Anxiety, End of Life, Fear of Death, Hospice, Pain, Palliative Care
Conditions
Keywords
hospice, palliative care, virtual reality, VR, quality of life, personalized, nature, tandem
Brief summary
Background: Nature-based virtual reality (VR) and other outdoor experiences in head-mounted displays (HMDs) offer powerful, non-pharmacological tools for hospice teams to help patients undergoing end-of-life (EOL) transitions. However, the psychological distress of the patient-caregiver dyad is interconnected and highlights the interdependence and responsiveness to distress as a unit. Hospice care services and healthcare need strategies to help patients and informal caregivers with EOL transitions.
Detailed description
Methods: This study uses a synchronized Tandem VR approach where patient- caregiver dyads experience immersive nature-based and other outdoor VR content. This mixed methods study will recruit 20 patient-caregiver dyads (N = 40) enrolled in home hospice services nearing the end-of-life. Dyads will experience a personalized nature-based or other outdoor VR experience lasting 5-15 minutes. Self-reported questionnaires and semi-structured interviews will be collected before and after the VR intervention to identify the impacts of personalized nature-based and other outdoor Tandem VR experiences on the QOL, pain, and fear of death in patient-caregiver dyads enrolled with hospice services. Additionally, this protocol will determine the acceptance of personalized nature-based and other outdoor Tandem VR experiences by dyads as a non-pharmacological modality for addressing patient and caregiver needs. Acceptance was quantified by the number of dyads accepting or declining the VR experience during recruitment. Discussion: Using personalized, nature-based and other outdoor VR experiences, the patient-caregiver dyads can simultaneously engage in an immersive encounter to help alleviate symptoms associated with declining health and EOL phases for the patient and the often overburdened caregiver. This protocol focuses on meeting the need for person- and caregiver-centered, non-pharmacological interventions to reduce physical, psychological, and spiritual distress.
Interventions
DEVICETandem Virtual Reality
Hospice patients and their primary caregiver will each wear virtual reality headsets and will experience a customized and synchronized 5-15min virtual reality experience.
Sponsors
Prisma Health-Upstate
Clemson University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Multiple Method Design
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* English speaking * Projected life expectancy of \<6 months (established by hospice experts) * Cognitively intact (has sufficient judgment, planning, organization, and self-control)
Exclusion criteria
* Having a cognitive impairment that affects protocol participation. This will be done with the assistance of Research Recruiters to assess eligibility. * Have a condition that interferes with VR usage, including but not limited to seizures, facial injury precluding safe placement of headset * Have a prognosis of hours or actively dying at the time enrollment * Patients with motion sickness * Patients with claustrophobia * Patients with visual and hearing impairment * Patients with inability to speak English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Life Domains | 15 minutes | Quality of life will be measured with the McGill Quality of Life Questionnaire (MQOL-E). This assesses eight important life domains: cognition, healthcare, environment, feeling like a burden, and their relationships with physical, psychological, social, and existential/spiritual domains. The 16-item questionnaire uses a 0-10 response scale with a higher score indicating a higher quality of life. |
| Fear of Death | 15 minutes | The Collett-Lester Fear of Death Scale (CL-FODS), measures changes in perception of fear of death and 28 items. The CL-FODS uses a 5-Likert scale ranging from 1= not to 5=very for how disturbed or made anxious a person is by different aspects of death and dying. A higher score indicates a higher fear of death. Some example items include rating how disturbed or made anxious you are about the shortness of life, the lack of control over dying, and feeling lonely without your person. The CL-FODS has four subsections: Death of Self, Death of Others, Dying of Self, and Dying of Others. The means of each subsection and then the total scale scores illustrate the degree of anxiety about death and dying, with a higher value indicating the severity of anxiety about death and dying. |
| Perception of Pain | 15 minutes | Wisconsin Brief Pain Scale Questionnaire will assess perception of pain. Patients will rate their pain from 0=no pain to 10=worst pain imaginable in response to items such as "average pain," "worst pain," "least pain" over the last seven days, and "pain right now." An average of the responses to these items is used to create a single pain severity score. A higher score indicates more perceptions of pain. |
| Acceptance of Tandem VR | 1 minute | Determine the acceptance of personalized nature-based Tandem VR experiences by dyads as a non-pharmacological modality for addressing the needs of dyads. Acceptance is quantified by the number of dyads accepting or declining the VR experience during recruitment. |
| Perceived Benefits and Value of Tandem VR | 20 minutes | Semi-structured interview data will be gathered and examined using a thematic analysis to capture the perceived benefits and value of Tandem VR. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJoshua K Pope
Prisma Health Hospice of the Foothills
Participant flow
Recruitment details
Recruitment began February 1, 2024, and concluded November 20, 2024. Recruitment began in the clinic setting, using the Uptake Form to assess the patient and informal caregiver interest in the VR intervention for deployment in the home environment.
Pre-assignment details
The patient and informal caregiver were screened for the inclusion criteria in the clinic setting before being presented to the intervention team for consent and approval. Upon presenting to the intervention team, a patient and their informal caregiver were then assigned a dyad number. Verbal consent for the intervention was obtained via a phone conversation, which also included setting the date and time of the intervention. Written consent was obtained on the date and time of the intervention.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 3 Participants |
| Age, Categorical Between 18 and 65 years | 9 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 11 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 10 Participants |
| Region of Enrollment United States | 22 Participants |
| Sex: Female, Male Female | 7 Participants |
| Sex: Female, Male Male | 2 Participants |
| Virtual Reality Content Bucket List Destinations | 6 Participants |
| Virtual Reality Content Bucket List Experiences | 6 Participants |
| Virtual Reality Content Past Home Videos | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 13 | 0 / 13 |
| other Total, other adverse events | 1 / 13 | 0 / 13 |
| serious Total, serious adverse events | 0 / 13 | 0 / 13 |
Outcome results
None listed