Table 4 Challenges and solutions

Pilot

Waiting for physician referrals limited the number of potential participants to approach each week.

Proactively screen patients from EHR and approach medical teams for referrals to increase the number of potential participants to approach each week.

Restrictive inclusion criteria with PHQ- 9 or GAD- 7 score ≥ 10 that posed additional documentation burden with screening consent.

Remove inclusion criteria and screening consent to reduce patients’ time and documentation burden, broaden eligibility criteria, and increase number of potential participants who could be recruited each week.

Future RCT

Unable to reach participants following discharge.

MyCap text communication and dedicated RA who maintains frequent text- and phone-based communication with participants to reduce attrition.

Frequent rescheduling needed following discharge.

MyCap text communication and dedicated RA who can quickly follow-up with participants to reschedule missed sessions.

Unreliable phone communication.

MyCap text communication for participants who prefer text- over phone-based communication.

Participants having challenges with Zoom.

In-person technology education session prior to discharge to practice skills including downloading Zoom software, joining a meeting, turning camera on and off, and muting/unmuting.

Participants having challenges with technology.

Add inclusion criteria that participant must have email already on smartphone. Add additional screening questions to ensure participant has prior experience accessing email to help ensure basic familiarity with technology needed for videoconferencing and measure completion.

ICU and readmissions delivery restriction limited therapists’ ability to complete sessions.

When appropriate, allow for ICU delivery and virtual delivery if readmitted so that participants can complete assigned interventions.

Random assignment for interview limited interview sample.

Remove randomization and interview until saturation is achieved to generate more qualitative data.

No follow-up care plan for participants desiring continued music therapy services.

Provide guide to music therapy community resources following intervention so that participants can continue to engage with music therapy services following completion of the study.

Dialysis presented a challenge to recruitment and participation.

Exclude patients with ESRD or who are currently receiving dialysis.