Table 1 Main study summary table

Baker et al. (2012) [64], Australia

Mixed-methods pilot study:

Quasi-experimental (one-group, no control, pre-test and post-test design without randomisation)

Qualitative (carers kept diary, interviewed post-program, thematic analysis)

Spouse carers (n=5)

Age range: 59-81

Gender: 3 female, 2 male

Individuals with dementia living at home

Early-late stage dementia

Delivered at pre-bereavement, intervention directed primarily at patient

Home-based Active Music Intervention (delivered by carer to patient)

None

GDS-SF (Depression)

GAI (Anxiety)

MCBS (mutual communal behaviours)

PACQ (positive aspects of caregiving)

Descriptive statistics only, outcome measures administered before and directly after intervention.

GDS-SF: small increase in depression from pre-test (M=5.6, SD=1.82) to post-test (M= 6.2, SD=1.64). ^*Small effect size (0.35).

GAI: moderate decrease in anxiety from pre-test (M=6.0, SD=7.55) to post-test (M=3.0, SD= 2.74). ^*Medium effect size (0.53).

MCBS: small increase in mutual communal behaviours from pre-test (M= 37.6, SD=1.82) to post-test (M=38.4, SD=1.67). ^* Small effect size (0.46).

PACQ: small increase in satisfaction from pre-test (M=41.8, SD=5.26) to post-test (M=43.0, SD=4.3). ^*Small effect size (0.25).

Qualitative:

Thematic analysis indicated that intervention beneficial to relationship, satisfaction with caregiving, and wellbeing, and enhanced mood of carer and patient.

Baker & Yeates (2018) [69], Australia

Qualitative study (semi-structured individual interviews and focus group, Interpretative Phenomenological Analysis (IPA))

Family carers (n=4)

Age not provided

Gender: 2 female, 2 male

Individuals with dementia living at home and receiving care at a dementia day centre

Early-late stage dementia

Delivered to carers who were pre-bereaved (n=3) and post-bereaved (n=1), directed only to carers

Group Therapeutic Songwriting Intervention

N/A

N/A

Five recurring themes emerged, with all but one theme being shared by all participants: Theme 1: experience exceeded expectations, Theme 2: co-creating a song is meaningful, Theme 3: the song product is meaningful, Theme 4: learning through the songwriting experience, Theme 5: having a voice and being heard

Baker et al. (2018) [71], Australia

Mixed-methods feasibility pilot study:

Quasi-experimental (controlled trial with experimental and control groups, but without randomisation, pre-test/post-test)

Qualitative (focus groups and semi-structured interview, thematic analysis)

Family carers (n=14)

Age range: 61-85

Gender: 9 female, 5 male

Individuals with dementia living at home and receiving care at a dementia day centre

Stage not specified

Delivered at pre-bereavement, directed only to carers

Group Therapeutic Songwriting Intervention

Standard care (n=6)

PHQ-9 (Depression)

QCPR (Quality of the Carer Patient Relationship)

PACQ (Positive

Aspect of Caregiving)

Feasibility pilot study, so findings are estimates of an effect. Outcome measures administered before intervention and directly after intervention.

PHQ-9: Moderate decrease was observed for the pre-post depression scores for the intervention group, medium effect size (0.64). Small increase observed for the pre-post depression scores on the PHQ-9 for control group, small effect size (0.33).

QCPR: Minimal increase observed for quality of carer patient relationship in intervention group, ^*small effect size (0.14). Moderate increase observed for quality of carer patient relationship in control group, ^*medium effect size (d=0.57).

PACQ: Small decrease observed for positive aspects of caregiving in intervention group, ^*small effect size (0.24). Minimal decrease observed for positive aspects of caregiving for control group, ^*small effect size (0.18).

Qualitative:

Theme 1. Sharing the Whole Carer Journey: From Woe to Go, Theme 2. We’re Singing the Same Tune: Finding Connections, Theme 3. Gaining Clarity Around the Carer Journey: Discovering We’ve Already Found a Way Through,

Theme 4. We All Fit Under the Same

Umbrella but We’re Miles Apart: Developing a Group Identity, Theme 5. We Can Stand Up for Ourselves, We’ve Got Stronger: Fostering Inner Strength And Personal Growth, Theme 6. Songwriting Groups Fill a Gap Not Met by Other Support Groups

Black et al. (2020) [67], Canada

Qualitative study (semi-structured individual interviews, audio-recorded music therapy sessions, music therapist researcher’s reflective phenomenological writing and field notes. Framework of interpretive-descriptive hermeneutic phenomenology)

Friend or family carers (n=8)

Age range: 53-86

Gender: 6 female, 1 male, 1 unknown

Individuals with advanced cancer who have requested medical assistance in dying, setting is hospital or hospice

Delivered at pre-bereavement, and primarily to patient but with carer present

Music Therapy (one-to-one sessions)

N/A

N/A

Theme 1: Immediacy of emotion (access to emotion through music): Music creates a holding space that allows for immediate access to emotion. Music connects to emotional content with immediacy. Theme 2: Reflection (on personal narratives (and pivotal life moments with their loved one, or anticipatory grief) within the music): Music invites a retrospective reflection into the carer’s experiences. A contextual reflection

period is created (within the music).

Theme 3: Witnessing (emotional and narrative expression): Witnessing patient’s experiences through the lens of music. Interconnectedness between patient narratives and carer

narratives. Theme 4: Unexpected opportunities (for life review through music): opportunity to express

unexplored/ unarticulated emotion

Brotons & Marti (2003) [72], Spain

Pilot study:

Quasi-experimental (one-group, no control, pre-test and post-test design without randomisation)

Spouse carers (n=14)

Mean age: 73.17 (SD =6.1)

Gender: 9 female, 5 male

Individuals with dementia living at home

Early-moderate stage dementia

Delivered at pre-bereavement, with patient only group sessions, patient-carer dyad group sessions and carer only group sessions

Group Music Therapy

None

CBQ (Carer Burden)

STAI (Anxiety)

BDI (Depression)

Satisfaction Questionnaire (developed by authors to measure satisfaction)

Outcome measures administered before intervention, directly after intervention and 2-month follow-up.

CBQ: Significant decrease in carer burden between baseline, post-test and 2-month follow-up (p=.01).

STAI: Significant decrease in carer anxiety between baseline, post-test and 2-month follow-up (p=.001).

BDI: Significant decrease in carer depression between baseline, post-test and 2-month follow-up (p=.009).

SQ: carers perceived improvement in social and emotional areas of their patients. All agreed intervention was positive because it helped them to relax. 66.7% added that it offered a pleasant and enjoyable space where they could share and feelings they had not been able to express before.

Choi et al. (2009) [57], South Korea

Pilot study:

Quasi-experimental (controlled trial with experimental and control groups, but without randomisation)

Carers (n=20)

Age not provided

Gender not provided

Individuals with dementia attending a day care unit

Moderate stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Active group music intervention

Standard care, no structured therapeutic programs (n=10)

Offered complementary music-intervention

program after study.

NPI-Q (Carer Distress)

Outcome measures administered before intervention and directly after intervention

NPI-Q: Significant difference between carer total distress score between intervention and control group (p=.003). ^*Large effect size (2.21).

Clark et al. (2018) [73], Australia

Qualitative study (semi-structured interviews, thematic analysis)

Family carers (n=12)

Mean age: 75.7 (SD=10)

Gender: 5 female, 4 male

Individuals with dementia living at home with family carer

Early-moderate stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Group Therapeutic singing

N/A

N/A

Theme 1: Therapeutic Facilitation and Design. Intervention included supportive therapeutic features that enhanced participants’ experiences

Theme 2: Accessibility. Therapeutic

Singing Group Made Singing More

Accessible for IWD and Their FC

Theme 3: Empathic Friendship.

Therapeutic group singing fostered

New supportive friendships for IWD and FC

Theme 4: IWD/FC Relationship.

Therapeutic group singing supported

Relationships between IWD and FC

Theme 5: Personal Wellbeing.

Therapeutic Group Singing Led to

Positive Individual Experiences for IWD and FC

Clark et al. (2020) [74], Australia

Mixed-methods feasibility study:

Quasi-experimental (one-group, no control, pre-test and post-test design without randomisation)

Qualitative (survey and semi-structured interviews. IPA)

Family carers (n=14)

Mean age: 67.1 (SD=10.1)

Gender: 9 female, 5 male

Individuals with dementia living at home or in care home

Early-late stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Group Therapeutic Songwriting

None

QCPR (Quality of the Carer–Patient Relationship)

PHQ-9 (Depression)

ZBI (Carer Burden)

Feasibility study, so findings are estimates of an effect. Outcome measures administered before intervention and within 2 weeks post-intervention.

QCPR: No statistically significant differences for relationship quality, ^*minimal effect size observed for increases in relationship quality (0.07).

PHQ-9: No statistically significant differences for depression, small effect size observed for decreases in depression (0.20).

ZBI: No statistically significant differences for carer burden, small effect sizes observed for decreases in perceived burden (0.45).

Qualitative:

Qualitative data indicated that session design and delivery were acceptable, and TSW was a positive shared experience with personal benefits, which supported rather than changed relationship quality.

Clark et al. (2021) [75], Australia

Qualitative study (semi-structured dyadic interviews, IPA)

Family carers (n=10)

Mean age: 70, (SD=9.8)

Gender: 6 female, 4 male

Individuals with dementia living at home or in care home

Mixed dementia stages implied

Delivered at pre-bereavement, patient-carer dyad targeted

Group Therapeutic Song Writing

N/A

N/A

Theme 1. Group TSW was an overwhelmingly positive shared experience, benefiting both members of the dyad and motivating further engagement with music.

Theme 2. TSW was engaging and valuable as it stimulated mental

processes and reignited participants’ interests, skills and memories.Theme 3. TSW provided meaningful opportunities for reflection and connection with memories and life

experiences.

Theme 4. TSW prompted interaction and collaboration, leading to social connections, empathic relationships and experiences of

inclusion

Theme 5. Group TSW included diverse challenges, however, the facilitated process supported participants to engage, highlighting abilities and challenging doubts

Dassa et al. (2020) [56], Israel

Qualitative study (case study design.

Audiotaped phone counselling sessions with carer. Questions asked at end of sessions. Researcher’s log. Cresswell (2007) used for analysing case studies)

Spouse carers (n=2)

Age range: 62-75

Gender: 2 female

Individuals with Alzheimer’s dementia

Early-moderate stage dementia

Delivered at pre-bereavement, patients-carer dyad targeted

Home based music therapy

N/A

N/A

Singing helped the individual with dementia to revive forgotten roles.

Singing assisted the spouse in her role as primary carer.

Singing improved the couple’s relationship

Denk et al. (2022) [62], USA

Mixed-methods pilot study:

Quasi-experimental (one-group, no control, pre-test and post-test design without randomisation)

Qualitative study (focus group discussion one week after final music therapy support group session)

Family carers (n=4)

Mean age: 62.5 (SD=14.15)

Gender: 4 female

Individuals with Parkinson’s disease or dementia

Stage not specified

Delivered at pre-bereavement, directed only to carers

Music therapy support group sessions

None

Three visual analog scales (perceived stress, anxiety, and depression)

Outcome measures administered immediately before and after each session. Descriptive statistics only.

Stress: mean score pre-session M=4.6 (SD=2.8) decreased to post-session M= 2.0 (SD=1.5)

Anxiety: mean score pre-session M= 36 (SD=1.9) decreased to post-session mean: 0.8 (SD=1.1)

Depression: mean score pre-session M= 1.6 (SD=1.6) decreased to post-session M= 0.3 (SD=0.3)

Qualitative:

Focus group yielded 2 themes: receiving support from group members, and personal support strategies employed outside of the music therapy support group sessions

Gallagher et al. (2017) [60], USA

Quasi-experimental study (one-group, no control, pre-test and post-test design without randomisation)

Family carers (n=50)

Age not reported

Gender not reported

Individuals receiving end-of-life services in hospice (nursing home or inpatient hospice care facility) or palliative medicine (inpatient palliative medicine unit)

Diagnosis not specified

Delivered at pre-bereavement, patient-carer dyad targeted

Music Therapy (one-to-one sessions)

None

Music therapy family survey (developed by authors to measure benefits of music therapy for patient and carer)

Outcome measures administered post-intervention.

Descriptive statistics only.

Family member perceptions were positive - no family members indicated that any scale got worse.

83% of family members perceived self-improvement for quality of life, 92% for mood, 94% for stress/distress; and 84% considered the music therapy experience to be extremely helpful. 49 out of 50 family members would recommend another music therapy session for the patient, and one did not respond.

García-Valverde et al. (2020) [76], Spain

Quasi-experimental study (one-group, no control, pre-test and post-test design without randomisation)

Family carers (n=31)

Age range: 44-87

Gender: 24 female, 7 male

Individuals with dementia using a dementia centre

Stage not specified

Delivered at pre-bereavement, patient-carer dyad targeted

Group songwriting program

None

SF-36v2 (perceived health status)

BDI-II (Depression)

STAI (Anxiety)

RSS (Self-esteem)

Outcome measures administered at baseline and post-intervention.

SF-36v2 – the mean score on the post-test Mental Component Summary was significantly higher compared to baseline (p=.02) with a medium effect size (0.57). The mean score on the post-test Mental Health dimension was also significantly higher compared to baseline (p=.004) with a medium effect size (0.70). There was no significant change across any other dimensions, all reporting small effect sizes (0.00-0.31).

BDI-II: the mean score on the post-test BDI-II was significantly higher compared to baseline (p=.01), with a medium effect size (0.57).

STAI: the mean score on the post-test STAI was significantly higher compared to baseline (p=.04), with a medium effect size (0.53).

RSS: the mean score on RSS was significantly higher in the post-test measure than at baseline (p=.03), with a medium effect size (0.47)

Garcia-Valverde et al. (2022) [77], Spain

Qualitative study (open-question questionnaires, focus group, the last session

video, and lyrics of three songs composed, inductive thematic analysis)

Family carers (n=31)

Mean age: 63.87 (SD=13.62)

Gender: 24 female, 7 male

Individuals with dementia (n=21), including 14 patients staying in temporary residential respite care facility

Stage not specified

Delivered at pre-bereavement, carers targeted

Group therapeutic songwriting program

N/A

N/A

Four themes: (1) GTSW generates a sense of connection, (2) it is a motivating, empowering, and meaningful experience, (3) it promotes emotional connection in a personal space, and (4) it increases wellbeing. Qualitative findings suggest that GTSW is a therapeutic tool that promotes carers’ connectivity, expression of emotions, and wellbeing.

Hanser et al. (2011) [65], USA

Feasibility study:

Quasi-experimental (one-group time series design without randomisation)

Family carers (n=8)

Age range: ≤65-≥85

Gender: 5 female, 3 male

Individuals with dementia, living at home

Moderate-late stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Music-facilitated stress reduction program (delivered by carer to patient)

None

Visual analogue scale- relaxation, comfort and happiness

CSS (Carer satisfaction)

Outcome measures administered immediately before and after each session

Relaxation- statistically significant improvement for most sessions (p<.01 – p<.02).

Comfort – statistically significant improvement for most sessions (p<.01 – p<.02).

Happiness- statistically significant improvement for most sessions (p<.01 – p<.02).

CSS- decrease but no statistically significant change over time.

Holden et al. (2019) [78], USA

Pilot study:

Quasi-experimental (one-group, no control, pre-test and post-test design without randomisation)

Family carers (n=18)

Age not reported

Gender not reported

Individuals with dementia, living at home, attending memory/movement disorder clinic or neuropalliative and supportive care clinic

Early-late stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Home-based Neurologic music therapy (one-to-one-sessions)

None

RSCSE (Carer self-efficacy)

ZBI (Carer burden)

Outcome measures administered at baseline, directly after intervention, and at 6-week follow-up.

RSCSE: non-significant increase in carer self-efficacy from baseline to 6 weeks (p=.39) with small effect size (0.43), and from baseline to 12 weeks (p=.055) with large effect size (0.92).

ZBI: non-significant decrease in carer burden from baseline to 6 weeks (p=.50) with large effect size (1.67), and from baseline to 12 weeks (p=.45) with large effect size (1.62).

Kim & Dvorak (2018) [58], South Korea

Randomised Controlled Trial (cross-over design, AB-BA)

Family carers (n=10)

Age range: 42-69

Gender: 8 female, 2 male

Individuals receiving end-of-life care in hospice

Diagnosis not specified

Delivered at pre-bereavement, patient-carer dyad targeted

Music Therapy (one-to-one sessions)

Chaplaincy (one-to-one sessions) (n=10)

FIOS (Family Intimacy)

Outcome measures administered during sessions (observation of behaviour in video-recordings).

FIOS verbal intimacy scores between music therapy and chaplaincy sessions were significantly different (p=.74). One specific behavior of “verbally letting go of patient” was statistically significant (p<.015) with a large effect size (r=−.540), indicating higher verbal intimacy with music therapy.

FIOS affective intimacy scores between music therapy and the chaplaincy were significantly different (p<.005) with a large effect size (r=−.627), indicating higher affective intimacy with music therapy.

FIOS physical intimacy scores between music therapy and chaplaincy were statistically significant (p<.005) with a large effect size (r=−.627), indicating higher physical intimacy with music therapy.

Klein & Silverman (2012) [79], USA

Qualitative study (linguistic enquiry and word count -written survey)

Family carers (n=14)

Age range: 19-75

Gender: not reported

Individuals with Alzheimer’s and other dementias, attending a family-centred care programme

Stage not specified

Delivered at pre-bereavement to carers and patients

Music therapy (MT) songwriting intervention

Psychoeducational intervention (PI)

N/A

Eight key themes identified, number of comments for each condition included in brackets: distraction from stress (MT: n=2, PI, n=2); reiteration of subject matter (MT: n=2, PI, n=2); fun (MT: n=3, PI, n=0); group cohesiveness and camaraderie (MT: n=1, PI, n=2); therapeutic insight and generalisation (MT: n=3, PI, n=4); appreciation (MT: n=2, PI, n=0); comment on presentation (MT: n=7, PI, n=3); and left blank (MT: n=2, PI, n=6)

Linguistic Inquiry and Word Count Results

Big words (>six letters) (MT: 18.50, PI: 16.89), Positive emotions (MT: 12.00, PI: 8.89), Overall cognitive words (MT: 8.50, PI: 7.56), Articles (a, an, the) (MT: 5.50, PI: 4.00), Self-references (I, me, my) MT: 4.50, PI: 4.89), Social words (MT: 4.00, PI: 7.56), Negative emotions (MT: 0.50, PI: 0.44), Total words (MT: 200, PI: 225)

Lee et al. (2022) [80], Ireland

Qualitative study (semi-structured interviews, IPA)

Family carers

(n=4)

Age range: 30-79

Gender: 3 female, 1 male

Individuals with dementia, living at home

Early-stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Community-based live group singing intervention

N/A

N/A

IPA revealed four superordinate themes: (1) Social Connection; (2) Happiness and Rejuvenation; (3) Reconnection with the Self; and (4) Supporting the Carer–Cared-for Relationship.

Madsø et al. (2022) [66], Norway

Quasi-experimental study (bi-phasic AB single-case design, replicated for three sessions)

Family carers (n=10)

Age not reported

Gender not reported

Individuals with dementia, living at home

Early-late stage dementia

Delivered at pre-bereavement to patients (family carers considered as collateral therapists participating in therapy to support patient, rather than being recipients of therapy themselves – but includes outcomes for carers)

Active music therapy intervention

None

RSS (Carer burden)

Outcome measure administered at baseline and directly after intervention.

RSS: No significant change from pre- to post-intervention (p=0.674)

Magill (2009a) [81], USA

Qualitative study (semi-structured interviews, field notes and researcher journal entries. Naturalistic enquiry)

Family carers (n=7)

Age not reported

Gender: 6 female, 1 male

Individuals with advanced cancer, receiving home hospice care through a hospice

Delivered at pre-bereavement, patient-carer dyad targeted

Home-based music therapy program

N/A

N/A

The carers described these aspects of music in sessions to have memorable and lasting effects as follows: “music is a conduit,” “music gets inside us,” “live music makes a difference,” and “music is love.” Findings support the benefits of preloss music therapy for bereaved carers.

Magill (2009b) [82] USA

See Magill [81]

See Magill [81]

See Magill [81]

See Magill [81]

N/A

N/A

Sustaining themes pervaded the interviews throughout a range of topics and were those overall feelings and reactions that seemed to nurture and motivate the carers through the illness and beyond. The two sustaining themes were (1) joy (autonomous joy and empathic joy) and (2) empowerment.

Analysis also revealed spirituality-laden themes that were sorted according to processes of reflection, that is, reflection themes. A further analysis of transcriptions revealed these themes: (1) reflection on the present: connectedness; 2) reflection on the past: remembrance; and 3) reflection on the future: hope.

Magill (2009c) [30] USA

See Magill [81]

See Magill [81]

See Magill [81]

See Magill [81]

N/A

N/A

The findings show that by including simple music therapy strategies in their sessions with patients, carers can offer their loved ones joy, comfort, relief from distress, meaning, aesthetic beauty, and peace. In this way, carers can improve their sense of empowerment.

Magill, (2011) [83], USA

Qualitative study (archived interview transcripts, content analysis)

See Magill [81]

See Magill [81]

See Magill [81]

N/A

N/A

The following 4 themes describe the significant characteristics of the role of music therapist as perceived by the carers.

The music therapist displays calming and compassionate personal attributes.

The music therapist uses subtleness of approach and has specialised person-centred therapeutic skills.

The music therapist maintains a supportive and interactive role.

The music therapist establishes and maintains an ongoing therapeutic relationship.

Mittelman & Papayannopoulou (2018) [84], USA

Pilot study:

Quasi-experimental (one-group, no control, pre-test and post-test)

Friend or family carers (n=11)

Mean age: 71.7 (SD=8.3)

Gender: 6 female, 5 male

Individuals with dementia

Early-moderate stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Unforgettables Choral Group

None

MOS (social support)

SF-8 (health related quality of life)

GDS (depression)

FAM (family communication)

RSS (self-esteem)

RSS: Self-esteem was the only outcome to change significantly (p=0.60), with an improvement in self-esteem reporting a medium effect size (0.68)

SF-8: Change in health-related quality of life was not significant, with a decrease in health-related quality of life reporting a medium effect size (0.45)

MOS: Change in social support was not significant, with an increase in social support reporting a medium effect size (0.42)

GDS: Change in depression was not significant, with a decrease in depression reporting a minimal effect size (0.05)

FAM: Change in communication with individual with dementia was not significant, with increase in communication reporting a small effect size (0.29)

O’Callaghan et al. (2013) [70], Australia

Qualitative study (semi-structured interviews, constructivist grounded theory (comparative analysis)

Friend and family carers (n=8)

Age range: 21-≥70

Gender: 5 female, 3 male

Individuals who had died from cancer

Delivered at pre- and/or post-bereavement, patient and carers

Music listening by the bereaved; song writing by the deceased and the bereaved

N/A

N/A

Theme A: remembering how music enhanced the lives of those mourned, and sharing music with deceased, was supportive.

Theme B: music-elicited memories, personal empathy, and messages related to the deceased can be purposive, sometimes Unexpected, and supportive or occasionally challenging.

Theme C: although music behaviors can alter, music often still improves mood, and although music use can signify mourners’ confrontation of grief, music’s occasional nonuse can signify efforts to not intensify sadness.

Theme D: feeling positive when musical efforts extend the deceased relative or friend’s legacy.

Theme E: what was shared and created in preloss music therapy could help before and after the death.

Theme F: music recommendations for other carers to support their bereavement.

Potvin et al. (2018) [31], USA

Qualitative study (semi-structured interviews, constructive grounded theory using situational analysis)

Family carers (n=14)

No age range provided but majority <65

Gender: 11 female, 3 male

Individuals with dementia, failure to thrive, or stroke, at end of life receiving hospice care

Delivered at pre-bereavement, patient-carer dyad targeted

Hospice-based collaborative musicking

N/A

N/A

Music therapy offers a resource (e.g. stable caring relationship that carers maintain with care recipients through reconnecting with their pre-illness identity, i.e. spouse, daughter, etc.). It does this through music-making together, so that caregiving becomes more purposeful and of value and that in turn helps build carer resilience during pre-bereavement period (being able to do something of value rather than just practical tasks, e.g. washing/feeding someone).

Analysis of the data resulted in the development of a theoretical model of resource-oriented music therapy with informal hospice carers during pre-bereavement. Two core categories—normalcy multilarity and collaborative musicking—and four subsequent theoretical codes—resource, risk, mediation, and outcome—explicate a theoretical avenue for conceptualising music therapy’s role in carer pre-bereavement.

Raglio et al. (2016) [85], Italy

Quasi-experimental study (one-group, no control, pre-test and post-test design without randomisation)

Family carers (n=4)

Age not reported

Gender: 3 female, 1 male

Individuals with dementia living at home

Moderate-late stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Structured Active Music Therapy (one-to-one sessions)

None

ZBI (Carer Burden)

HAM-A (Anxiety)

BDI (Depression)

Outcome measures administered at baseline, directly after intervention, and at 1-month follow-up.

Descriptive statistics only.

ZBI: carer burden improved from baseline (M= 43.50), to post-intervention (M=32.75) to follow-up (M=39.75).

HAM-A: anxiety improved from baseline (M=29.25) to post-intervention (M=20) to follow-up (M=19.75).

BDI: depression was more stable across time from baseline (M=16) to post-intervention (M=15.25) to follow-up (16.75)

Särkämö et al. (2014) [59], Finland

Randomised controlled trial (single-blind)

Family carers (n=59)

Age not reported

Gender not reported

Individuals with dementia living at home or in long-term care

Early–moderate stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Music listening intervention (group-based music coaching programme) (n=29)

Standard care (n=28), including continuation of regular group-based activities at day centre

A second intervention arm, group singing sessions, was facilitated by a music teacher (n=27)

ZBI-12 (Carer Burden)

GHQ-12 (Mental health)

Outcome measures administered at baseline, directly after intervention, and at 6-month follow-up.

ZBI-12: A significant long-term specific effect was observed for the ZBI scores, Time × Group (p=.026), which decreased (indicating reduced burden) more in the singing group than in both music listening group (p=.029) and control group (p=.069) from baseline to Follow-up 2.

GHQ: The same effect was observed also for mental health, but it failed to reach statistical significance (p=.174).

Tamplin et al. (2020) [63], Australia

Quasi-experimental study (controlled trial with experimental and control groups, but without randomisation, pre-test/post-test)

Family carers (n=44)

Age not reported

Gender: 30 female, 14 male

Individuals with Parkinson’s disease

Early-moderate stage

Delivered at pre-bereavement, patient-carer dyad targeted

ParkinSong

Group Singing Programme:

Weekly singing group (n=10)

Monthly singing group (n=15)

Two active control groups

Weekly Parkinson’s Disease dancing, painting, or tai chi classes (n=8)

Monthly peer support groups with a similar socialisation component (n=11)

QCPR (Quality of Carer-Patient Relationship)

Depression, Anxiety and Stress Scale DASS (Depression, anxiety, stress)

EQ-5D (quality of life)

Outcome measures administered at baseline, and at 3-month, and 12-month follow-up.

QCPR: Carer relationship quality total scores increased for the weekly carer singers, for the monthly singers, and weekly controls, and decreased for the monthly carer controls. No statistically significant differences between groups for perceived relationship quality as measured by the QCPR (p=0.09).

DASS: For depression, there was a significant interaction effect of group and time (p=0.05). Pairwise comparisons showed a significant difference (p=0.031) at 12 months between carers in the weekly singing groups (whose depression scores decreased) and monthly control groups (whose depression scores increased).

There were no statistically significant differences between groups for carer anxiety, but clinically relevant trends towards a group main effect (p=0.067) for carer stress. Carers in the weekly singing groups had significantly lower stress scores than that of weekly controls (p=0.044) and of monthly controls (p=0.022) at 12 months.

EQ-5D: No statistically significant differences between groups for carer quality of life (p=0.70)

Tamplin et al. (2018) [86], Australia

Mixed-methods feasibility study:

Quasi-experimental (one-group, no control, pre-test and post-test design without randomisation) Qualitative (semi-structured interviews, thematic analysis)

Family carers (n=12)

Age range: 58-88

Gender: 6 female, 6 male

Individuals with dementia, living at home

Early-moderate stage dementia

Delivered at pre-bereavement, patient-carer dyad targeted

Remini-Sing Music Therapy Intervention (group singing intervention)

None

QCPR (Quality of Carer Patient Relationship)

PHQ-9 (Depression)

SWLS (Satisfaction with life)

FS (Flourishing)

PACQ (Positive aspects of caregiving)

Feasibility study, so findings are estimates of an effect. Outcome measures administered before intervention, midway through (11 weeks) and post-intervention.

QCPR: No statistically significant pre to post differences between time-points for relationship quality. A medium effect size for mid-point increase (0.65) but this decreased again at post-intervention.

PHQ-9: No statistically significant pre to post differences between time-points for depression. Depression scores were low at baseline and remained relatively stable.

SWLS: No statistically significant pre to post differences between time-points for satisfaction with life. Satisfaction with life scores increased over time (medium effect at mid-point, 0.51, and small effect at post-point, 0.41).

FS: No statistically significant pre to post differences between time-points for flourishing. Flourishing scores were high at baseline and also remained relatively stable.

PACQ: No statistically significant pre to post differences between time-points for positive aspects of caregiving. Positive aspects of caregiving scores were lower post-intervention (medium effect, 0.56).

Teut et al. (2014) [68], Germany

Qualitative study (open interviews, grounded theory)

Family carers (n=3)

Age not reported

Gender: 1 female, 2 male

Individuals with advanced cancer and at end of life, receiving palliative care in a stationary hospice

Delivered at pre-bereavement, primarily delivered to patient, (body tambura placed on or near patients’ body, but family carers who were present were considered to have “experienced” the intervention)

The Body Tambura

N/A

N/A

The most often described subjective experiences (by carers) were the generation of relaxing images and visualisations. Family members enjoyed listening to the music and felt more connected with the sick family member.

Thompson et al. (2022) [87], Australia

Qualitative study (semi structured interviews, IPA)

Family carers (n=7)

Age range: 50-89

Gender: 5 female, 2 male

Individuals with dementia living at home

Early-moderate stage dementia

See Tamplin et al. [86]

N/A

N/A

Eight themes identified the perceived benefits of choir singing and elements of the choirs and research project more broadly that influenced participation.

Overarching theme 1: participating in the Remini-Sing choirs afforded experiences of personal and social benefits:

Theme 1: therapeutic choir participation fosters positive feelings

Theme 2: singing in THE choir promotes cognitive stimulation, connection to identity, for individuals with Dementia

Theme 3: opportunities to engage musical identity

Theme 4: choir participation enables much needed social connections

Theme 5: participating as dyads for pragmatic and personal reasons

Overarching theme 2: pragmatic aspects of the choirs and research design impacted the experience for participants:

Theme 6: getting started can be challenging – a welcoming environment is needed

Theme 7: accessibility of therapeutic Design

Theme 8: sustainability of choirs is desired

Young & Pringle (2018) [61], Canada

Qualitative study (individual semi-structured qualitative interviews. Optional written participant feedback after each session. Researcher reflexive journal and analytic memos. IPA)

Family carers (n=7)

Age range: 51-80

Gender: 7 female

Individuals who were deceased within past three years, with none of these deaths sudden or unexpected

Deaths due to cancer (n=3), other diagnoses not specified (n=4)

Delivered at post-bereavement, carers only

Singing Well group (community hospice-based music therapy group)

N/A

N/A

Themes organised in five categories.

1: Group singing experiences/the Singing Well context: Fostered feelings of connection, evoked emotions, allowed participants to enjoy themselves in safe space and express themselves in a way that was different than talking. Importance of qualities of music therapist.

2: Vocal warmups, breathing and relaxation exercises: mixed responses to these.

3: Songs (precomposed/original): Validated and re-conceptualised grief and loss, evoked memories, emotional release. Choosing songs was important. Songwriting.

4: Improvised vocal experiences:

For most, felt supportive, evocative, and liberating. Provided musical framework where participants could feel togetherness and be independent.

5: Overall experiences of Singing Well: Commitment to the group. Motivated participants to make changes, explore new/revive previous interests and helped to move forward in their lives. Experience of the group and impact was difficult to describe.