Translated from the original French version
After the Royal Trinity Hospice1 in London and the Ashiya Hospital2 in Japan, virtual reality is now becoming available for palliative care patients in France.
Dr Charlotte Decherf is a physician in a palliative care unit at the Hôpital du Bois in Lille, Northern France. For some time now, her ward has been experimenting with virtual reality. The adjacent oncology department had already been using the technology during chemotherapy sessions. There, patients were able to visit the famous Louvre-Lens museum in 3D.
When some palliative care patients told us about their favourite trips, the nursing team chose to offer them an "à la carte" programme. For instance, one 70-year-old man was able to return to Venice, following in the footsteps of his honeymoon. Others went on a 3D ride on a dog sled, or attended a concert with either spiritual music or with U2.
People at the end of their lives are faced with constant anxiety arising from their deteriorating condition or the prospect of a painful treatment, such as the insertion of a Huber needle or blood gas analysis. The Léon-Bérard Cancer Centre in Lyon was a pioneer in the field of virtual reality. Over time, the technology has gradually found its way into the palliative care department in the shape of a 3D stress relief programme.
For about 20 minutes, the patient goes on a 360° journey in a calming environment and soundscape. Particularly popular among patients is diving with a whale, which combines breathing and sophrological exercises as well as self-hypnosis. The patient sits or lies alone and lets the gentle rise and fall of the whale's tail lull him to sleep. They can let go. Claustrophobics, for example, prefer a 3D walk at sunset.
The relaxation methods learned through virtual reality can then be recalled and used again as needed. This is why VR is a good complement to hypnosis, which is often used on the ward anyway. „For one patient, hypnosis didn’t seem to work because he was too caught up in reality. So he tried the 3D glasses and that worked," says Sullivan Gérard, a nurse on the ward.
Another advantage of VR is that it helps to reduce pain. The bandaging of tumour wounds is often a tedious, long and painful process. Gérard described the experience of one patient: "She was in a lot of pain during the bandaging and had to take anti-anxiety medication in advance. During the treatment, we administered Meopa, a mixture of nitrous oxide and oxygen that has a pain-relieving effect. Thanks to virtual reality, she no longer needed medication. Her fear of the treatment dropped from 7/10 to 0 and she no longer felt any pain either."
The study3 conducted on this ward in 2019 – a first for France – is convincing: Among the ten participants, the team observed a 50 % reduction in pain and a reduction in anxiety ranging from 50 to 100 %. Gérard also points out a third effect that VR has: "Patients no longer have to look at the wound during treatment. This saves them from being confronted with their injured body.
Although the introduction of 3D in these clinics has been somewhat empirical, the approach is very structured. "We check for contraindications, such as seizures or headaches," says Dr. Decherf. So, no usage without medical advice, and the caregivers closely observe any adverse physical effects. "The headset is light, but the patients are often weakened and have difficulty moving their heads, especially if there are metastases in the bones. Fifteen minutes is already plenty," adds the doctor, who points out that the patient can interrupt the session at any time by simply removing the headset.
Confronting a person at the end of life with his or her past, or with what he or she will no longer be able to do "in real life" is not trivial. We carefully take into account the psychological aspect in order to avoid depression. Virtual reality is not offered as a self-access service, but the patient is guided through the process. "When a person shows interest, a specialist in psycho-motorics stays with them in their room for the first five minutes. After that, we leave to protect their privacy," explains Dr. Decherf. A gentle approach that is bearing fruit: after his virtual walk in Venice, the patient was deeply moved, but not depressed.
What is crucial is to leave the initiative to the patient at all times. We must be careful because virtual reality is developing and it is now possible to make "tailor-made" films. Tomorrow, the patient might find himself transported to the wedding of a relative... "It is absolutely necessary to respect his or her private wishes and not to project our own ideas onto them. The danger is to cause anguish and frustration. We would like to exchange views with other teams who use virtual reality, to understand its benefits, but also its limits," explains Dr Decherf.
Virtual reality might cause concern among relatives who want to spend as much time as possible with their loved ones. However, this is hardly the case. At the Hôpital du Bois, a patient's son even did a session right after his mother to see what she had just experienced. Some patients who were focused on their pain were able to engage in new conversations with their families and caregivers. Perhaps a patient and a loved one could even share the experience and go on the same journey together. A second headset would be required for this, which is a significant investment.
Gérard says that for the moment the sessions take place outside of visiting hours, often in the evenings, "so that patients can enjoy time with their loved ones, and then calmly move on to their session." What remains at the heart of all activities on the palliative care ward are the interpersonal relationships with the relatives and caregivers.
These trials are new and limited in scope with a few patients in Lille and a dozen in Lyon. Although the results are promising, the cost of the equipment is a real obstacle regarding the use of virtual reality in palliative care. The Centre Léon Bérard has paid €3,000 for the 3D goggles and would like to purchase additional units. Based on the results of the study already conducted, the palliative care team has submitted an application for a research project. This could help fund new equipment needed to continue the work, possibly also in conjunction with other cancer centres in the form of a large study.