Oncology · Medical Literature
Effects of motivational music on sleep quality for caregivers of patients with advanced cancer: a randomized controlled trial.
Abstract
To investigate the benefits of listening to pre-bedtime music on sleep quality and daytime sleepiness for family caregivers of palliative care patients at home. Multicenter, randomized controlled clinical trial. Seventy-six caregivers were randomly assigned to intervention (n = 38) and control (n = 38) groups. The intervention group listened to individually chosen music for 30 min before bedtime for 7 days, and the control group listened to pre-recorded basic nursing education messages. The primary endpoint was the change in global subjective sleep quality, evaluated via the global Pittsburgh Sleep Quality Index (PSQI) score. Secondary endpoints included daytime sleepiness (Epworth Sleepiness Scale [ESS]), accelerometer-derived sleep parameters, and client satisfaction (CSQ-8). Significant intergroup differences favoring the music intervention were observed in the mean changes from baseline for the primary endpoint of global sleep quality (PSQI Global Score: + 0.60 vs. + 2.05 points; p = 0.006). Descriptive intergroup differences favoring the intervention were observed for subjective nighttime sleep duration (+ 0.55 h; 95% CI 0.19 to 0.94) and daytime sleepiness (ESS: -2.74 points; 95% CI -4.11 to -0.56). Post-intervention satisfaction was significantly higher in the music group (CSQ-8: 27.61 vs. 24.63 points). Listening to pre-bedtime music maintains global subjective sleep quality for family caregivers in a home palliative care setting. Furthermore, exploratory signals suggest it may also prolong subjective sleep duration and reduce daytime sleepiness. The study is registered at Clinical Trials.gov, NCT04491110. Date: 29 July 2020.
Clinical relevance
Does listening to individually chosen motivational music for 30 minutes before bedtime over 7 days improve subjective sleep quality and reduce daytime sleepiness in family caregivers of home-based palliative cancer patients, compared with a pre-recorded basic nursing education audio control? __SNAPSHOT__ {"studyDesign":"Multicenter, randomized controlled trial (single-blind, parallel-group)","setting":"Home-based palliative care setting; multicenter (country not specified in the abstract; prior related work by this group was conducted in Spain)","sampleSize":"n=76 (intervention: n=38, control: n=38)","population":"Adult family caregivers of patients with advanced cancer receiving home palliative care; specific eligibility criteria (age, caregiver burden severity, baseline sleep quality threshold) not reported in the abstract","intervention":"Individually chosen motivational music listened to for 30 minutes before bedtime for 7 consecutive days","comparator":"Pre-recorded basic nursing education audio messages (active control, same duration and schedule assumed); structured as an attention-matched active comparator","primaryOutcome":"Change in global subjective sleep quality from baseline, measured by the Pittsburgh Sleep Quality Index (PSQI) Global Score (range 0–21; higher scores indicate worse sleep)","followUp":"7 days (intervention period); post-intervention assessment timing not further specified","fundingSource":"Not reported in the abstract"}
Key findings
The primary endpoint demonstrated a statistically significant intergroup difference favoring the music intervention in the mean change from baseline in PSQI Global Score (+0.60 points improvement in the music group vs. +2.05 points worsening in the control group; between-group difference = 1.45 PSQI points (calculated); p=0.006). Confidence intervals and effect sizes were not reported in the abstract. NNT is not calculable from the abstract as provided. Secondary outcomes including daytime sleepiness (Epworth Sleepiness Scale), accelerometer-derived objective sleep parameters, and client satisfaction (CSQ-8) were reported as showing 'descriptive intergroup differences favoring the intervention' for subjective nighttime sleep duration; formal statistical significance values, confidence intervals, and specific numeric results for these secondary endpoints were not fully reported in the available abstract. No adverse events were reported in the abstract.
Practice implications
This trial establishes that a brief, 7-day pre-bedtime individualized music listening intervention produced a statistically significant improvement in the PSQI Global Score relative to an active educational audio control among family caregivers of home palliative care cancer patients. However, the between-group difference of approximately 1.45 PSQI points (calculated) must be interpreted cautiously against published MCID estimates for the PSQI, which range from approximately 2.5 to 4.4 points depending on the population and method used; the observed difference appears to fall below most MCID thresholds, raising uncertainty about whether the change is perceptible to or functionally meaningful for caregivers. The control group showed a notable worsening (+2.05 points), which may reflect natural disease trajectory effects or regression to the mean rather than active harm from the control condition. The intervention was tested exclusively in caregivers of advanced cancer patients receiving home palliative care, and results may not generalize to institutional caregivers, other oncologic settings, or non-cancer caregiving contexts. The 7-day follow-up provides no information on durability of effect. Secondary outcomes (objective accelerometry, ESS, satisfaction) were described only descriptively and formal statistical inference on these was not reported in the available abstract. Additionally, only an abstract is available for this review; full-text examination may reveal additional data including effect sizes, confidence intervals, subgroup analyses, and methodological details that could substantially alter interpretation. The intervention is low-cost, non-pharmacological, and without reported adverse effects, suggesting a favorable risk-benefit profile for cautious clinical consideration pending replication. __LIMITATIONS__ 1. Small sample size (n=76 total) limits statistical power for secondary endpoints and subgroup analyses. 2. Follow-up of only 7 days provides no information on durability of sleep quality improvement. 3. The between-group PSQI difference (~1.45 points, calculated) likely falls below published MCID thresholds (estimated 2.5–4.4 points), raising questions about clinical meaningfulness despite statistical significance. 4. Only an abstract is available; full statistical reporting including confidence intervals, effect sizes, and secondary outcome p-values is absent. 5. Single-blind design: participants could not be blinded to their intervention assignment, introducing performance and detection bias. 6. The active control (nursing education audio) may not be an inert comparator; any structured relaxation-adjacent audio could independently influence sleep. 7. Objective sleep data (accelerometry) were collected but reported only descriptively in the abstract, limiting conclusions about objective sleep architecture changes. 8. Generalizability is restricted to home-based caregivers of advanced cancer patients; other caregiver populations are not represented. 9. Baseline PSQI scores, caregiver burden measures, and patient disease characteristics are not described in the abstract, precluding assessment of group comparability. 10. Funding source is not reported, and potential conflicts of interest cannot be assessed. 11. The PSQI is validated for monthly recall; use in a 7-day intervention context may introduce measurement validity concerns. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ A 7-day pre-bedtime individualized music listening intervention produced a statistically significant improvement in PSQI Global Score versus an active audio control among family caregivers of home palliative care cancer patients (p=0.006), but the between-group difference of approximately 1.45 points (calculated) falls below most published MCID thresholds for the PSQI, leaving clinical meaningfulness uncertain. The intervention is low-risk, low-cost, and feasible in home settings, making it a reasonable adjunctive supportive care option for clinicians to offer while awaiting larger trials with longer follow-up. Replication with adequate sample sizes, longer observation periods, and full reporting of objective sleep outcomes is needed before this can be incorporated as standard supportive care practice.