“The moment is all we have”: patients and visitors reflect on a staff Christmas choir

For thousands of years, music has significantly enhanced health, character and behaviour.1,2 Music was prescribed to treat disorders in ancient Egypt and Greece, and throughout the Middle Ages, Renaissance and Baroque periods.1 Shamanic cultures still use music as part of rituals for maintaining health and supporting the dying and bereaved.2,3

Supported by Florence Nightingale, concerts were performed in London hospitals from 1891 and, by 1925, 15 New York hospitals had adopted the practice.4 After World War I, music therapy — a profession that tailors music techniques to individualised needs — emerged.5

In the present day, and closer to home, Melbourne Symphony Orchestra members have performed at the Royal Children’s Hospital,6 and tertiary music students regularly perform at St Vincent’s Hospital, Melbourne. Choirs in Melbourne and other parts of Australia often perform in hospitals at Christmas.

The Peter MacCallum Cancer Centre (“Peter Mac”) in Melbourne is a public hospital with 94 inpatient beds, outpatient clinics and an outpatient radiotherapy service. Its Staff Christmas Choir has performed annually since 1956. Given the increasing emphasis on addressing supportive care needs in oncology,7,8 we decided to conduct a small research study on the effects of the staff choir on inpatients, outpatients and visitors during the Christmas period in 2008.

One hundred and eleven questionnaires were returned. At least 47% of inpatients responded. The response rate among outpatients and visitors was impossible to calculate, as scores of people moved through the listening areas during performances.

Respondents’ demographic features are summarised in Box 3. Nearly all patients and visitors (104/111 [94%]) expressed positive responses. Observed reactions were mostly favourable, occasionally negligible, and rarely negative. Two people (one visitor and one outpatient) commented about the music’s loudness. Many observers moved towards the choir, while others ignored it. Some sang along, played instruments and joked with the conductor. A few cried with heads bowed.

To our knowledge, this article presents the first research into the appropriateness of religious or cultural practices in an Australian health care space. Our findings indicate an overwhelmingly favourable response to the staff choir from oncology patients and visitors, regardless of whether they were from Christian or non-Christian backgrounds. Their enjoyment, in an environment characterised frequently by “blunt silence”, “gloom” and “struggle” (words quoted from respondents), was striking. While duration of effect was not examined, being able to “enjoy the moment” was regarded as paramount, especially when dealing with uncertainty shrouding cancer treatment or end-of-life care. Even though three respondents found the music emotionally confronting or too loud, two of them recommended that the choir continue for the benefit of others. A staff choir will not appeal to everyone.

The choir’s positive effects on respondents’ emotions, memories and images were comparable with music therapy’s effects in oncology.14 However, adverse experiences of oncology patients to music therapy have not been reported, possibly because music therapists work in therapeutic relationships with willing participants.15 Music alters mood through an extensive network of activated neural regions and connections involving pleasure, arousal, opioid transmission and dopamine production.16 Memory traces of previously heard music and experienced emotions are also involved.16 Witnessing the choir’s “happy” and “warm” performances (words quoted from respondents) may have also triggered mirror neurones.17

Respondents’ sad memories were accompanied by positive feelings. Through offering multiple messages in non-referential ways, music can expand listeners’ ways of thinking and feeling.18 Music’s power is reflected in its capacity to arouse paradoxical states, acknowledging our fears and grief alongside our thanksgiving and hope.19

Limitations of our study were its small size, small proportion of non-Christian respondents, and restriction to a single institution. We examined responses from oncology patients and visitors who heard the choir, were aware of the questionnaire, and were motivated and able to participate. Thus the survey was open to responder bias, the direction of which is unknown.

Christmas is a Christian celebration that is observed in Australia with public holidays. Christmas music (live and recorded) is played in many health care settings at this time. There has been debate in some sectors in Australia about appropriate observation of religious holidays, and religious spaces in some public hospitals are being converted to multi-faith worship areas in acknowledgement of different religious practices.

Future examination of reactions from people with varied religious and ethnic backgrounds would extend our understanding of the effects of Christmas choirs. We would also encourage others to examine the effects of Christmas music (on patients, visitors and staff) in their own health care institutions.

In summary, the Christmas choir music was welcomed by many at Peter Mac and should be encouraged for supporting oncology patients and their visitors in similar facilities. In the words of a January 2009 article in The Age, “Music binds strangers simply because it does not speak to one person. It is the universal become personal”.20

1 The Peter Mac Staff Christmas Choir in performance

2 Choir performance to patients, visitors and staff in an outpatient area