Mitali Patel, Locum Consultant, Palliative Medicine
Industry partner: Orchard
Velindre University NHS Trust
This Bevan Exemplar project uses virtual reality headsets to support patients undergoing radiotherapy.
I’m wheeled through the corridor and feel only the movement of the elevator ascending coupled with my anxiety. Finally I arrive to the ping of opening doors of an unknown cancer ward. I cannot move my legs. I’m advised to stay still on bed rest to prevent further paralysis. I see only the dim light of the ceiling above and become to know the walls that soon become my only view in this solitary cubicle. I’ve never been in a hospital bed, I’ve always been fit and well. This is sudden. This is suddenly debilitating. Even the effort of having a drink whilst lying flat is impossible. I consciously lie without moving, shooting back pain crippling me when I’m rolled for care. To lie in the same position, and fear that will be your fate fills me with dread. I am terrified. Terrified of this new place, this new circumstance, this new diagnosis. They spoke about Radiotherapy to my spine and I know I have to do it to help. But I’m scared. Will it hurt, will it be long, will I be alone. What do they do, what actually is radiotherapy?
I’m panicked, and feel embarrassed to ask-who do I ask? There is no escape-I cannot move and this is all I know, may ever know.
On average, Radiotherapy treatment:
Can take up to 2 hours to plan treatment with the patient lying flat and still.
Can take 15-30min for each fraction.
May require breath holding, face mask application, positioning limbs to direct field of radiation more accurately.
May range from a single dose to over 30 doses daily (a total of 15 hours).
The main side effects of treatment are tiredness and pain. When treatment is long, this can be a challenge for patients, and a source of anxiety.
Good quality care and communication of information is at the heart of delivering healthcare that our patients value and can easily access. Improving the resources available to patients allows them greater choice and should aim to improve their overall patient experience. When patient experience is good, there is value held in it.
Simulating the experience of an environment/procedure or allowing immersion into a relaxed setting are techniques already employed by Virtual Reality technology to support pain management, post-traumatic stress and dementia care.
Virtual reality (VR) can guide patients before they undergo their radiotherapy treatment by employing relaxation/distraction as well as simulating their treatment environment and preparing them with the exercises/breathing techniques they need. It allows, even those who are debilitated, the option to have a broader yet supportive experience of their forecasted care and treatment.
The patient may not be able to watch a video upright, they may not be able to hold and read a booklet, they may not be able walk to the Radiotherapy unit and view the facility. They can however apply a VR headset and be guided through the process at their pace with relaxation as an additional aid.
The concept of using Virtual Reality in Healthcare is evolving in an industry where patients seek more choice and want better understanding of their care. Velindre Cancer Centre in Wales leads in developing its use for patient relaxation/distraction therapy, patient information and is now also supporting its use in clinical training.
The intervention should be user-friendly and support the patient needs e.g. information gathering, consent, anxiety, exercise techniques etc. Ideally it should be multi-lingual to honour the diversity of the population that we care for.
To introduce VR technology in Velindre Cancer Centre to give patients information about their radiotherapy treatment and provide distraction therapy to help with relaxation and pre-procedure anxiety.
To add to the current resources available so that patients have more choice, standardised consent, access to broader (immersive) understanding of their treatment and an overall meaningful experience.
To generate ideas for VR application for various radiotherapy targeted treatments e.g. breast radiotherapy, supporting patients with their breath hold and arm position during and between treatments working with local physiotherapists for guidance.
To gain feedback from patients about their experience of VR, and measure its qualitative value as a product.
Introducing new technology within an acute hospital can generate scepticism, fear and a feeling of increased responsibility by health professionals. Although the aims of the project was to introduce VR into the mainstream and get patient feedback, there was reluctance to allow its use with patients (until it had been screened by the local health professionals).
The work over the last year has therefore focused on gaining healthcare provider appeal, acceptance and engagement. It has involved negotiating meetings with the radiotherapy department, arranging workshops for the VR device and the various programmes (relaxation/patient information) to be trialed (Orchard and local Media team support).
In the last year, the initial aims had to be revised in order to gain local Trust interest at the health professional level before VR could be implemented to obtain patient feedback.
The main outcome this year has been changing healthcare provider opinion and engaging their interest to take the product forward and ultimately sustain its use. It has centred on building confidence and empowering ideas.
The radiotherapy department was invited to several workshops to trial use of the device to enable better understanding of its potential use and benefit. The device was publicised at conferences, exhibitions and within the hospital to gain informal feedback from a variety of professionals and laypersons. Most importantly, collaboration with the department has encouraged them to generate ideas for its use for making other programmes. This co-creativity has changed the momentum and captured their imagination.
The Media department in the Trust has now invested in its own videoing kit, thus can work with professionals in-house to create videos that they feel represent what patients are likely to use.
The technology is extending to other health boards served by the Cancer Centre and has potential to be developed in other medical specialties as well as management structures e.g. remote communication into meetings without the need to travel to a central location-improving time efficiency.
With more clinical acceptance for the use of VR in practice, the next step would be to review in detail patient feedback and overall cost benefit. The initial focus has been the quality of the product and its value. Next steps include the need to:
Continue to work with the radiotherapy department in supporting their ideas for collating a video library for patients;
Survey feedback from the patients who have completed radiotherapy to gain insight into whether they would have valued VR resource at any point in their treatment;
Understand any infection control issues: research in progress; liaise with Manufacturers to devise kit for ‘Healthcare’ users;
Explore whether VR has a cost-effective impact?
Part of cohort Bevan Exemplar Projects 2017-18