Biological Effects of Music Therapy in End-of-Life Care: A Narrative Review

Background and Objectives: Music therapy has a long tradition in palliative care, and recent studies have investigated its Neuro-Psycho-Endocrine-Immunological (NPEI) effects in terminally ill patients. Despite numerous published articles, there is a lack of a compendium connecting the physiological basis of music therapy with the specific musical elements most effective in end-of-life settings. This narrative review aims to synthesize current evidence on the physiological mechanisms underlying responses to music, with a focus on terminal patients and implications for nursing practice. Materials and Methods: For quality and possible reproducibility, a narrative review was conducted in accordance with Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. The review targeted articles from the past five years indexed in PubMed, CINAHL, Cochrane Library, Embase, Scopus, Web of Science, and PsycInfo, supplemented by additional relevant references identified through manual searching. The PICOS framework was performed to structure the search strategy and study selection, focusing on studies relevant to the biological effects of music therapy in end-of-life care and their practical implications for nursing care. Results: The neurophysiology of music perception in terminal patients is complex, involving a wide array of clinical and cultural factors. Key musical elements-such as rhythm, melody, harmony, tempo, and mode-can influence physiological and psycho-emotional responses. Music therapy interventions, when tailored to the individual's preferences and cultural background, may modulate parameters like heart rate, blood pressure, stress hormone levels, and pain perception. Evidence supports the need for individualized approaches and highlights the NPEI rationale for integrating music therapy into end-of-life care. Conclusions: A deeper understanding of the scientific mechanisms discussed in this narrative review can enhance the effectiveness of music therapy interventions in end-of-life settings. Nursing practice can benefit by integrating evidence-based selection of musical pieces and personalizing interventions to the clinical and cultural profile of each patient. Further interdisciplinary research is needed to establish standardized criteria for music therapy in palliative care and to optimize outcomes for terminally ill patients.