Music Intervention for Preoperative Anxiety and Acute Pain Among Mastectomy Patients

Music intervention (MI) is considered useful for anxiety and pain management in various surgical populations. It is a mind-body therapy that is expressive and requires interpersonal processes which could be active or passive. In MI, a combination of the emotional, physical, social, mental, spiritual, and aesthetic aspects of music are used to maintain and improve the client's health condition. MI achieves its analgesic effects by acting on mu-opiate receptors, morphine-6-glucuronide and the level of interleukin-6. It could also compete with other peripheral nerve stimuli such as pain transmission to the brain via the spinal cord. MI also enacts a powerful and subtle psychological effect on people because it is rooted in their emotional lives. The psychological effect is rooted in the entrainment to the rhythm of the music which causes alteration of the neuron activities in the lateral temporal lobe. A systematic review of literature conducted revealed that MI has been employed both in the preoperative phase for the management of anxiety and in the postoperative phase for the management of postoperative pain in breast cancer patients undergoing surgery. All the studies included in the systematic review used music that is culture-specific and face-to-face mode of delivery. None of the studies used theory-driven approach in their intervention development nor considered both preoperative and postoperative patient outcomes together. Sequel to the recent global pandemic, many healthcare facilities are restricting access to patients in clinical settings creating limitations for music therapy interventions that rely on only face-to-face mode of delivery. Therefore, the delivery of music therapy via hybrid mode becomes an area worthy of research. As with the traditional delivery mode, the cultural context and the use of theory-driven intervention are considerations to be made when developing the intervention. In order to develop a theory-driven and culture-specific intervention, the Symptom Management Model (SMM) will be adopted in this study. SMM was selected based on the review of other literature on MI and considering the relatedness of components of MT and the components of the SMM. Theoretical framework underpinning MI As stated previously, the SMM could underpin the MI in this study. The model was firstly developed by the School of Nursing symptom management faculty group of the University of California, San Francisco, and further revised. It has three domains which are symptom experience, symptom management strategy and symptom outcomes. The domains are dependent on the nursing concepts of person, environment, and health and illness. The symptom is described as a subjective experience that evinces a patient's biopsychosocial functioning, cognition, and sensation. Symptom perception, evaluation and response to symptoms are the concepts indicated in the symptom experience domain. The symptom experience domain is directly influenced by risk factors or disease or injury and health status. For mastectomy patients, pain is usually influenced by the type of mastectomy and its extensiveness. However, the type of mastectomy to be done is dependent on the stage of cancer, the possibility of the patient undergoing radiotherapy, and the intended aesthetic result. The symptom management strategy domain is considered as a dynamic domain that aims at slowing down or averting negative outcomes using either professional, self-care, or biomedical strategies. MI is a type of intervention that can be used by both healthcare professionals and patients as an adjunct to pharmacological therapy for pain management. The components of the symptom management strategy include who delivers the intervention, what, how, when, why, where, and how much of the intervention is to be delivered. These are similar to the standards for reporting music intervention which includes consideration for the expertise, duration, frequency, dosage, mode of delivery and environment for the intervention to be delivered. Finally, the symptom outcomes domain according to the SMM includes the effects of the intervention on the symptom status (pain intensity and analgesic consumption), functional status (vital signs), mood/emotional status (anxiety), and satisfaction with care. The SMM stresses that symptom experience assessment and adherence to the symptom management strategy will influence the outcomes achieved. Since pain is multidimensional, the amenability of each dimension to change by MI varies. In relation to the findings that the cultural context in which MI will be implemented is crucial to the acceptance and effectiveness of the intervention and that symptom outcome in the SMM model in relation to MI for pain management can include symptom status (pain intensity and analgesic consumption), functional status (vital signs), mood/emotional states (anxiety), and satisfaction with care. To the best of our knowledge, an hybrid mode of delivering music intervention to women undergoing mastectomy has never been used to address postoperative pain. Given the strong relationship between music and pain, we hypothesize that the hybrid-mode delivered music therapy will reduce the preoperative anxiety, postoperative pain intensity, vital signs as well as improve satisfaction with pain management of women undergoing mastectomy. Therefore, this study aims to test the feasibility and evaluate the effectiveness of hybrid-mode delivered MI on preoperative anxiety, and acute postoperative pain, vital signs, analgesic consumption, and satisfaction with pain management among African women undergoing mastectomy. Objectives of the study The objectives of the study are to: i) test the feasibility of implementing the MI intervention in clinical settings in Africa ii) Estimate the effects of MI on preoperative anxiety, acute postoperative pain, vital signs, analgesic consumption, and satisfaction with pain management among African women with breast cancer undergoing mastectomy