Article Analysis and Evaluation Article Review

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performed by a group of professionals that included: Dr. Xiao-Mei Li (Doctor of Philosophy in Nursing, Registered Nurse), dean and associate professor of the nursing department of Chinese university, Jiao tong University's College of Medicine; Kai-Na Zhou (Master of Science in Nursing, RN), assistant researcher in the same department; Professor Dr. Hong Yan (PhD), public health department of same university's College of Medicine; Yin-Ping Zhang (PhD RN), Associate Professor at the same department; and Professor Dr. Duo-Lao Wang (PhD) from Medical Statistics department, Faculty of Population Health and Epidemiology, London School of Hygiene and Tropical Medicine, UK. The randomized clinical study was titled "Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy." The Care, Cure and Core model of Hall was used. A clinical trial of 120 women suffering from breast cancer was conducted between March and November 2009, using randomized controlled research design. Half the patients (n=60) were allocated randomly to the experiment group, and were administered music therapy as well as regular nursing care, while the remaining half were allocated to the control population (n = 60) and were only administered regular nursing care. The aim of the research was: analysis and detailed reporting of a clinical trial on music therapy's impacts on anxiety among women afflicted with breast cancer, subsequent to radical mastectomy. The study found that music therapy positively affected anxiety- i.e., it reduced anxiety scores.

Problem, Study Purpose, Background and Significance

An alarming number of cases of the above form of cancer among women across the globe prompted this research. The disease, treated by conventional means (adjuvant therapies, surgery, etc.) can lead to acute psychological disorders in patients, the most commonly-occurring problem being anxiety. The chief objective of this research was analysis and detailed documentation of a clinical trial on music therapy's impacts on anxiety among female patients suffering from breast cancer subsequent to radical mastectomy.

Because of inadequate evidence on music therapy impacts, in-depth analysis was needed. In China, breast cancer incidence has risen by 37.6% in the last twenty years; average growth rate per annum is 13%. Music therapy used as adjuvant, has been widely utilized in the reduction of anxiety among different types of patients. However, according to the article, there exists negligible information on music therapy's impacts on anxiety among female patients suffering from breast cancer subsequent to radical mastectomy. For tackling the anxiety issue, music therapy is employed in the care of cancer patients. It addresses their psychological as well as physical needs that arise from radiation, chemotherapy, and the disease itself. The AMTA (American Music Therapy Association) (2005) has provided the following definition for music therapy:

Music therapy denotes the evidence-based and clinical application of music to accomplishing individualized objectives in therapeutic relationships by any credentialed professional in the field in an approved course in music therapy.

The therapy will help improve, prevent, maintain, or remediate a minimum of one clinical issue(s) among patients, as stated in their rehabilitation/habilitation needs. In diverse nursing care contexts, music therapy may be administered by professional therapists as well as by unpaid caregivers, performing musicians, and volunteers.

Even in case of non-availability of music therapists, the concept of music in care has been advocated as a procedure of the nursing profession.

Hypothesis

This research follows the following contention: experimental group patients will exhibit reduced anxiety scores compared to control group patients, subsequent to music therapy administration (to the former group). Effect of treatment differs for different follow-up times. In other words, an interactional effect exists between follow-up time and treatment/experimental group. The Researchers used a standardized questionnaire for collecting demographic information, and crucial information for research purposes was gleaned using the SAI (State Anxiety Inventory). The main endpoint was: state anxiety scores at the pre-test stage (i.e., one day prior to radical mastectomy treatment) and at a total of 3 post-tests (i.e., one day prior to discharge from the hospital, and the 2nd and 3rd time hospitalization for chemotherapy).

Literature Review

Research on music therapy's impacts on patients afflicted with cancer, with different diagnoses, has demonstrated several benefits. A widely-utilized way to implement music therapy -- making patients listen to calming music -- has proved successful in increasing patient relaxation and comfort, alleviating pain (self-reported pain), decreasing vomiting and nausea, and reducing treatment-linked distress and anxiety.

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Other similar researches have also proven that such therapy using music effectively evokes positive memories and emotions; expands consciousness; improves psychological health; decreases psychological symptoms like fear, anxiety, worry, diastolic blood pressure, and fatigue; and improves moods, sleep, self-image, and QOL (quality of life) in the course of treatment (Bruscia et al., 2009, De Niet et al., 2009).

At present, breast cancer is growing rapidly and widely observed in all parts of the world. Global statistics reveal that yearly breast cancer incidence is increasing even among nations that showed low incidence (Vahdaninia et al., 2010) earlier. Information from industrialized nations reveals that one out of every eight females is prone to the disease, which constitutes one among the major causes of deaths from cancer among females aged 35 to 50 years old (Puig et al., 2006, Avci and Gozum 2009). In the year 1972, 532 new breast cancer cases were recorded (standardized incidence per 100,000 individuals was between 18 and 90), making up 9.7% of all abnormal growths to the body and ranking third. In the year 1999, 1651 new cases were recorded (standardized incidence per 100,000 individuals was 52 to 98) and the disease ranked first among tumors. As of 2007, standardized incidence per 100,000 persons grew to 81) (Wu and Dong, 2009).

Music therapy's effectiveness in delivering previously-mentioned benefits has been verified by patients; outcomes are well-documented (Clark et al., 2006, Li et al., 2007, Jin et al., 2008, Lv et al., 2008, Wan et al., 2009). Nevertheless, not many nursing researches have been conducted on music therapy application among women with breast cancer, subsequent to radical mastectomy treatment. Literature findings indicate that the disease is prevalent in China and exhibits a rapid rise among age-specific groups of females. Additionally, patients suffered high anxiety -- this constituted a common issue among patients. While prior research works have depicted that such therapy has proven valuable in reducing anxiety among cancer patients, the randomized control trial under study will offer additional proof of music therapy's impacts on female patients' state anxiety after radical mastectomy.

Primary breast-cancer treatment modality is surgery along with other adjuvants like hormonal therapy, chemotherapy, and radiotherapy. Such advanced cancer therapies are, however, aggressive and increase patient exposure to side effects of treatment. Women suffering from breast cancer (particularly those treated with radical mastectomy) face indispensable stresses in their lifetime, including a blow to their body-image due to loss of a breast. This can result in them enduring and being subject to the negative effects of resultant unhealthy moods. Disease and treatment-linked symptoms constitute key contributors to stress among women being treated for breast cancer. Of all symptoms, anxiety represents the most dominant psychological symptom noticed among people diagnosed with breast cancer, with 21.1-29% prevalence in countries other than China (So et al., 2010) and 50-86.4% in China (Gao et al., 2006, Wang and Yan, 2007, Chen et al., 2009).

Percentage of in-text citations in literature review published during the past five years.

Total in texts = 30

Those published in the last five years = 14

Variables

Demographic variables

Mean ages for control and experimental groups were 45.13 (9.48) years and 44.88 (9.37) years respectively. Most patients were employed [28.3% (control group) and 30.0% (experimental group)], had completed high school [45% (control group) and 28.3% (experimental group)], and resided in urban localities [76.7% (control group) and 71.7% (experimental group)]. With regard to monthly income, 58.3% (control group) and 53.3% (experimental group) patients earned a moderate monthly income of 1000 to 3000 RMB (Chinese Yuan Renminbi) a month. Most patients indicated they were married [85.0% (control group) and 91.7% (experimental group)], while 40.4% (control group) and 56.4% (experimental group) indicated their relationships with their spouse 'improved'. Most patients had a child [60.0% (control group) and 58.3% (experimental group)]; best 'parent-child' relationships were reported by 79.3% (control group) and 81.4% (experimental group) of patients. Also, most patients were administered Modified Radical Mastectomy [91.7% (control group) and 95.0% (experimental group)], while 83.3% (control group) and 93.3% (experimental group) received chemotherapy soon after surgical treatment. 56.7% (control group) and 60 per cent (experimental group) patients were first-time patients of breast cancer; mean age for experimental and control groups was roughly 42 years.

Music therapy was used as independent variable, whereas anxiety state among females with breast.....

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