Virtual Reality and Palliative Care

You’re walking along a coastline where forest meets sea. You hear the rhythm of crashing waves and see gulls swooping down from a crystal blue sky. A light breeze ruffles your jacket. You take a deep breath of the salty, pungent air and watch as a foaming wave washes away your footsteps and sweeps the sands clean, leaving behind a shimmering, vitreous surface that reflects a pale white sun.

The next thing you know, you’re in an examination room, the sun’s rays replaced by overhead fluorescent lighting. A nurse is standing next to you. She removes your headset and asks how you’re feeling.

This is not a scene from a futuristic sci-fi movie. It’s an illustration of how virtual reality (VR) is currently being used for palliative care treatment. Although VR in palliative care is still considered experimental, early research shows that it can improve patient outcomes.

How VR Is Being Used in Palliative Care

Popular in video gaming and entertainment, VR has more recently been deployed in health care for a variety of purposes, from treating phobias and PTSD to training physicians.

An increasing number of palliative care professionals are utilizing VR in their practices. Palliative care is specialized medical care that focuses on treating the physical and emotional suffering of patients living with serious illnesses. While it can be provided at the end of life, palliative care is not limited to that stage. It can be given to the patient in the home as an inpatient, or as an outpatient at a hospital or a specialized clinic such as a hospice.

VR technology allows users to interact with a computer-generated, immersive environment using a headset like the Microsoft HoloLens, the Meta Quest, and the Oculus VR device. The computer-generated, customizable simulated environments can be personalized to the user, allowing them to do things in a virtual world that they cannot do physically in the real world. This can be particularly valuable to palliative care patients, many of whom have limited mobility and are home or bedbound.

VR Can Enhance Patient Comfort and Quality of Life

Demand for palliative care is increasing as the global population ages. Palliative care is widely considered a human right, but the World Health Organization estimates that only around 14 percent of the roughly 60 million people who need palliative care each year worldwide receive it.

VR has shown potential as an alternative to the high-cost pain therapy services and medications that palliative care patients typically receive. The executive vice president and chief medical officer of VITAS Healthcare, the largest provider of hospice care in the United States, said that “VR technology can deliver surprising results at a relatively low cost and with little training required for caregivers.”

An article in The Conversation describes how this is being done. Palliative care staff in an acute ward gave patients three 20-minute VR sessions. They worked with the patients to create a VR experience tailored to them, including a walk through the streets of Paris and a VR Star Wars Game, and asked them before and after each session how they felt.

The results, published in the journal BMJ Supportive & Palliative Care, were promising. More than 50 percent of patients experienced “clinically meaningful” reductions in pain and depression immediately following a 20-minute VR session.

One patient told the researchers, “When the service is finished you feel like you’re floating.” A second patient said, “Oh, it’s just amazing, it was nothing like I expected […] it takes you from this world into another beautiful world.”

In addition to immediate relief from their physical and emotional discomfort, VR can give patients access to experiences and places on their bucket list and help them to achieve a last wish, improving their quality of life through a peaceful escape — if only in a virtual environment.

VR headsets also enable patients to engage in activities like working in the garden and stacking blocks that can support brain and body health. They can be programmed with images of a patient’s family and slideshows of their life and even allow families to share experiences that are not otherwise possible, such as traveling together to a remote destination or revisiting a childhood home.

Positive patient outcomes like those measured in the BMJ study have been reported elsewhere:

• A study published in BMC Palliative Care found that around 17.5 percent of participants reported lower rates of pain-related sleep impairment after a virtual reality session, while about 82.5 percent reported feeling “joy” or “happiness.”
• A second study found that close to 88 percent of palliative patients who used VR reported physical and/or psychological symptom relief.
• The authors of the BMC Palliative Care study reviewed several other studies on palliative care VR interventions published between 2012 and 2021. The patients in these studies, who had a wide range of illnesses and ages, reported improved pain management, reduced feelings of anxiety and depression, a “significant improvement” in quality of life, and positive behavioral changes.
• A data analysis of 31 studies on VR and palliative care concluded that VR eases the pain and distress of patients with conditions like cancer, dementia, kidney disease, and multiple sclerosis. The researchers suggest that VR might be able to reduce the subjective experience of pain or boost a patient’s ability to cope with their physical and psychological symptoms by distracting them and altering their state of mind.

Not all patients enjoy the VR experience. Some have told researchers the simulated world made them feel worse or that the headset was uncomfortable. However, new technologies are being developed to suit the needs of palliative care patients.

A clinic in Australia, for example, replaced their older VR equipment with new headsets that are light and wireless. Specific VR therapies are being developed to help patients in palliative care as well. Flourishing-Life-of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) is a treatment that combines traditional relaxation breathing practice with panoramic video played on a headset. And VITAS Healthcare is teaming up with AT&T to develop therapies that use 5G virtual and augmented reality systems.

Researchers caution that, despite its demonstrated potential as an alternative therapy, VR is just one tool in the palliative care team’s toolbox of treatment options. They say it requires further study to develop more standard treatment protocols and to determine what side effects or long-term effects there might be.

Ways to Access VR Palliative Care

If you or a loved one is interested in accessing VR as part of your palliative care plan, inquire with hospitals and clinics or consult with your health care provider about potential options.

Patients can also reach out directly to a VR company such as Guided VR or Rendever and ask about any solutions they offer for palliative care. In addition, it might be possible to work with a caregiver who is trained to use VR in palliative care or participate in a clinical trial or similar study.

A local elder law attorney who is knowledgeable about the latest VR palliative care research can help to answer your questions and connect you with a provider.