The overarching purpose of this study was to explore the thoughts and attitudes of hospice chaplains and music therapists (MTs) related to the questions, "Is it appropriate for music therapists to provide spiritual care as part of the hospice team," "What kind of training and preparation do music therapists and chaplains think hospice music therapists should have before engaging in spiritual care work," and "What should the content be of spiritual care training for music therapists?" The study used a sequential exploratory qualitative/quantitative mixed methods design utilizing parallel purposive subject samples to examine the research questions.
The first phase of the study included semi-structured interviews with eight music therapists and seven chaplains specializing in hospice care. These interviews were designed to collect in-depth information about the research questions. Each interview was recorded, transcribed, and analyzed using open coding within a grounded theory approach. Thematic analysis revealed the prevalence of the categories of "ethics" and "training." Participants discussed issues related to scope of practice, cultural competence, maintaining personal boundaries, educational content, and educational methods. Analysis of the data information also indicated the need to expand the research questions, which were examined with larger participant samples in the second phase of the study.
Phase II of the study included the development and implementation of a survey tool to explore the results of Phase I with a larger group of participants. The following questions were used as the basis for the survey tool: 1) How appropriate do chaplains and music therapists feel it is for music therapists to provide spiritual care as part of the hospice team? 2) What is the scope of practice for music therapists with regards to providing spiritual care as part of the hospice team? 3) How important are specific aspects of cultural competence in providing ethically sound spiritual care to hospice patients? 4) How do music therapists' music selections for addressing spiritual goals reflect culturally competent practice? 5) What are the personal boundaries that should be maintained by music therapists in order to provide ethically sound spiritual care? 6) How do music therapists feel their personal spiritual beliefs influence their interactions with patients? 7) What types of previous spiritual care training do music therapists report completing? 8) What training topics do music therapists and chaplains feel music therapists should study in order to provide competent spiritual care? 9) What types of training methods do music therapists and chaplains think are most appropriate for music therapists wanting to learn more about spiritual care? 10) What, if any, differences exist between chaplains' and music therapists' responses to these research questions?
A final sample of music therapists (n=48) and chaplains (n=44) completed the survey. Results indicated that the role of music therapists includes providing spiritual care as part of the hospice team.
The spiritual care scope of practice for music therapists identified by survey participants included assisting with spiritual practices, experiencing God or a higher power, assisting with meditative practices, and assisting with guided imagery experiences. According to participants, music therapists should not lead religious rituals or ceremonies, nor should they conduct spiritual assessments. Music therapists felt that all aspects of cultural competence mentioned in the survey were important, especially selecting interventions that are reflective of patients' cultural and spiritual backgrounds. This was also reflected in the ways music therapists wrote about selecting music for use in addressing spiritual goals.
Participants identified specific personal boundaries that should be maintained when providing spiritual care, including avoiding pushing one's personal beliefs onto a patient or family. Music therapists expressed a variety of opinions about how their personal beliefs affected their interactions with patients. These varied from "not at all" to "allows me to be open to others." Music therapists and chaplains expressed similarly varied responses to a question about the wearing of religious symbols when providing hospice services.
Questions about spiritual care training methods and content revealed that music therapists were more likely to engage in on-the-job learning, or attend continuing education and conference presentations about spiritual care. Music therapists and chaplains also wrote about learning from patients, participating in group feedback sessions, and reading materials about spiritual care as ways to learn about spiritual care provision.
Differences were seen between music therapists and chaplains on their understanding of the concept of "spirituality" and "spiritual care." There were also differences between the two groups on questions of the importance of knowing one's own background as a component of cultural competence, as well as the appropriateness of music therapists providing spiritual care/counseling.