Professor Joanne Reid

1. Bridging the gap between qualitative and quantitative research: A randomised controlled pilot and feasibility study of the effectiveness of music therapy in improving the quality of life of palliative care patients. Professor Joanne Reid

2. Introductions • who you are, • where you are from, • how comfortable are you using both qualitative and quantitative research methods (very, somewhat, not at all)?

3. Qualitative and quantitative research – key differences • The obvious difference – numerical v. textual data; numbers v. words

4. Why use both qualitative and quantitative research methods? • You have a question that has rarely been asked or has been asked with questionable results • You want the strength of multiple methods - triangulation • Some, and only some, of your variables are easily quantifiable at this stage of inquiry • To “illuminate the black box” of relationships defined only in statistical terms • To hear from those who are rarely reached effectively by typical quantitative approaches

5. How to combine qualitative and quantitative research methods • Multi-methods research • E.g. more than one qualitative method • Mixed – methods research • Both qualitative and quantitative methods of data collection and analysis • MRC guidance 2008 included a process evaluation

7. Case study: A randomised controlled pilot and feasibility study of the effectiveness of music therapy in improving the quality of life of palliative care patients: J.Reid,1 T.McConnell,1 M.Clarke,4. L.Graham,2 M.McKeown,2 J.Regan,2 K.McGrillen,2 J.Leitch,2 N.Hughes,3 & J.Kirkwood,3S.Porter 5 1 School of Nursing and Midwifery, Queen’s University Belfast 2 Marie Curie Hospice Belfast 3 Every Day Harmony Music Therapy 4 School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast. 5 Social Sciences and Social Work, Bournemouth University

8. What is music therapy? https://www.youtube.com/watch?v=1NF73a9lPJY

9. Music therapy • Use of music and sounds to facilitate the development of a relationship between patients and professionally trained therapists with the aim of supporting relaxation and improving both physical and emotional well-being • Used in palliative care for more than a decade

10. Background • Anecdotal evidence strongly supports music therapy as a palliative therapy, with the primary aim of improving people’s quality of life ……..However the evidence base is weak …….Research challenging in this area

11. Study aims • Aim – the feasibility of conducting a phase III pragmatic RCT • Primary objectives • Outcome measures • Intervention duration • Recruitment and attrition rates • Secondary objectives • Indicative outcomes related to Quality of life • Inter-familial communication (data not available until results unlocked)

12. Method • UK-based, single-centre, pilot RCT • Two parallel arms (randomised 1:1) • Participants (n>52) 18-bed specialist palliative care inpatient unit in Northern Ireland • Eligibility criteria - ECOG≤ 3, AMT≥ 7 • McGill Quality of Life Questionnaire (MQOL), and socio-demographic data. • Baseline (before randomisation), one, three and five-week follow-up • Qualitative data collection – patients and focus groups HCPs to examine impact and context

13. Analysis • MQoL questionnaire - evaluated at each data collection point - feedback on the questionnaire’s appropriateness and level of burden • The viability of delivering a 3-week music therapy intervention - assessed by the number of patients completing the intervention and reasons for attrition • Recruitment and attrition figures - power calculation for definitive RCT • The potential effectiveness of music therapy- change in the outcome variables from baseline • Qualitative methods, in particular interviews and focus groups, will be used to assess impact, interfamilial communication and contextual factors

14. Intervention Format • Individual, inpatient unit setting • 2 x › 45 minute sessions, for 3 consecutive weeks, in addition to care as usual • Family may be present Delivery • Delivered by an HCPC certified music therapist • Involving live and recorded music • ‘Receptive’ and ‘recreative’ Content • A standardised yet tailored intervention • May include song composition, life review, active music making, listening to familiar music, creating legacy recordings

15. Quantitative results • Recruited our target sample • Determined the viability of the intervention delivery period • Ascertained the acceptability of the QoL measure (content and level of burden) • Clarified the primary end point for data collection • Potential effectiveness - most notably, improvement in psychological and existential well-being sub-measures of MQoL

16. Practitioner perspective • One of our patients, he never would have spoken about feelings and stuff, and he composed a whole song for his wife and literally handed her the CD and was like “Listen to that on the way home”, and she was just like “That’s the nicest thing you’ve ever done for me”, and it was all about her, so it was lovely. (AHP 5)

17. Family perspective • Was a bright spark in a dark environment. A wonderful experience. Great comfort to see XX having fun. (Husband) • Helped to see mum happy and having good time. (Daughter and son)

18. Patient perspective • Music therapy helped • Joy to have lovely girl come in and we bonded through the music • Was amazing - the relationship, got on so well • Something to look forward to • I chose the music – uplifting • Overwhelming how this girl was sent to us • It was a wonderful experience. Never would’ve dreamt it could be so wonderful

19. Group work • What are the challenges and advantages of combining qualitative and quantitative research methods? • Example • Challenges • Need to have expertise in both qualitative and quantitative research • Advantages • Can explore aspects of the topic quantitative tool can’t get to

20. Email: j.reid@qub.ac.uk • Webpage – MusiQual