Critical Review of an Article on the Role of Music Therapy in the Clinical Cancer Setting

Introduction
Recently, the research on cancer has increased rapidly owing to the increasing number of cancer cases recorded across the globe. Most of the research is focused towards prevention and management of the condition, with the aim of reducing the condition’s prevalence and helping patients manage its chronic pain. O’Callaghan, O’Brien, Magill, & Ballinger, (2009) are the respective authors of the reviewed article Resounding attachment: cancer inpatient’s song lyrics for their children in music therapy.

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The article was submitted to the Support Care Cancer Journal in 2009, which is relevant to the nature of the study. All the authors have a background in either cancer, music therapy or social work, which is relevant to the current research. The article is well organized with a clear abstract detailing the goals of the research, the materials and methods used in the study, the main results of the study and the study conclusion. The authors begin by providing background information that helps the reader identify the issue under study and its significance. According to the authors, over one third of the patients under cancer treatment have under 18 children living at home in the United States.
However, the study identifies lack of available resources to help these patients in coping with the condition as well as discuss their illness with their children are unavailable as the major research problem (O’Callaghan, et al, 2009: 1149).
Similarly, there is no supporting parent-child communication for these patients while under hospitalization to receive cancer treatment, reducing the parent –child interactions during hospice care. This critical article review will highlight the research articles strengths and limitations on the choice of research questions, methodology, type of sampling, data collection, results interpretation and analysis and lastly the conclusion.
Research questions
The authors have carried out an extensive review of literature relevant to the issue under study before developing the research question. The review identifies the role of music therapy and music therapists in clinical population such as cancer settings. The literature review section is divided into subtopics, which the authors have extensively covered. The subtopics discuss on the experiences of parents with their children for patients undergoing cancer treatment and research on song writing in adult oncologic music therapy.  According to the review of literature conducted in the study, music therapy can help reduce the profound effects of cancer treatment on child-parent relationship, helping parents fulfil their parental roles. The study identified these effects of cancer treatments as changes in self-image, loss of control and strained family relationships, which disrupts normal life between parents living with cancer and their children. Musical therapy can help children rebuilt there emotional stability, overcome fear and uncertainty of an impending death by providing a communicative language especially for parents with end stage cancer. In addition, the actors carried out a review of the lyrical analysis for the palliative care patients and the identified themes. The literature review adequately presents the magnitude of the issue or problem under research. In addition, the review of literature is relevant to the current study, as it discusses significantly on existing research on the use of musical therapy in improving communication between children and parents living with Cancer. Although the study has carried out an extensive review which emphases on the magnitude of the issue and problem under study, the review of literature has also another strength. The authors have identified limited resources and scant research focused on helping the hospitalized cancer patients discuss their condition with their children as well as maintaining connectedness as the exiting research gap, which justifies the need of the current research (O’Callaghan, et al, 2009: 1151). The study identified the grounded theory is the theoretical framework informing the present research.
The authors have a well-defined study purpose as well as a clear formulated research question to guide the study.  The purpose is to research on the use of music therapy as a solution the creating a therapeutic, psychosocial, spiritual and physical relationship between parents receiving cancer treatment and their children. The study identified a single clear research question. What do cancer inpatients express in their lyrics when song writing for their children? (O’Callaghan, et al, 2009: 1151). The question specifically identifies the research will focus on the themes of therapeutic music, written by parents living with cancer to their children. Therefore, it is evident that the formulated research question is consistent with the phenomena investigated by the study of the use of music therapy in improving communication between cancer inpatients and their children. Similarly, the research question is formulated before the authors formulate the data collection procedures, which is one of the strength of the article. In addition, the researchers carried out an in-depth review of literature as an analysis to the formulated research question.
Methodology
The article uses a qualitative research framework to carry out an inductive lyrical analysis of 35 songs written by 27 palliative care patients and with different themes. O’Callaghan, et al, (2009) used previously outlined paradigms in analyzing the lyrics of the reviewed songs. Paradigms identify four comparable elements, which include brain storming, song structure, melodies, rhythms and harmonies and lastly a completed song. The analyses only included the original lyrics composed by the patients. The nature of the data being collected and analyzed by the study justified the use of qualitative research approach.  A triangulation qualitative inter-rater design involving the authors was used in the initial analysis process. The authors affirmed their considerations, clarifications, verification which ensured the findings validity and reliability. Management of textual data was carried out using a textual data management software. The authors noted that St Peters Maccalllum cancer ethical committee approved the research. However, although the authors acknowledge affirmation to clarification, considerations and verification, it the approach was limited by researchers own perception, which could introduce potential biasness.  
Sampling
The current used criterion-sampling method. The inclusion criteria is that the songs had to have original lyrics composed by the patients Only the cases that met this criteria were selected. The authors used two song groups to collect and analyze the song separately. One group included 19 songs written by 12 patients collected by the first author while working in a cancer center. The second group included 16 songs published for cancer patients to the public. The second author published 13 of these songs while the third author published the two songs and another therapist publishing one songs. As the song cases were used from patient is who already deceased, the authors could not conduct the interviews or train them to participate in the study. 
Data collection
Using A comparative analysis procedure based on grounded theory, the lyrics of each song were inductively coded using descriptive labels representing their text. Codes that were comparable were grouped into categories. These themes in these categories were further grouped together, and similar themes condensed to a descriptive statement.  Song statements from the two groups were then merged into an amalgamated statement that included lyrics from 35 songs in an iterative, analytical process (O’Callaghan, et al, 2009). The researchers analyzed the songs written by parents under their care. Although the authors do not explicitly state conflict of interest in the selection criteria, the use of their own published, songs written by some of the patients under their care could present a conflict of interest. The
Analysis and results
The researchers have well described the results of the study. The findings identify that three fathers and nine mothers with an average age of 44 years composed 19 of the songs to 23 children. The children were aged between 18 months to 18 years. The parents had a metastatic or hematological illness receiving cancer or palliative care and died in 3 days to six months of the song writing sessions (O’Callaghan et al, 2009: 1152). The study also identified that 15 songs were specifically written for the patient’s children, with two songs composed for the spouse and the children and two other written to a group of people. Thirteen of the songs are commercially available, written by 12 hematology and oncology patients while nine songs were written for pre-school and school age children. The age of the children for four songs was unknown and possibly adults. Patients with advanced cancer wrote three of the songs.
In addition, the authors have presented a well-described process used in transforming data to themes and codes. The findings of the study are well-organized using tables and in presented in section making it for reader to follow. According to the study, the identified codes included spiritual, undying love, assurance, guidance and strength; a message to the heart, and mum did not plan this. These codes revealed that the lyrics expressed hope for a bright future, expressed love, encouraged ambition, and expressed support especially from family members’ best life wishes among several others. The identified categories were hopes and wishes for children, loving, satisfying and fulfilling future and life without struggle. Other categories identified through the study include affirmation, support and encouragement, dancing, memories, compliment, emotional, intellectual, longstanding and enduring love, positive reminiscences among others. In total, the lyrics classified under CO music therapy sessions identified 11 categories and the other group for publically available 13 sessions (O’Callaghan, et al, 1153).
The results of the study reveal that the cancer patients use songs to convey their heartfelt and undying love for their children. In addition, the songs were used in sharing past memories and moments shared together, giving encouragement, and compliment. In addition, the study identified that the songs offered patients express their guidance to their children on qualities that can help them in personal development, give strength, and share the experiences of the cancer treatment journey, offer optimism and forgiveness or seek for forgiveness. Other uses identified from the study include personal reflections, references to metaphysical beliefs such as faith, hope, Gods blessings, and prayers as well as after life (O’Callaghan, et al, 2009: 1154).
The research findings support the phenomena under study that music life can help patients suffering from life threatening cancer condition offer a creative structured and esthetic approach to offering support messages to their children, advice, express emotions that is an essential interaction platform for parent-child attachment. The authors also noted that the writing provide an way for parent to communicate with their children on what they may want to know before their death, as well as help them construct an internalized parental figure essential for their development. In addition, it offered guidance on family and support network to help them cope with the loss and reintegrate with society (O’Callaghan, et al, 2009: 1154).
The authors identify the implications of the research findings as essential in inform attachment, developmental and bereavement theories, which can guide parents with cancer in helping their children, cope with their intermediate and long-term future (O’Callaghan, et al, 2009: 1157). The authors have also included a recommendation that parents diagnosed with cancer can use music therapy as an opportunity for engaging with their children. In general, based on the research findings, one can generalize that use of music therapeutic by parents will include atleast a helpful theme for parents to share with their children, which justifies and promotes its use to improve patient-child relationship for parents with cancer.
Conclusion
The study has identified the triangulated design approach, which grouped the lyrics analyzed into two groups as strengthening the validity of the research. However, the authors also acknowledge that qualitative interrater process as affecting the study reliability. The presence of isolated differences between the two groups’ findings is an indication that data saturation was not reached to allow consolidating the findings in the formal grounded theory. The conclusion of the study is based on the findings of the study and stated logically. The researchers have also identified recommendation for future research to focus on the effectiveness on and the perception of the songs by the children on different development stages. This is important to understand the therapeutic implications and usefulness of musical therapy for communicative, educative and the emphatic purposes.  
Reference

O’Callaghan, C., O’Brien, E., Magill, L., & Ballinger, E. (2009). Resounding attachment: cancer inpatients’ song lyrics for their children in music therapy. Supportive Cancer Care, 17, 1149-1157. [Qualitative]