Background Effective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms. Aims We investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs. Design This is an observational, single-arm and national single-center feasibility trial. Methods A one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain. Results We analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone. Discussion The present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.
Background: Effective symptom control is the primary goal in palliative care (PC). Virtual reality (VR) allows a temporary escape from pharmacological resistant pain and enables experiences and journeys palliative patients are not capable of experiencing due to frailty or hospitalization. Patients can immerse in virtual worlds, be distracted by playing games or go on a journey once again. Another benefit of enabling unrealizable wishes in the virtual world is potentially an additional control of psychological and physical symptoms. We evaluated in a national single-center feasibility trial, whether a onetime VR experience is a feasible, satisfactory and effective tool for improving end of life-symptoms for hospitalized patients with palliative needs. Methods: 45 patients at the University Hospital of Muenster with inpatient palliative treatment were offered a one-time VR experience. We excluded patients with brain tumors, brain-metastases, seizure, motion sickness, claustrophobia, vertigo attacks, hearing or visual impairment and those who could not consent.A selection of several videos and games were offered by a VR system. The primary endpoint was patient-reported pain recorded by visual analogue scale. Pre-, during- and post-interventional pain scores were reported. Additionally, health-related quality of life (HRQOL) was measured by the EQ-5D-5L questionnaire. The Pain-Out questionnaire for postoperative pain was handed to the participants before and after the VR intervention.Results: Data of 21 women and 19 men were analyzed, their average age was 51.9 (SD: 15.8) years. Five patients were excluded for loss of glasses, a VR experience less than five minutes, claustrophobia, acute disorientation or hardly comparable environmental circumstances. The mean Karnofsky score was 45.5 (SD: 14.9) and self-reported health in EQ-5D-5L was 41.9 (SD: 23.1).A significant pain reduction could be shown during, directly post- and one hour postinterventional (VAS preinterventional 2.25 (SD: 0.4399), during 0.7 (SD: 0.2983, p<0.0001), postinterventional 0.9 (SD: 0.3354, p=0.0001), one hour postinterventional 1.15 (SD: 0.4163, p=0.0004). More than 80% evaluated the VR-experience as very good or good, as many as wanted to use the device again. No serious side effects were reported, but three patients felt nausea (7%), two headache (5%) and three stated dry eyes (7%). Conclusion: This pilot trial suggests that VR seems to be a feasible and effective tool to reduce pain and ameliorate the mood in PC. The usage of VR in PC has broad acceptance and might be a valuable future tool for symptom control. Trial registration: ClinicalTrials.gov Identifier: NCT03698526(https://clinicaltrials.gov/ct2/show/NCT03698526?term=virtual+reality&cond=palliative+care&cntry=DE&city=Münster&rank=1)
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