Virtual Reality improves symptom control in palliative care – a feasibility trial

Abstract 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)