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Abstract
Introduction Community singing programs may improve quality of life for breathless people with long-term respiratory disease but there has been limited formal exploration of its social and psychological importance. This qualitative study aimed to investigate the impact of a long-term weekly singing group on empowerment, breathlessness, psychological wellbeing and social engagement of respiratory patients at an inner city London hospital.
Methods Patients attending a weekly, 1-hour singing group led by a music therapist and open to all patients with respiratory disease were recruited. Demographic, disease severity and self reported health care resource utilisation data were collected from those who consented to participate. Semi-structured interviews (Figure 1), were used to collect qualitative data which were analysed using grounded theory methodology.
Results 16 patients (4M:12F, mean (range) age 72.6 (50–92) years) were interviewed. Diagnoses included COPD (11/16), asthma (2/16), bronchiectasis (2/16) and fibrosis (1/16) with mean (±SD, range) FEV1 1.31(± 0.54, 0.69–2.58,) litres, FEV1 54% predicted (± 22.01 range 26% - 96%). All were non-smokers (ex-smokers 12/16); 12/16 (75%) had previously attended pulmonary rehabilitation. 10/16 lived alone and 8/16 had a history of mental health comorbidity requiring treatment. Duration of singing group attendance (mean±SD) was 15.3 ± 6.5 months. Four themes were identified from the qualitative analysis of the semi-structured interviews: 1. ‘Control of Symptoms’, 2. ‘Community and Friendship’, 3. ‘Psychological Benefits’, 4. ‘Mastery of Illness’. The singing group improved breathlessness symptoms, enabled access to further sources of support and formed new friendships. Self reported primary care (GP) visits were (non-significantly) fewer in the year following commencement of singing. There was no difference in hospital admissions in the year after starting singing compared to the year before.
Conclusion The singing group had a profound impact on this group of patients with moderate chronic respiratory disease, a high prevalence of anxiety and depression and social isolation. The dominant effects were improving mood, providing a sense of mastery (control) over breathing to better cope with breathlessness, and tackling social isolation. These findings should help to inform commissioners of the value of singing groups as an effective, low-cost, non-pharmacological long-term therapy for patients with chronic respiratory disease.