Virtual reality has been available for many years and is starting to gain traction in
clinical setting in varied fields with multiple applications. Some of the primary clinical
settings that virtual reality has shown benefit are in pain attenuation and mental health,
particularly anxiety. Palliative Care is a field of medicine that most patients have both
pain and anxiety to a certain degree. The medications used to manage this (opioids,
benzodiazepines) are used but not without side effects to the patient as well as cost to the
medical system. So far, there are very few studies looking at the effect of virtual reality
on symptom burden in palliative care. The primary outcome of this study would be to look at
virtual reality's role in decreasing breakthrough opioids use for pain and benzodiazepine use
for anxiety by decreasing symptoms experienced by patients by providing them with an
immersive computer generated experience. The secondary outcome of this study will be
patient's perception of symptoms with the use of virtual reality.
Virtual reality has been shown to be effective in many areas of medicine, particularly in
pain management and mental health. Studies utilizing VR in pain management have commonly been
done with burn victims, as burns are thought to be among the most painful injuries people
sustain. Using a within subject design where the patient is his/her own control, these
studies have shown an observable benefit in decreasing pain as well as cutting down on the
opioid doses required to get analgesia in patients requiring wound debridement and
physiotherapy in both adults and children. The investigator's patient population in
palliative care is susceptible to painful metastases, pressure ulcers, and other causes of
pain, which are comparable to pain experienced by burn victims. Therefore, the results of
theses studies are relevant and may prove beneficial for patients receiving palliative care.
In this study, patients will receive alternating days of standard palliative care and
standard palliative care with virtual reality as an option for symptom management for a total
of 4-10 days. Patients will be randomized to start with standard care with virtual reality or
start with standard care alone. The immersive virtual reality experience would be delivered
through an Oculus Quest. There will be 3 different software options that can be used based on
preference. Patients will be asked the degree of pain/anxiety prior to applying the virtual
reality headset and then the same scale immediately after indicating their pain/anxiety
during the experience. After the 4-10 days, breakthrough use of opioids and benzodiazepines
during days with standard care and virtual reality will be compared to breakthrough use with
standard care alone.
It is anticipated that the use of virtual reality will decrease the amount of medication
necessary to manage symptoms of pain and/or anxiety. It is also anticipated that this will
provide the patient with a pleasant respite from their symptoms.