Stelpflug, Amy J.

Background: Music therapy (MT) offers benefits of improved symptom relief and quality of life at the end of life, but its impact on hospice patients and caregivers needs more research. Objective: To assess the impact of MT intervention on symptom burden and well-being of hospice patients and caregivers. Methods: A total of 18 hospice patients, selected based on scores ≥4 on the revised Edmonton Symptom Assessment System (ESAS-r) items on pain, depression, anxiety, or well-being, participated in MT sessions provided by a board-certified music therapist. Over a period of 2-3 weeks, 3-4 MT sessions were conducted for each. Patient Quality of life (QOL) was assessed using the Linear Analogue Self-Assessment (LASA). Depression and anxiety were measured with the Patient Health Questionnaire-4 (PHQ-4). For the 7 caregivers enrolled, stress levels were measured using the Pearlin role overload measure and LASA. Results: Patients reported a reduction in symptom severity and emotional distress and an increase in QOL. All patients endorsed satisfaction with music therapy, describing it as particularly beneficial for stress relief, relaxation, spiritual support, emotional support, and well-being. Scores on overall QOL and stress were worse for caregivers. Conclusion: This study provides evidence that MT reduces symptom burden and enhances the quality of life for hospice patients. Hospice patients and their caregivers endorsed satisfaction with MT. Given the benefits observed, integrating MT into hospice care regimens could potentially improve patient and caregiver outcomes. Larger studies should be conducted to better assess the impact of MT in this population.

Abstract Background Clinical laboratories are constantly changing with automated analyzers and total lab automation (TLA) implemented and replaced over time. Some benefits of newer technologies include decreased specimen volume requirements, less need for repeat testing, and greater throughput. Recent implementation of new analyzers and replacement of TLA in the Central Clinical Laboratory (CCL) at Mayo Clinic, Rochester, MN, prompted the laboratory to reassess blood collection volumes for commonly ordered tests. Objectives The aim of this study was to evaluate whether updating the blood collection volumes for clinical chemistry and immunoassay tests performed in the CCL could reduce the volume of blood collected from patients and the number of blood collection tubes utilized. Methods Nearly 100 different serum assays from the CCL test menu were reviewed including the basic and comprehensive metabolic, hepatic function, renal function, electrolyte, and lipid panels as well as thyroid function tests, enzymes, hormones, electrolytes, and iron status tests. Cortisol, ferritin, folate, and Vitamin B12 testing were performed on the Beckman DxI800; all other testing was on Roche Diagnostics Cobas 8000 chemistry (ISE, c701, c502) and immunoassay (e801) analyzers. Updated blood volumes for each assay were calculated utilizing manufacturer’s analytical volumes and “dead volume” requirements. Baseline data retrieved from the laboratory information system (LIS) included blood collection volumes and number of tubes collected for 128 patients with physician-orders for laboratory testing on 5/2/21. The collection logic was then updated in the test LIS environment using the new blood volumes requirements and applied to the same 128 orders. Blood volumes and number of tubes collected per order were compared before and after the volume updates. Results Baseline data from 128 unique orders showed that 414 total tubes were collected with a median(range) of 3 (2–6) tubes per order and 5 (1–18) tests per tube. The total volume of blood requested at baseline was 2065 mL. Post-intervention, 197 tubes were needed with a median(range) of 2 (1–3) tubes per order and 13 (1–30) tests per tube. The total volume of blood requested after updating volumes was 851 mL. Conclusions The practice of reviewing and updating specimen volume requirements when replacing or implementing new analyzers or TLA can greatly reduce the volume of blood collected from patients and the number of blood collection tubes per order. In this study of 128 physician orders for common laboratory tests, updating blood collection information in the LIS reduced the requested blood collection volumes by 59% and decreased the number of blood collection tubes required by 52%. This not only benefits patients because less blood is collected but also conserves blood collection tubes and reduces supply chain demands. Additionally, fewer tubes on the TLA system has the potential to improve throughput and test turnaround time.

Evidence for massage therapy (MT) in hospice patients remains limited. We conducted a prospective pilot study on MTs impact on quality of life of hospice patients and caregivers. Patient-caregiver dyads were enrolled if patients scored ≥5 on pain, depression, anxiety, or well-being using the revised Edmonton Symptom Assessment System Revised (ESAS-r). The patient received MT weekly for up to 3 massages with assessments completed at baseline, after each massage, and 1 week after the final massage for patients and at baseline and 1 week after final massage for caregivers. A satisfaction survey was completed at study completion. A pro-rated area under the curve (AUC) was utilized to assess the primary endpoints of change in ESAS-r for patient ratings of pain, depression and anxiety as well as the Linear Analogue Self-Assessment (LASA). Median difference scores (end of study value)-(baseline value) for each participant and caregiver were calculated. Of 27 patients and caregivers enrolled, 25 patients received MT. Fifteen patients completed all 3 MT sessions and were given the final symptom assessment and satisfaction survey and their caregivers completed final assessments. The proportion of patients considered success (AUC > baseline) in the primary endpoints were the following: pain 40.9%, depression 40.9%, anxiety 54.5%, LASA 54.5%. Median difference scores were largely zero indicating no significant temporal change in symptoms. Patients were highly satisfied with MT. This pilot study indicated that MT was a feasible and well-received intervention in our population of patients with inadequately controlled symptoms.