Virtual Reality Use and Patient Outcomes in Palliative Care

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Virtual reality (VR) is described as the simulation of reality where the users are immersed in a technologically generated virtual environment creating an illusion that the environment exists.  The use of VR has increased in the past decade, particularly across entertainment, education and industry sectors.  VR use in health care settings is also increasing, with some evidence of positive effects on managing the symptoms of depression, pain management and anxiety management.

While virtual reality is increasingly used in healthcare settings, there limited knowledge on how virtual reality use in palliative care (PC) impacts patients’ outcomes.

Moloney and colleagues (2023) sought to answer the research question, “What knowledge and evidence exists in the literature on virtual reality use in palliative care, particularly in relation to biopsychosocial patient outcomes?”  The researchers followed the Arksey and O’Malley scoping review framework which includes: (a) identifying the research question, (b) identifying relevant studies, (c) selecting studies, (d) charting the data and (e) arranging, summarizing and communicating the outcomes.

Full-text reviews of 31 papers were conducted by the research team and 10 papers reporting on virtual reality use and patient outcomes in palliative care were included in the scoping review.

  1. What types of VR modalities have been used and reported in PC environments?

All studies in the review included an interaction between patients and VR technology, but the types of experiences were varied.  Some studies presented VR as a meditative/relaxing experiences, while others offered exciting experiences (e.g. a roller coaster ride) or travel experiences.  Two papers included life review interventions where patients’ voices, gestures, and movements were synchronized onto an avatar in a virtual environment.

  1. What patient groups has VR been used with, and in what context (e.g. inpatient care or home care), and who was involved in facilitating the VR experience?

All patients described in included studies were adults receiving either inpatient or outpatient PC.  Inpatients included those receiving care in hospice facilities and those on general wards receiving PC consultations.  Outpatients were either attending PC clinics or were under the care of home PC programs.

VR experiences were coordinated by multidisciplinary professionals, with the involvement of hospice-based professionals such as PC physicians, nurses and social workers.  Only one study reported the involvement of an experienced VR facilitator.

  1. How have VR interventions been evaluated to date, i.e. what patient outcomes are measured?

The type of evaluations and outcomes measured described in included papers were varied but aligned with three categories of outcomes measures:

  • Patient outcomes include quality of life assessments, physical and psychological symptoms, functional assessments, physiological signals, spiritual well-being, and behavioral changes. Eleven different tools were used, with the Edmonton Symptom Assessment System (ESAS) being the most reported.
  • User experience including patient-reported adherence, tolerance, acceptability and comfort of VR interventions, usability, likeability, preferences and perceived benefit, and perceived level of fun, happiness and enjoyment pre- and post-VR experiences.
  • Other stakeholder perspectives – two papers described stakeholder perspectives, including caregiver and staff perceptions.
  1. What evidence base (if any) exists on the clinical effectiveness of VR in PC?

The evidence of the clinical effectiveness of VR in PC is limited. Qualitative and quantitative data on patient outcomes such as symptom relief or health benefits/risks is limited, with most evidence coming from studies conducted in a single location with a small sample size. In the studies that used validated assessment tools, scales or instruments, there were minor or no improvements reported, with only one paper reporting improvements in ESAS items related to pain, depression, anxiety, well-being and shortness of breath immediately after the VR experience. One paper measured physiological signals via smart wristband, but reported no statistically significant changes before, during and after the VR sessions.

Included studies did highlight possible benefits of VR including improved physical health, well-being and quality of life for patients.  Additionally, potential risks were also identified, including, the emotional risks around unexpected or surprising emotions, increased pain scores and/or worsening symptoms, infection control risks with the use of shared VR equipment, and technical issues (eg. device malfunctions and calibrations) as possible complications or risks.

  1. What guidelines/policies exist regarding the use of VR in PC?

Across the included review papers, there were no reports of pre-existing policies, procedures, protocols or guidelines utilized in relation to the design, development or implementation of VR experiences in PC.

While the evidence includes positive data on usability, feasibility and acceptability of virtual reality in palliative care, evidence regarding biopsychosocial patient outcomes is limited.  The authors call for more research to underpin the evidence base supporting its application, particularly in understanding the impact on biopsychosocial patient outcomes.

Source: Moloney, M., Doody, O., O’Reilly, M., Lucey, M., Callinan, J., Exton, C., … & Coffey, A. (2023). Virtual reality use and patient outcomes in palliative care: A scoping reviewDIGITAL HEALTH9, 20552076231207574.