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Virtual reality (VR) is a simulation of reality using a high-end user-computer interface that allows real-time simulation and interactions through multiple sensorial channels creating an illusion that the environment exists. VR can simulate being in nature, and can be used for “bucket-list goals”, allowing patients activities that are no longer physically accessible to them.
VR is increasingly being used in health care settings, including hospice and palliative care. Research studies have shown evidence of positive effects on pain and anxiety management and managing the symptoms of depression. Little is know about the duration of the VR effect.
A recent study by Deming and colleagues (2024) sought to learn more about the effects and duration of head-mounted display VR (HMDVR) by showing nature and bucket-list videos to patients nearing the end of life.
Thirty adult hospice or palliative care patients participated in the study. Patients complete a revised Edmonton Symptom Assessment Scale (ESAS-r) form before, immediately after, and 2 days after each VR experience. Palliative Performance Scale (PPS) scores were also recorded to track functional status.
Participants wore a cordless Meta Quest 2 HMDVR headset. The first video was a 15-minute, 360-degree video of 19 serene nature scenes with ambient sounds. Participants selected up to 30 minutes of short, 360-degree video clips from a list of 49 possible bucket-list experiences for their second VR experience. Following the viewing of the video clip, participants answered the following questions with the corresponding responses:
- Have you visited the place or participated in the experience before? (Response: never, a little, a lot)
- How strong is your connection to the experience? (Response: none, mild, strong)
- What is your overall impression of the video? (Response: not good, just okay, outstanding)
Effectiveness of the intervention was determined by comparing the mean symptom scores on ESAS-r before and immediately after the experience and the duration of effectiveness was determined by comparing the mean symptom scores before and 2 days after the intervention.
Immediately after the nature video, the mean total symptom score decreased significantly from 24.2 to 17.0. Individual symptom scores for drowsiness, tiredness, depression, anxiety, absence of well being and dyspnea decreased the most. There were no improvements seen in symptom scores for pain or nausea.
The bucket-list videos decreased total symptom scores immediately afterwards from a mean of 21.6 to 17.8, which was not statistically significant.
When the symptom scores at 2 days were compared with the before scores, the benefit did not last. The mean total scores for the nature video increased 6% over 2 days, and those for the bucket-list videos increased 4%.
The authors concluded that HMDVR videos can be effective and safe in temporarily alleviating patient symptoms near the end of life.
Source: Deming, J. R., Dunbar, K. J., Lueck, J. F., & Oh, Y. (2024). Virtual Reality Videos for Symptom Management in Hospice and Palliative Care. Mayo Clinic Proceedings: Digital Health.
