancer Centre (QCCC) is
a state-wide pediatric cancer center with the tertiary ser-
vice situated at the RCH Brisbane. The Queensland
Pediatric Haematology and Oncology Network and the
QCCC work as an integrated entity to plan and provide
quality care for patients through a well-coordinated team
of multidisciplinary professionals across the state. The
RCH site of the QCCC provides both inpatient and outpa-
tient cancer care including a Blood and Marrow Transplant
Unit and access to radiation oncology services.
There are 2 dedicated oncology wards within RCH
Brisbane consisting of 24 beds in total, with capacity for
oncology patients to be housed in other wards when
these are full or infection control dictates. Five beds are
isolated for bone marrow transplant, and 2 beds are spe-
cifically designed to be suitable for palliative care
patients. On an average day, approximately 20 children
and young people would be inpatients on the oncology
wards with approximately another 10 accommodated in
other wards. The QCCC also provides outpatient ser-
vices in a dedicated Oncology Day Care Unit, which on
an average day would see approximately 60+ children
and adolescents.
In 2010, the QCCC saw 134 new diagnoses of cancer
(does not include hematological diagnoses or relapses).
In 2009, there were 159 new diagnoses, 176 in 2008, and
141 in 2007. The QCCC is staffed by a multidisciplinary
team including pediatric oncologists, radiation oncolo-
gists, nurses, liaison nurses, a nurse practitioner, and vari-
ous allied health professionals providing both
developmental and psychosocial input. Allied health ser-
vices include social work, child psychology, occupational
therapy, music therapy, speech pathology, pharmacy, and
dietetics.
Music therapy was introduced to the oncology unit at
RCH Brisbane in 1998 via a pilot program. Music ther-
apy services at QCCC are currently provided by 1 full-
time and 1 part-time registered music therapists.
Respectively, these positions are funded by external
nongovernment organizations, Redkite and the Royal
Childrens Hospital Foundation. The mission of the music
therapy department at RCH Brisbane is to build a stable
& supportive music therapy service, focusing on deliver-
ing family-centered and evidence based clinical services
while expanding music therapy research horizons within
acute pediatric health care (Music Therapy Department,
Mission Statement of RCH, 2011).
Music therapy is available by referral for all oncology
inpatients who require intervention to assist with pain and
anxiety management, family/parentchild bonding
opportunities, emotional expression, engagement in
meaningful and positive experiences while in hospital
and as part of a developmental or rehabilitation program
in conjunction with other therapists. Needs for referral
are identified by medical, nursing, and allied health staff,
with 8% of referrals received by allied health, followed
by 15% medical and nursing staff.
On referral, the music therapist liaises with the mul-
tidisciplinary team and conducts an assessment with the
patient and family to identify their needs and goals in
relation to their medical experience and illness. A brief
description of some of the music therapy programs pro-
vided at QCCC is outlined in Table 2. Every patient and
family are unique, therefore each music therapy pro-
gram is tailored to meet their specific needs. When nec-
essary, an active multidisciplinary team approach to
treatment is implemented, and music therapy combines
with other allied health in order to maximize therapeutic
outcomes.
Patient/Family Feedback Survey
A 15-question survey was developed and distributed to
all patients who received music therapy during their
inpatient hospitalization from 2008 to 2010. The purpose
of this survey was to obtain information from patients
and families regarding their perception and experience
of music therapy services and explore whether this was

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332 Journal of Pediatric Oncology Nursing 31(6)
congruent with the literature and benchmarking survey.
This consumer feedback was intended to guide future
direction and areas for growth in clinical service
delivery.
Ethics approval was not required as the survey was
considered low risk. The survey was distributed via post
for those patients not in hospital and in person by a music
therapist other than the patients therapist for those who
were inpatients.
NonEnglish speaking parents were excluded, given
an interpreter was not available. Parents who attended
less than 2 music therapy sessions were also excluded,
because of limited exposure to the service. Families of
patients who had passed away and those patients who had
progressed to a palliative care stage of treatment were not
invited to participate to respect space and privacy.
Design
Using a 5-point Likert-type scale, ranging from
strongly agree to strongly disagree, the survey included
a range of questions related to the role of music ther-
apy and therapist (interaction, communication, inclu-
sivity, approachability), structure of the music therapy
program (individual and/or group sessions, environ-
ment), and perceived benefits to the patient (increased
coping ability, improvement in developmental skills,
opportunities to express and explore feelings, enjoy-
ment, helping child during hospitalization). Space was
provided for any additional comments, thoughts or
ideas (see Appendix B).
Results
There were 53 surveys distributed, and 72% returned (N =
38). Patients age ranged from 0 to 16 years (mean = 5
years). Patients aged 12 years and older were provided
with the opportunity to complete the survey indepen-
dently, and 50% did so instead of their parents.
Of the participating families and patients, 84% (N = 32)
indicated that music therapy was a valuable tool within the
pediatric hospital. With regard to music therapy clinical
outcomes, parents highlighted family bonding as the most
important component, followed by assisting with their
childs coping abilities and providing an avenue for self-
expression. Structurally, 45% (N = 17) of families identi-
fied a preference for additional group music therapy
programs.
Within the survey, 89% (N = 34) of parents provided
unsolicited additional written comments about their expe-
rience of music therapy. A content analysis approach was
used to quantify and analyze the data into 3 categories:
treatment, service, and perception of music therapy.
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Music therapy treatment was highlighted as the
most common theme in families perception of music
therapy services (39%, N = 13). Parents expressed that
music therapy played a significant role in supporting
their child during procedures, distracting them from
pain and anxiety. Music therapy was described as a
tool in providing rehabilitation for children while
regaining their premorbid skills. Parents reported
music therapy also provided an opportunity for family
bonding in the midst of an unpredictable and challeng-
ing journey.
Parents opinions of music therapy as a service and
their gratitude toward the program and therapists was
highlighted as the next most common theme (37%, N =
12). Parents commented on the importance of an accom-
modating and flexible service, which individually
addressed their childs needs at different stages of treat-
ment. Flexibility was described as not only the thera-
pists approach and personality but also the logistic
planning of the structure and duration of the program,
intervention, and use of resources in supporting a range
of developmental, emotional, and physical needs of
their child.
Finally, parents perceived music therapy as a vital part
of their childs mental health well-being and overall
recovery (23%, N = 8). Music therapy was described as a
consistent, professional, and positive service that directly
benefits patients and families.
Discussion
The qualitative and quantitative research in pediatric
oncology music therapy is growing as the field expands,
and the demand for nonpharmacological approaches to
symptom management continues to increase. Evidence
from the literature, combined with the outcomes of
national benchmarking, provides a baseline of current
practice and a pathway to the development of future prac-
tice. Results from the quality activity suggest that pediat-
ric patients and their families need experiences that offer
a sense of normalcy and control in an often chaotic
environment.
The baseline of current practice in pediatric oncology
provided by the results of the benchmarking survey
indicate that music therapy services in Australia are
aligned with the literature, with regard to goals
addressed. In the patient/family feedback survey, par-
ents highlighted family bonding as the most important
component in relation to clinical outcomes, followed by
assisting with their childs coping abilities, and provid-
ing an avenue for self-expression. This is compatible
with current practice, given the benchmarking survey
highlights emotional support, parent/child bonding, and
Tucquet and Leung 333
self-expression being 100% incorporated into clinical
service delivery.
The patient/family feedback survey also revealed par-
ents reports that music therapy plays an important role in
supporting their child during procedures, distracting them
from pain and anxiety. This is reflected in the benchmark-
ing survey with pain and anxiety management (71%), and
procedural support (63%), being incorporated as program
goals. It is interesting to note that these components,
highlighted by the participating consumers, are not inte-
grated 100% into music therapy programs. This poses the
question of differences in models of care among the dif-
ferent sites, and how this may shape the role of music
therapy given certain facilities may delegate a different
allied health professional to be solely responsible for
addressing these needs.
In relation to the structure of music therapy, a prefer-
ence for more group music therapy programs was voiced
by parents in the patient/family feedback survey. The
benchmarking survey indicates that most facilities do run
group programs (87%), with a small proportion providing
individual programs only (13%), highlighting a prefer-
ence for more groups even though it is a service already
being provided. On further examination, most facilities
providing group programs conduct them once weekly,
and some provide specific days throughout the year
focused on different needs (eg, siblings). This informa-
tion poses the question of whether there is capacity to
consider more group programs, and whether or not extra
funding would be required to meet this need. It also
strengthens the value parents perceive of groups helping
to normalize the hospital environment for their children
by providing social interaction with peers. These normal
activities are often lost opportunities outside of the hospi-
tal environment because of infection control risks while
receiving treatment. It would be beneficial to further
explore the reasoning behind this preference for more
groups.
This national clinical practice review illustrates that in
Australia music therapists work in pediatric oncology
practice similarly in some areas and differently in others.
Although we are working with the same population, we
are working at different facilities; it would be beneficial
to further explore how this affects the delivery of music
therapy services. Are pediatric oncology models of care
similar among these facilities or varied, and how does
this influence the structure of music therapy? It seems
there is great scope to learn from each other and extend
clinical service provision through our shared knowledge
base.
In Australia, pediatric oncology music therapy ser-
vices make up a large percentage of total pediatric service
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provision (44%). This suggests a strong foundation for
growth, particularly with the intent of sharing clinical
expertise. Perhaps this process has already begun, with 3
sites participating in multisite research analyzing the rel-
evance of music therapy in pediatric oncology
(OCallaghan et al., 2011). Hopefully this project will
inspire further collaborative research within pediatric
oncology and lead to increased communication as a pro-
fession to expand services within Australia.
In consideration of our consumers, the quality activity
revealed that patients and their families place greatest
emphasis on music therapys ability to provide emotional
support to children with cancer. Parents referred to music
therapy as playing an active role in helping their child to
adjust to hospitalization and illness, develop positive cop-
ing strategies during long-term hospitalization, connect
with the outside world and the normal part of themselves,
and positively affect mental health and overall
well-being.
A major limitation of this review is that the patient/
family feedback survey was only distributed at one hospi-
tal site. Further sampling is required to gather more infor-
mation from patients and their families and better inform
clinical practice. It has already been mentioned that per-
haps differences in models of care affect the structure of
music therapy services. Further research that shares and
compares models of care, discusses the results of the
benchmarking survey in more detail, and brainstorms a
questionnaire suitable for distribution to all patients and
families within Australia would better inform practice
and provide further information for future direction.
It would seem beneficial to clinical service delivery to
determine what elements of music therapy help to maxi-
mize childrens coping abilities. The national bench-
marking survey indicates that multiple sites evaluate
music therapy services via patient and family feedback
surveys. Future collaborative research could be focused
on sharing this consumer feedback with each other, with
the aim of broadening our knowledge of our patient and
family needs and tailoring services accordingly. A sys-
tematic method of collecting this data could be estab-
lished through sharing our knowledge and clinical
expertise.
To roll out this project nationally would be a big
achievement for our profession in creating a solid foun-
dation of shared knowledge. If successful, the next phase
could be to liaise with our overseas counterparts and
design and implement an international clinical practice
review of music therapy services in pediatric oncology.
This would establish a gold standard in regards to inform-
ing clinical practice and improving outcomes for families
and patients.
334 Journal of Pediatric Oncology Nursing 31(6)

Appendix A For example: ++ Rehabilitationmeans the most

common goal that you address in your music therapy
National Benchmarking Survey program
Questionnaire. The Royal Childrens Hospital (Brisbane)
Music Therapy Department is conducting a national sur- __ Emotional support
vey to benchmark Music Therapy Paediatric Oncology __ Developmental (Communication, Cognition, Physical)
services in Australia. __ Rehabilitation
This information will be included in an abstract sub- __ Parent/Child Bonding
mission to be presented at 2 conferences in 2010: __ Anxiety Management
Australia & New Zealand Children Haematology & __ Relaxation
Oncology Group (ANZCHOG) Australian Music __ Socialization
Therapy Association (AMTA) National Conference. __ Pain Management
The presentation aims to provide an overview of the __ Adjustment to hospital/illness
Australian Paediatric Music Therapy services within the __ Sensory stimulation
Haematology and Oncology area, with further focus on __ Self-expression
the Music Therapy service delivery at the Royal __ Procedural support (MRI, Port access)
Childrens Hospital (Brisbane). __ Play
We would like to invite your Music Therapy __ Distraction
Department/Program to participate in this survey. This __ Other (please be specific _________________)
will be a great opportunity to demonstrate the Paediatric
Music Therapy services across Australia in a national 4.Which of the following Music Therapy interven-
forum to other medical, nursing and health tions are used? (You may tick more than one)
professionals. Songwriting Improvisation
Your sites contribution will be acknowledged and you Song-singing Lyric discussion
will receive a copy of the PowerPoint presentation post Instrumental learning Instrumental playing
conference. We respect your decision if you do not wish Music listening Music and movement
to participate; however we will not be able to include Guided Imagery and Music
your service in our presentation. Music Software (Super Duper Music Looper, etc)

Thank you for your participation. 5.Which Music Therapy Modalities are offered?
Please email to: Maggie_Leung@health.qld.gov.au Individual Music Therapy Program
Maggie Leung (Clinical Senior Music Therapist) Group Music Therapy Program
Belinda Tucquet (Music Therapist, Redkite) Joint Therapy Programs (circle):

Please answer the following questions regarding PTOTSLPPsychologistsOther

only your oncology and hematology caseload within For:
music therapy.
For any questions that do not relate to your site Inpatient service ONLY
Please indicate not applicable. Outpatient service ONLY
For any questions that you do not wish to answer In- and Outpatient service
Please indicate not disclosed.
6.If group Music Therapy programs are offered,
1.How many music therapists are currently working please briefly describe your program (i.e., MT &
in oncology at your site? OT Outpatient Playskills weekly programpar-
2.How many hours per week is your department pro- ents and siblings are invited)
viding MT service within oncology?
3.Which of the following therapy goals are currently 7.What is the referral process to your Music Therapy
addressed within your music therapy program? dept/program? (You may tick more than one)
(Please to indicate your program goals for the Verbal referral at Team Meeting/Ward Round
MOST commonly focused goal, please add ++ and for Verbal referral at nurse station
the 2nd MOST common goal, please add +) Email

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Tucquet and Leung 335

Referral form (standardized referral form used Childs age: _______________________________

throughout the hospital) Length of Rx at RCH to date: ___________________
All of the above ___________________
Other: _____________________
Please circle the most relevant response.
8.Who makes the most referrals to Music Therapy?
(Please rank from 1-5, 1 = most common, 5 = least) 1.I was satisfied with the explanation provided by the
MT regarding their role.
Nursing staff
Medical staff 1 2 3 4 5
Allied Health Professionals
Strongly Disagree Neither Agree Strongly
Families/Parents disagree agree nor agree
Self-referral disagree

9.Do you employ any formal Music Therapy assess- Comment: _______________________________________________
ment tools? _________________________________________________________
If so: _____________________________________________
Developed by your site _____________________________________________
Existing published MT Assessment form _____________________________________________
(i.e., Individualized Music Therapy ___
Assessment Profile, 2007)?
2. The MT was approachable and caring.
10.How do you or your department evaluate the out-
comes of your Music Therapy Service? 1 2 3 4 5
11.Are you or your music therapy department cur-
Strongly Disagree Neither Agree Strongly agree
rently participating or conducting any research disagree agree nor
project? (If so, please briefly explainoptional) disagree

Comment: _______________________________________________
Appendix B _________________________________________________________
_____________________________________________
Patient/Family Feedback Survey
_____________________________________________
Service Evaluation Form _____________________________________________
Music Therapy (MT) ___
QLD Childrens Cancer centre (QCCC)
Thank you for completing this form to help us ensure that Please complete if relevant
we provide the best services to your child.
2.The MT interacted appropriately with my child/
Please note that completing this survey is entirely children.
your choice and will not affect your childs care in any
way. 1 2 3 4 5
Strongly Disagree Neither Agree Strongly
Please note that the abbreviation MT is used for disagree agree nor agree
either Music Therapy or Music Therapist. disagree

Personal Information Comment: _______________________________________________

Name of person completing form (optional):
___________________________
N.B. this will allow us to further discuss any ideas or
issues that you may have.
Childs diagnosis: __________________________
_________________________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
___

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336 Journal of Pediatric Oncology Nursing 31(6)

3.The MT communicated appropriately with me and _____________________________________________

other family members. _____________________________________________
_____________________________________________
1 2 3 4 5 ___
Strongly Disagree Neither agree Agree Strongly
7.I believe that the MT was able to provide my child
disagree nor disagree agree
with opportunity to express/explore their feelings
Comment: _______________________________________________ through music.
_________________________________________________________
_____________________________________________ 1 2 3 4 5
_____________________________________________ Strongly Disagree Neither Agree Strongly
_____________________________________________ disagree agree nor agree
___ disagree

4.The MT appeared to welcome and be inclusive of Comment: _______________________________________________

_________________________________________________________
other family members.
_____________________________________________
1 2 3 4 5
_____________________________________________
_____________________________________________
Strongly Disagree Neither Agree Strongly agree ___
disagree agree nor
disagree 8. I believe that my child and family enjoy music
therapy.
Comment: _______________________________________________
_________________________________________________________
_____________________________________________ 1 2 3 4 5
_____________________________________________ Strongly Disagree Neither Agree Strongly
_____________________________________________ disagree agree nor agree
___ disagree

Comment: _______________________________________________
5.I believe that the MT was able to help improve my
_________________________________________________________
childs coping ability while in hospital.
_____________________________________________
_____________________________________________
1 2 3 4 5
_____________________________________________
Strongly Disagree Neither Agree Strongly ___
disagree agree nor agree
disagree Has your child attended:

Comment: _______________________________________________ Individual Music Therapy sessions

_________________________________________________________
Group Music Therapy sessions
_____________________________________________ Both
_____________________________________________
_____________________________________________ 9.I believe my child benefits from receiving individ-
___ ual MT sessions.

6.I believe that the MT was able to help improve my 1 2 3 4 5

childs developmental skills (i.e., play skills, com-
Strongly Disagree Neither Agree Strongly
munication skills).
disagree agree nor agree
disagree
1 2 3 4 5
Comment: _______________________________________________
Strongly Disagree Neither Agree Strongly _________________________________________________________
disagree agree nor agree _____________________________________________
disagree
_____________________________________________
Comment: _______________________________________________
_____________________________________________
_________________________________________________________ ___

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Tucquet and Leung 337

10. I believe my child benefits from participating in _____________________________________________

group music therapy sessions. _____________________________________________
_____________________________________________
1 2 3 4 5 _____________________________________________
______________________________
Strongly Disagree Neither Agree Strongly
Thank you for taking the time to complete this
disagree agree nor agree
disagree survey.
Please return to the MT Dept. using the replied paid
Comment: _______________________________________________ envelope OR drop it in the box at the MT/OT Dept.,
_________________________________________________________ Level 3 Coles Building, Royal Childrens Hospital (just
_____________________________________________ near entrance to the Banksia Day Unit).
_____________________________________________
_____________________________________________ Acknowledgments
___ The authors would like to acknowledge Queensland
Childrens Cancer Centre and thank the patients and families
11. If given the choice, would you prefer more: who participated in the consumer feedback survey. The
results received in the benchmarking survey from registered
Individual music therapy sessions music therapists working across various pediatric oncology
Group music therapy sessions sites within Australia is very much appreciated. The authors
would also like to acknowledge Redkite and the Royal
The MT service was provided in a suitable
12. Childrens Hospital Foundation for their generous funding of
environment. music therapy services within Queensland Childrens Cancer
Centre.
1 2 3 4 5
Declaration of Conflicting Interests
Strongly Disagree Neither Agree Strongly
disagree agree nor agree The author(s) declared no potential conflicts of interest with
disagree respect to the research, authorship, and/or publication of this
article.
Comment: _______________________________________________
_________________________________________________________ Funding
_____________________________________________
The author(s) received no financial support for the research,
_____________________________________________ authorship, and/or publication of this article.
_____________________________________________
___
References
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_____________________________________________ 233-263.
_____________________________________________ Daveson, B. A. (2001). Music therapy and childhood cancer:
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palliative care for hospitalized children & adolescents.
ideas that you may have:
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_____________________________________________ Kennelly, J. D. (2001). Music therapy in the bone marrow
_____________________________________________ transplant unit: Providing emotional support during adoles-
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Author Biographies
Belinda Tucquet, BComm, MMusThrpy, RMT, is a music
therapist at the Royal Childrens Hospital (Brisbane). She is
funded by Redkite and works full-time in pediatric oncology
and currently chairs the Australian Music Therapy Association
Inc Paediatric Health Reference Group.
Maggie Leung, BMus, GDipMusThy, RMT, NMT, is the team
leader in the Music Therapy Department at the Royal Childrens
Hospital (Brisbane). She has published in a number of journals
in the use of music therapy to improve speech communication
with children with an acquired brain injury. She is currently
undertaking an evaluation of the music therapy clinical service
delivery in oncology and pediatric intensive care unit in
Australia.