Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers
Abstract
:1. Introduction
1.1. Virtual Reality in Healthcare
1.2. VR’s Impact on Emotional Support and Anxiety Reduction
1.3. The Unique Advantages of VR for Patient Education
2. Materials and Methods
2.1. Context
2.2. Video Production
2.3. VR Platform and Distribution
2.4. Measures
2.5. Participants
2.6. Procedure
2.7. Data Analysis
3. Results
- VR Experience: This theme captured the overall user experience, including concepts like the first-person perspective, the friendliness and support of the staff, the realism of the VR content, side effects such as dizziness, and specific mentions of the nurse.
- Knowledge: information conveyed through the VR experience, including the process of chemotherapy, explanation of treatment steps, symptoms and side effects, question and answer sessions, and the elimination of myths and misconceptions about chemotherapy.
- Environment: the physical setting portrayed in the VR experience, such as interactions prior to meeting the nurse, the surroundings and space, and resources provided (e.g., snacks, blankets, seat warmers).
- Emotional: the emotional impact of the VR experience on participants, particularly in terms of relieving or inducing anxiety.
- Improvements: areas for enhancement in the VR experience, including technical aspects of the VR video (e.g., audio quality, video clarity, camera stability) and content-related improvements (e.g., tailored chemo experiences, simulations of actual treatment procedures).
- Overall Reactions: This theme summarized the overall positive and negative reactions of participants to the VR experience.
3.1. Reducing Anxiety
- “The experience let us have a clear understanding on what will occur during the first chemotherapy appointment and would take away some of the unknowns and answer questions that we may have going into it. Having more information and feeling educated about chemotherapy would greatly help take the anxiety out of a very anxious time.”
- “Seeing that space I would be in would be helpful to ease anxiety and understand where I’m going.”
- “Just knowing what to expect and where to go [greatly] lowers my anxiety in situations like these.”
- “Simply seeing and hearing the process beforehand. Nerves would already be a mess so having a place to turn for repeated info would be great.”
- “It’s way less stressful to approach the situation when you have already been virtually walked through all the steps beforehand.”
3.2. Previous Experience with Cancer
- “My mom is currently undergoing treatment. This would have been so helpful in the beginning of her treatment.”
- “I am familiar with chemo. I am positive people who are doing chemo for the first time will find it very useful.”
- “As a survivor I personally feel as though my anxiety surrounding my very different experience is always going to be there having already gone through the situation without the help of VR, but looking at this as an individual only recently diagnosed I believe that this could be put to wonderful use for future patients. It can ease anxiety by showing how manageable the illnesses often are and can equip individuals for things to expect while going through treatment.”
- “I had breast cancer and was able to take Exemestane for 5 years and [undergo] radiation. If I had this VR before it would have helped my anxiety.”
3.3. Understanding from a First-Person Perspective
- “The first person perspective was a powerful tool in managing my expectations and holding my attention.”
- “I truly felt the emotion of going to a new procedure, and it made me emotional to basically have someone holding my hand and walking me through the process so I wouldn’t be afraid or anxious.”
- “The first person perspective and being able to look around as if I’m the patient made everything feel more direct to me. I liked that I could go back and relisten if needed.”
- “This helps me understand what relatives in the past have experienced.”
3.4. Understanding
- “I didn’t understand all that was involved in the process before the video. Now I understand what can be expected for physical needs and potential emotions I would experience if I had to go through it.”
- “It was good to be able to go through the facility and receive information about the process on my own terms. Sometimes it is easier to process a lot of information on my own as opposed to in the physical presence of another person, especially in a medical setting.”
- “Compared to “internet knowledge”, [it] gave me a better understanding of chemotherapy experience.”
3.5. Enabling and Equipping
- “Seeing the facilities in advance, knowing the route to take, seeing the kindness and the patience of the staff, and understanding such an invasive/sensitive process before you’re living it for the first time–all of those factors could make the lived experience easier.”
- “It automatically took me to the comfort level I’d have going into the second appointment. I already feel as though I have one appointment under my belt, and I don’t feel as scared.”
- “Anxiety-provoking situations are as such because they are experiences that are unfamiliar, and there’s a general fear of the unknown or change; however, VR allowed me to be more equipped to face, familiar with, and informed about the chemotherapy process, reducing the anxiety.”
3.6. Complaints
- “The audio was not great, and I think it would be better with clearer instructions.”
- “The presence of other people in the room was distracting and confusing.”
- “I think the VR tour lost some [of] its immersion/realism due to moments where the video blurred.”
- “The only note I really had was that their (sic) were some noises in the VR experience that made me a bit uneasy… I do absolutely think that being provided with information about the process in this way was helpful, it was just the external factors that made it a bit anxiety inducing.”
3.7. Realistic Experience
- “It would have been helpful back when I received treatment as it sets realistic expectations.”
- “Everything… this was very realistic.”
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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360-Degree Video | VR Headset | ||
---|---|---|---|
(n = 241) | (n = 26) | ||
Demographics | n (Percent) ϯ | n (Percent) ϯ | p |
Age Category (In Years) | 0.412 * | ||
18–29 | 110 (45.6) | 13 (50.0) | |
30–39 | 70 (29.0) | 5 (19.2) | |
40–49 | 29 (12.0) | 7 (26.9) | |
50–59 | 16 (6.6) | 1 (3.8) | |
60+ | 16 (6.6) | 0 (0.0) | |
Gender | |||
Male | 55 (22.8) | 13 (50.0) | 0.004 ** |
Female | 176 (73.0) | 13 (50.0) | |
Transgender | 3 (1.2) | 0 (0.0) | |
Other | 6 (2.5) | 0 (0.0) | |
Prefer Not to Answer | 1 (0.4) | 0 (0.0) | |
Race and Ethnicity ✢ | |||
Native American or Alaskan Native | 1 (0.4) | 1 (3.8) | |
Asian | 17 (7.1) | 1 (3.8) | |
Black or African American | 34 (14.1) | 0 (0.0) | |
Hispanic of Any Race | 11 (4.6) | 2 (7.7) | |
White | 178 (73.9) | 23 (88.5) | |
Other | 5 (2.1) | 0 (0.0) | |
Prefer Not to Answer | 5 (2.1) | 0 (0.0) | |
Level of Education | |||
Primary | 0 (0.0) | 0 (0.0) | |
High School | 42 (17.4) | 5 (19.2) | |
Pre-University | 43(17.8) | 2 (7.7) | |
Graduate | 116 (48.1) | 14 (53.8) | |
Post-Graduate | 40 (16.6) | 5 (19.2) | |
Employment Status | 0.782 | ||
Employed | 189 (78.4) | 21 (80.8) | |
Unemployed | 52 (21.6) | 5 (19.2) | |
Cancer Survivor? | 0.143 *** | ||
Yes | 23 (9.5) | 0 (0.0) | |
No | 218 (90.3) | 26 (100.0) | |
Loved One or Close Friend with Cancer | 0.279 *** | ||
Yes | 199(82.9) | 19 (73.1) | |
No | 41 (17.1) | 7 (26.9) | |
Viewing Technology | |||
Cell Phone | 113 (46.9) | 4 (15.4) | |
Tablet | 10 (4.1) | 0 (0.0) | |
Laptop Computer | 90 (37.3) | 0 (0.0) | |
Desktop Computer | 22 (9.1) | 0 (0.0) | |
Virtual Reality Headset | 6 (2.5) | 22 (84.6) |
Variable | Category/ Measure | Group A n (Percent) | Group B n (Percent) | Statistic | p |
---|---|---|---|---|---|
Categorical Variables | |||||
Perception of Chemotherapy | Stays the Same | Males: 12 (18.2) | Females: 61 (33.2) | χ2 = 5.266 | 0.022 |
More Positive | Males: 54 (81.8) | Females: 123 (66.8) | |||
Change in Emotional/Physical Understanding of Chemotherapy | Yes | Black: 17 (50.0) | Non-Black: 161 (69.7) | χ2 = 5.214 | 0.022 |
No | Black: 17 (50.0) | Non-Black: 70 (30.3) | |||
Realism of VR | Average | White: 36 (18.4) | Non-White: 20 (31.3) | χ2 = 4.738 | 0.030 |
Above Average | White: 196 (81.6) | Non-White: 64 (68.8) | |||
VR Useful Tool in Managing Anxiety | Somewhat | White: 23 (11.6) | Non-White: 13 (19.7) | χ2 = 6.052 | 0.049 |
Moderately So | White: 71 (35.7) | Non-White: 29 (43.9) | |||
Very Much So | White: 105 (52.8) | Non-White: 24 (36.4) | |||
Continuous Variables | |||||
Age x Realism of VR | Mean ± SD | Age: 33.4 ± 13.2 | Realism: 4.1 ± 0.8 | rs(265) = 0.132 | 0.032 |
Variable | Category/ Measure | Group A n (Percent) | Group B n (Percent) | Group C n (Percent) | Statistic | p |
---|---|---|---|---|---|---|
Understanding | ||||||
Perception of Chemotherapy | Stays the Same | Average 23 (41.8) | Above Average 40 (27.4) | Excellent 11 (21.2) | χ2 = 6.087 | 0.048 |
More Positive | Average 32 (58.2) | Above Average 106 (72.6) | Excellent 41 (78.8) | |||
Reduce Anxiety | ||||||
Perception of Chemotherapy | Stays the Same | Somewhat 54 (31.8) | To a Great Extent 3 (4.9) | χ2 = 17.408 | <0.001 | |
More Positive | Somewhat 116 (68.2) | To a Great Extent 58 (95.1) | ||||
Manage Expectations about Chemotherapy | ||||||
Perception of Chemotherapy | Stays the Same | Somewhat 52 (36.6) | To a Great Extent 18 (16.7) | χ2 = 12.114 | <0.001 | |
More Positive | Somewhat 90 (63.4) | To a Great Extent 90 (83.3) | ||||
Understanding | ||||||
Change in Emotional/Physical Understanding of Chemotherapy | Yes | Average 28 (50.0) | Above Average 108 (72.5) | Excellent 36 (69.2) | χ2 = 9.452 | 0.009 |
No | Average 28 (50.0) | Above Average 41 (27.5) | Excellent 16 (30.8) | |||
Reduce Anxiety | ||||||
Change in Emotional/Physical Understanding of Chemotherapy | Yes | Somewhat 110 (64.0) | To a Great Extent 52 (85.2) | χ2 = 9.636 | 0.002 | |
No | Somewhat 62 (36.0) | To a Great Extent 9 (14.8) | ||||
Manage Expectations about Chemotherapy | ||||||
Change in Emotional/Physical Understanding of Chemotherapy | Yes | Somewhat 88 (62.0) | To a Great Extent 87 (78.4) | χ2 = 7.864 | 0.005 | |
No | Somewhat 54 (38.0) | To a Great Extent 24 (21.6) |
Variable | Category/ Measure | Group A n (Percent) | Group B n (Percent) | Group C n (Percent) | Statistic | p |
---|---|---|---|---|---|---|
Understanding | ||||||
VR Useful Tool in Managing Anxiety | Somewhat | Average 15 (27.3) | Above Average 17 (11.3) | Excellent 2 (3.8) | rs(265) = 0.263 | <0.001 |
Moderately So | Average 24 (43.6) | Above Average 58 (38.4) | Excellent 16 (30.8) | |||
Very Much So | Average 16 (29.1) | Above Average 76 (50.3) | Excellent 34 (65.4) | |||
Reduce Anxiety | ||||||
VR Useful Tool in Managing Anxiety | Somewhat | Somewhat 17 (9.9) | To a Great Extent 2 (3.2) | rs(234) = 0.462 | <0.001 | |
Moderately So | Somewhat 89 (51.7) | To a Great Extent 2 (3.2) | ||||
Very Much So | Somewhat 66 (38.4) | To a Great Extent 58 (93.5) | ||||
Manage Expectations about Chemotherapy | ||||||
VR Useful Tool in Managing Anxiety | Somewhat | Somewhat 30 (21.1) | To a Great Extent 2 (1.8) | rs(2538) = 0.238 | <0.001 | |
Moderately So | Somewhat 73 (51.4) | To a Great Extent 23 (20.5) | ||||
Very Much So | Somewhat 39 (27.5) | To a Great Extent 87 (77.7) | ||||
Understanding | ||||||
Control of Situation after VR Tour | A Little | Average 13 (23.6) | Above Average 11 (7.3) | Excellent 2 (3.8) | rs(264) = 0.323 | <0.001 |
Moderately | Average 24 (43.6) | Above Average 61 (40.7) | Excellent 16 (30.8) | |||
Quite a Bit | Average 18 (32.7) | Above Average 78 (52.0) | Excellent 34 (65.4) | |||
Reduce Anxiety | ||||||
Control of Situation after VR Tour | A Little | Somewhat 15 (8.7) | To a Great Extent 1 (1.6) | rs(233) = 0.436 | <0.001 | |
Moderately | Somewhat 83 (48.3) | To a Great Extent 6 (9.8) | ||||
Quite a Bit | Somewhat 74 (43.0) | To a Great Extent 54 (88.5) | ||||
Manage Expectations about Chemotherapy | ||||||
Control of Situation after VR Tour | A Little | Somewhat 19 (13.4) | To a Great Extent 2 (1.8) | rs(257) = 0.318 | <0.001 | |
Moderately | Somewhat 75 (52.8) | To a Great Extent 29 (25.9) | ||||
Quite a Bit | Somewhat 48 (33.8) | To a Great Extent 81 (72.3) | ||||
Understanding | ||||||
Clear Image of Chemotherapy After VR Tour | Unsure | Average 7 (13.2) | Above Average 3 (2.0) | Excellent 1 (1.9) | rs(265) = 0.381 | <0.001 |
Helpful | Average 35 (66.0) | Above Average 90 (60.8) | Excellent 16 (30.8) | |||
Reduce Anxiety | ||||||
Clear Image of Chemotherapy After VR Tour | Unsure | Somewhat 6 (3.6) | To a Great Extent 0 (0.0) | rs(233) = 0.362 | <0.001 | |
Helpful | Somewhat 162 (96.4) | To a Great Extent 61 (100.0) | ||||
Manage Expectations about Chemotherapy | ||||||
Clear Image of Chemotherapy After VR Tour | Unsure | Somewhat 9 (6.4) | To a Great Extent 0 (0.0) | rs(258) = 0.206 | <0.001 | |
Helpful | Somewhat 131 (93.6) | To a Great Extent 112 (100.0) | ||||
Understanding | ||||||
Likelihood of Recommending VR for Other Procedures | Average | Average 22 (41.5) | Above Average 29 (19.3) | Excellent 2 (3.8) | rs(262) = 0.261 | <0.001 |
Above Average | Average 31 (58.5) | Above Average 121 (80.7) | Excellent 50 (96.2) | |||
Reduce Anxiety | ||||||
Likelihood of Recommending VR for Other Procedures | Average | Somewhat 43 (25.3) | To a Great Extent 1 (1.6) | rs(232) = 0.314 | <0.001 | |
Above Average | Somewhat 127 (74.7) | To a Great Extent 60 (98.4) | ||||
Manage Expectations about Chemotherapy | ||||||
Likelihood of Recommending VR for Other Procedures | Average | Somewhat 37 (26.6) | To a Great Extent 14 (12.5) | rs(255) = 0.331 | <0.001 | |
Above Average | Somewhat 102 (73.4) | To a Great Extent 98 (87.5) | ||||
Understanding | ||||||
Realism of VR Tour | Average | Average 22 (41.5) | Above Average 29 (19.3) | Excellent 2 (3.8) | rs(258) = 0.314 | <0.001 |
Above Average | Average 31 (58.5) | Above Average 121 (80.7) | Excellent 50 (96.2) | |||
Reduce Anxiety | ||||||
Realism of VR Tour | Average | Somewhat 41 (25.3) | To a Great Extent 1 (1.6) | rs(234) = 0.375 | <0.001 | |
Above Average | Somewhat 127 (74.7) | To a Great Extent 60 (98.4) | ||||
Manage Expectations about Chemotherapy | ||||||
Realism of VR Tour | Average | Somewhat 37 (26.6) | To a Great Extent 14 (12.5) | rs(254) = 0.350 | <0.001 | |
Above Average | Somewhat 102 (73.4) | To a Great Extent 98 (87.5) |
Theme | Definition | Exemplar Quote |
---|---|---|
VR Experience | Captures the overall user experience, including first-person perspective, staff support, realism, and side effects like dizziness. | “The first person perspective was a powerful tool in managing my expectations and holding my attention.” |
Knowledge | Information conveyed through the VR experience, such as the chemotherapy process, treatment steps, and addressing misconceptions. | “I didn’t understand all that was involved in the process before the video. Now I understand what can be expected for physical needs and potential emotions.” |
Environment | The physical setting portrayed in the VR experience, including the surroundings, space, and available resources. | “Seeing that space I would be in would be helpful to ease anxiety and understand where I’m going.” |
Emotional Impact | The emotional responses elicited by the VR experience, particularly in terms of relieving or inducing anxiety. | “It’s way less stressful to approach the situation when you have already been virtually walked through all the steps beforehand.” |
Improvements | Areas for enhancement in the VR experience, including technical aspects and content-related suggestions. | “I think the VR tour lost some [of] its immersion/realism due to moments where the video blurred.” |
Overall Reactions | Summarizes participants’ positive and negative reactions to the VR experience. | “Everything... this was very realistic.” |
360-Degree Video | VR Headset | ||
---|---|---|---|
(n = 241) | (n = 26) | ||
Qualitative Codes | n (Percent) ϯ | n (Percent) ϯ | p |
Experience | 133 (55.2) | 16 (61.5) | 0.536 |
First Person | 36 (14.9) | 6 (23.1) | 0.265 * |
Friendliness/Support of Staff | 20 (8.3) | 5 (19.2) | 0.080 * |
Realistic | 53 (22.0) | 3 (11.5) | 0.214 |
VR Side Effects/Dizziness | 4 (1.7) | 6 (23.1) | <0.001 |
Speaking About the Nurse | 80 (33.2) | 12 (46.2) | 0.187 |
Knowledge | 189 (78.4) | 23 (88.5) | 0.229 |
Process | 140 (57.7) | 15 (58.1) | 0.969 |
Explaining Chemo/Treatment | 65 (27.0) | 8 (30.8) | 0.68 |
Symptoms/Side Effects | 57 (23.7) | 11 (42.3) | 0.038 |
Q&A | 66 (27.4) | 7 (26.9) | 0.96 |
Eliminated Myths/Misconceptions | 19 (7.9) | 3 (11.5) | 0.459 * |
Environment | 91 (34.6) | 9 (37.8) | 0.753 |
Pre-nurse (Prior to Seeing Nurse) | 21 (8.7) | 1 (3.8) | 0.706 * |
Surrounding/Space | 71 (29.5) | 6 (23.1) | 0.65 |
Resources Provided (e.g., Snacks) | 10 (4.1) | 2 (7.7) | 0.330 * |
Emotional | 209 (86.7) | 25 (96.2) | 0.220 * |
Relieved Anxiety | 207 (85.9) | 25 (96.2) | 0.220 * |
Increased Anxiety | 7 (2.9) | 4 (15.4) | 0.015 * |
Improvements | 76 (31.5) | 19 (73.1) | <0.001 |
VR Video | 30 (12.4) | 14 (53.8) | <0.001 |
Content | 56 (23.2) | 10 (38.5) | 0.087 |
Tailored VR Experience | 10 (4.1) | 0 (0.0) | |
Simulation of Treatment | 27 (11.2) | 7 (26.9) | 0.032 * |
All | |||
Positive | 221 (91.7) | 26 (100) | 0.235 * |
Negative | 79 (32.8) | 20 (76.9) | <0.001 |
Variable | Category/ Measure | Group A n (Percent) | Group B n (Percent) | Statistic | p |
---|---|---|---|---|---|
Categorical Variables | |||||
Process | |||||
Understanding | Average | Yes 24 (15.7) | No 32 (30.2) | χ2 = 8.218 | 0.016 |
Above Average | Yes 98 (64.1) | No 53 (50.0) | |||
Excellent | Yes 31 (20.3) | No 21 (19.9) | |||
Perception of Chemotherapy | Stays the Same | Yes 39 (25.7) | No 38 (35.2) | χ2 = 2.749 | 0.097 |
More Positive | Yes 113 (74.3) | No 70 (64.8) | |||
How Much Did VR Reduce Anxiety | Somewhat | Yes 99 (71.7) | No 74 (76.3) | χ2 = 0.607 | 0.436 |
To a Great Extent | Yes 39 (28.3) | No 23 (23.7) | |||
Emotions | |||||
Understanding | Average | Yes 44 (19.2) | No 12 (40.0) | χ2 = 6.801 | 0.033 |
Above Average | Yes 138 (60.3) | No 13 (43.3) | |||
Excellent | Yes 47 (20.5) | No 5 (16.7) | |||
Perception of Chemotherapy | Stays the Same | Yes 63 (27.5) | No 14 (45.2) | χ2 = 4.081 | 0.043 |
More Positive | Yes 166 (72.5) | No 17 (54.8) | |||
How Much Did VR Reduce Anxiety | Somewhat | Yes 151 (72.2) | No 22 (84.6) | χ2 = 1.821 | 0.177 |
To a Great Extent | Yes 58 (27.8) | No 4 (15.4) | |||
Reduce Anxiety | |||||
Understanding | Average | Somewhat 42 (91.3) | To a Great Extent 4 (8.7) | χ2 = 15.859 | <0.001 |
Above Average | Somewhat 100 (73.5) | To a Great Extent 36 (26.5) | |||
Excellent | Somewhat 27 (55.1) | To a Great Extent 22 (44.9) | |||
First Person | |||||
Understanding | Average | Yes 7 (16.7) | No 49 (22.6) | χ2 = 3.824 | 0.148 |
Above Average | Yes 22 (52.4) | No 129 (59.4) | |||
Excellent | Yes 13 (31.0) | No 39 (18) | |||
Perception of Chemotherapy | Stays the Same | Yes 10 (23.8) | No 67 (30.7) | χ2 = 0.810 | 0.368 |
More Positive | Yes 32 (76.2) | No 151 (69.3) | |||
How Much Did VR Reduce Anxiety | Somewhat | Yes 22 (59.5) | No 151 (76.3) | χ2 = 4.532 | 0.033 |
To a Great Extent | Yes 15 (40.5) | No 47 (23.7) | |||
Myths | |||||
Understanding | Average | Yes 3 (14.3) | No 53 (22.3) | 0.394 * | |
Above Average + Excellent | Yes 18 (85.7) | No 185 (77.7) | |||
Perception of Chemotherapy | Stays the Same | Yes 4 (19.0) | No 73 (30.5) | χ2 = 1.224 | 0.269 |
More Positive | Yes 17 (81.0) | No 166 (69.5) | |||
How Much Did VR Reduce Anxiety | Somewhat | Yes 10 (52.6) | No 163 (75.5) | χ2 = 4.687 | 0.030 |
To a Great Extent | Yes 9 (47.4) | No 53 (24.5) |
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Thomas, M.K.; Jarrahi, A.; Dennie, L.; Scott, S.; Lau, T.; Johnson, A. Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers. Int. J. Environ. Res. Public Health 2024, 21, 1163. https://doi.org/10.3390/ijerph21091163
Thomas MK, Jarrahi A, Dennie L, Scott S, Lau T, Johnson A. Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers. International Journal of Environmental Research and Public Health. 2024; 21(9):1163. https://doi.org/10.3390/ijerph21091163
Chicago/Turabian StyleThomas, Melissa K., Abolfazl (Abel) Jarrahi, Lauren Dennie, Sam Scott, Ted Lau, and Annika Johnson. 2024. "Virtual Reality in Cancer Care: Enhancing Knowledge and Reducing Anxiety about Chemotherapy among Patients and Caregivers" International Journal of Environmental Research and Public Health 21, no. 9: 1163. https://doi.org/10.3390/ijerph21091163