BackgroundResearch shows that VR is effective as a tool in managing acute pain (Hoffman & Patterson, 2000; Hoffman & Garcia-Palacios, 2001; Hoffman & Chambers, 2011). There is also evidence that meditation is beneficial in reducing persistent pain, that the effect is cumulative and builds overtime (Morone et al., 2008). We have developed a VR Guided Meditation app narrated by Sir David Attenborough and are planning a mixed method randomised controlled trial to examine whether an immersive meditation experience enables palliative patients to enter a meditative state more easily and achieve long term pain reduction.AimTo test the feasibility and acceptability of using VR Guided Meditation in a hospice setting.Specific Objectives• Compare two types of hardware.• Establish whether the headsets are comfortable.• Find out if the technique has an impact on pain.• Ascertain feedback.Method• Hospice patients were offered the opportunity to participate.• The VR Gear which connects to a mobile phone was compared with an Oculus Rift which connects to a computer. Each was used for 10 min.• Feedback via a structured questionnaire.Results• Participants: six female, 12 male. Age range 33 to 84 years. Sixteen with cancer, two with neurological conditions.• Preference for Oculus Rift was unanimous.• All enjoyed the experience and wished to repeat it.• All described the headsets as comfortable.• None experienced side effects.• All experienced a reduction in pain, ranging from 20% to complete reduction.• Comments: ‘first time in months I forgot I had pain’; ‘ could have stayed there forever’; ‘wonderful’; ‘so distracted I forgot my pain’; ’in another world and didn’t feel a bit of pain.’ConclusionVR Guided Meditation is effective in distracting patients from their pain and it is acceptable and feasible to use in a hospice setting. Research is needed to establish whether its use enables patients to enter a meditative state more effectively leading to longer term benefits.

more patients to be cared for in their place of choice. However, for a very small number of complex patients, the lack of inpatient facilities had proved problematic. To avoid this consequence during the second wave, a new plan to open a virtual ward, staffed by some of the inpatient team, was devised. Aim To ensure that dying patients with complex needs were given equitable and appropriate care whilst the inpatient unit was closed. Method Clinical staff were once more re-located to the community teams, but this time with 24-hour provision of nursing care, rather than the usual four times daily visits. Medications were administered in a more timely way, and delivery of personal care was given at the patient's convenience, rather than set times, with increased support for families. Closer liaison with the multi-disciplinary team (MDT) also improved the patient experience, with daily MDT discussion. Results Eight patients who required complex medical intervention, were admitted to other local hospices. However, 47 patients were admitted to the virtual ward, averaging 8.6 admissions per month. Identification of the last weeks of life was greatly improved by the internal referral process, reflected in an average length of stay of 7 days (range 3-13 days). Conclusion By offering complex care to people at end of life in their own homes, this approach fulfilled the ideal criteria of 'providing everyone the right care, from the right person at the right time' and reduced prior inequality of care provision (Thomas, 2021).

ConclusionCoupled to the significant increase in referral numbers to our service there has been a noticeable increase in the number of patients referred with haematological diagnoses. Many require multiple recurrent transfusions over many months which allows a natural progression from active treatment into palliative services, within an environment which is well equipped to support them as their illness deteriorates. Our patient feedback shows we are running an excellent service for our patients, in a setting they enjoy.

opportunities for using emerging technologies in interventions and training. Our next project is a VR tour of our inpatient unit and grounds filmed using a 360 degree camera for patients to watch at home to try and alleviate some of the worries and anxieties they may have about staying with us or accessing our services. Conclusion The use of VR in healthcare has endless possibilities. Working with our local education partners is an opportunity to explore this for our patients. Positive outcomes have provided the impetus to try new approaches that will have real impact on patient wellbeing and symptom management.