The Power of Virtual Reality for End-of-Life Patients

The use of virtual reality (VR) is expanding throughout the healthcare industry for pain management, physical therapy, psychiatry, neurology, fitness, and more. In addition, virtual reality has the power to improve care and quality of life, driving palliative care experts to explore its use for dying and chronically ill patients.

What isolated COVID-19 patients taught us

During the heat of the COVID-19 pandemic, I cared for quarantined patients, alone and separated from family and friends. The only touch they felt for days and sometimes weeks was through gloved hands. The only face they saw was ours, masked and barricaded, so tightly they could hardly see our eyes, let alone hear our voices.

They were scared knowing SARS-CoV-2 invaded their bodies, and isolation increased those fears and anxieties. Our nursing staff did their best to offer video conferencing for patients to talk with friends and family. With just a few electronic tablets on our COVID-19 unit — that didn't always connect well — patients interacted with loved ones in 2D.

Today, I imagine the experience that virtual reality could have offered to those quarantined patients. To feel the presence of loved ones in such a real — albeit virtual — way may have quickened the healing for some and provided comfort for those still conscious but nearing death.

COVID-19 taught the public and reminded healthcare professionals how the love and comfort of human presence could improve one's physical health or, at the very least, help you die in greater peace. Today, studies are catching up to prove VR is a promising therapy for palliative care patients.

Current use of VR

Virtual reality uses computer technology to simulate the real world. With head-mounted displays, patients become enveloped in a different world, interacting with a virtual space as if it were tangible — like a science fiction hologram.

In the commercial world, VR is burgeoning within the travel industry and retail. In the health industry, athletes and the general public alike use it for workouts and fitness.

In rehabilitation medicine like physical therapy and cognitive rehab, experts say VR improves balance and mobility in Parkinson's patients. Virtual reality may also improve memory, tasking, and visual attention for those with cognitive impairment, according to a 2020 systematic review of the data.

In psychology, VR is compelling for meditation and therapy. For example, the review noted above — published in Complementary Therapies in Medicine — also found improvement in pain, anxiety, phobias, ADHD, autism spectrum disorders, eating disorders, and serious psychiatric conditions like psychosis and schizophrenia.

VR benefits for palliative patients

While VR is growing throughout the health and wellness industry, there's little research about its use in palliative care with seriously ill patients who have years to live or mere days. Current studies reveal encouraging data and recommend further study, since small sample sizes and poor funding limit most research. Measurable data from the studies are still ambivalent, but general outcomes are positive.

A 2023 review published in Supportive Care in Cancer found significant improvement in pain, fatigue, anxiety, upper extremity movement, and quality of life for 799 cancer patients after VR therapy. Three of the 17 studies also reported positive effects on cognition.

A 2019 research study published in Supportive and Palliative Care shows a possible reduction in similar physical and mental symptoms — like fatigue, shortness of breath, pain, anxiety, and depression — in other palliative care patients.

Additional studies and experts point to many other possible benefits of VR for palliative care patients. For those undergoing conscious procedures and treatment, virtual reality distracts patients in a way that provides less anxiety and more comfort, two key outcomes for palliative care patients.

Experts say “meaningful activities” are essential for the well-being of people with serious illnesses. However, many don't have the financial resources, health, energy, and family support to engage in their interests and events. VR can overcome these barriers and help older adults engage virtually in activities they find meaningful. Experts found improved anxiety, depression, and mental health disorders in older participants.

Virtual reality has the potential to create moments of joy and pleasure — that palliative care patients find so rare and fleeting. For example, patients with only months to live could virtually travel to places on their bucket lists, feeling almost as if they were there. Patients could also “visit” places that hold sweet, old memories. The same study, published in Healthcare, found that reminiscing by visiting memorable places was more positive for palliative care patients than visiting new or desired sites.

Most people want to die at home, but unfortunately, many die in hospitals and nursing homes. Virtual reality could allow conscious patients to choose their ideal location to feel like they are dying at home or some other dreamy place.

And what about loved ones? During lucid moments, VR could record patients talking to loved ones in their last few weeks. More potent than video recordings, VR could improve the emotional closure and well-being of grieving friends and families.

As technology improves, VR devices may allow real-time simulated interaction, making patients feel as if their loved one is truly standing in the room. Nothing compares to someone's actual presence, but it's not hard to imagine the sheer joy of talking with loved ones around the globe from your hospital bed or quarantined room using VR.

The thought of VR's potential soothes my memory of anguished patients with hope and encouragement. Carrying the weight of a patient's sense of hopelessness is a sacred honor, but it's also a factor in burnout for healthcare providers. Some studies reported that patients weren't the only ones encouraged by VR therapy. Loved ones and caregivers felt improved mental well-being, too, from patients' positive outcomes.

The side effects of using VR

The research, thus far, reveals minimal risk and few side effects of using virtual reality with palliative patients. A 2019 study published in the Journal of Palliative Medicine found that patients tolerated 30-minute VR sessions well, finding them enjoyable and useful.

However, for some patients, the headset was heavy, causing discomfort or sore shoulders. A few people reported difficulty adjusting straps, focusing on the image, or claustrophobia. Additionally, one study of VR use with dementia patients noted one of their 25 participants experienced increased crying, while another hallucinated. The other 23 participants tolerated it well.

Virtual reality use in the general public can cause nausea, headaches, dizziness, light-headedness, confusion, and cybersickness — a type of motion sickness. Virtual reality for palliative care patients — who already face many chronic symptoms — should likely offer gentle movements to prevent further discomfort.

Is VR realistic in palliative care?

Despite widespread interest, it's difficult to implement virtual reality into healthcare practice. This is frustrating because most studies found VR usable, feasible, and acceptable, even for ICU patients. It's generally well-received by patients, staff, and loved ones as well.

Nevertheless, time and resources are barriers. For example, someone must teach patients and staff how to use a head-mounted display. As a busy nurse, I know the nursing staff lacks time to teach them. Medical facilities would need designated staff members or volunteers to help patients use VR.

Another clear barrier is cost. As technology progresses, devices will become more affordable for many medical facilities. In the meantime, public grants and fundraising may be necessary to purchase VR technology for palliative care programs.

Money is also needed to fund clinical trials to collect objective data and assess the value of VR therapy for palliative patients. A big budget is required to gather high-quality, quantitative data targeted to patient care.

Accessing VR as a palliative care patient

Most palliative and hospice services are unlikely to offer virtual reality therapy yet. However, if VR appeals to you, ask your palliative care provider if they offer it and if it's right for you. If they don't provide VR treatment, they may know a facility that does.

Studies and psychologists say building a legacy before you die is good for mental health at any age. If you're a palliative care patient able to donate money, consider purchasing VR technology for your local palliative care team and donating funds to train their personnel. This could be a powerful act of kindness — leaving a legacy of potential joy and pleasure to countless suffering patients.