Response to Wang Et Al., Virtual Reality As a Bridge in Palliative Care During COVID-19 (DOI: 10.1089/Jpm.2020.0212)

Journal of Palliative MedicineVol. 23, No. 7 Letters to the EditorFree AccessResponse to Wang et al., Virtual Reality as a Bridge in Palliative Care during COVID-19 (DOI: 10.1089/jpm.2020.0212)Kazuyuki Niki, Yoshiaki Okamoto, and Mikiko UedaKazuyuki NikiAddress correspondence to: Kazuyuki Niki, PhD, Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871, Japan E-mail Address: [email protected]Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.Department of Pharmacy, Ashiya Municipal Hospital, Hyogo, Japan.Search for more papers by this author, Yoshiaki OkamotoDepartment of Pharmacy, Ashiya Municipal Hospital, Hyogo, Japan.Search for more papers by this author, and Mikiko UedaDepartment of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.Search for more papers by this authorPublished Online:9 Jun 2020https://doi.org/10.1089/jpm.2020.0261AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Dear Editor:Because the new coronavirus disease 2019 (COVID-19) has manifested to be particularly severe in the elderly and those with underlying diseases,1 cancer patients receiving palliative care are at higher risk. Many palliative care units (PCUs) have strict restrictions on visitation, through prohibiting visitation or allowing only a few relatives to meet patients. However, failure to provide adequate care for anticipatory grieving at the end of life will result in stronger postbereavement grief for the patients' families.2 Some patients feel sad that they cannot return home because they are restricted to stay indoors. Therefore, the demand for remote medical care is increasing rapidly. Although videophone is a useful communication tool, we agree with Wang's suggestion that virtual reality (VR) technologies can push the boundaries of communication that videophones cannot offer.3 Therefore, we would like to present how VR can be used under the current visitation restrictions and to propose to medical professionals who are considering VR about our knowledge of pioneering VR in palliative care.Specifically, we introduce remote VR operations (VR travel) and features of VR headsets. As a further developmental approach, we also introduce VR live streaming, which can connect homes and hospital rooms with a sense of immersion.Conducting VR Travel Remotely and Features of the HeadsetAs long as a VR headset is connected to the Internet, the multiplayer mode of the Oculus app called "Wander" allows people to enjoy VR travel together, no matter where people are. It is suggested that VR travel to memorable places can temporarily improve various symptoms in inpatients on PCU.4 However, when it comes to introducing VR, some people may be confused about which headset to choose. Thus, we summarized the features of the main commercially available headsets (Table 1). Please note that this table is a personal statement based on experiences and not the result of a consensus.Table 1. The Features of the Main Commercially Available Immersive Virtual Reality HeadsetsMain product name (Company)VIVE (HTC Corporation), Oculus Rift (Facebook Technologies)Oculus Quest (Facebook Technologies)Oculus Go (Facebook Technologies)Mirage Solo with Daydream (Lenovo)Gear VR (Samsung), Daydream view (Google)Headset for ordinary smartphonePCNecessaryUnnecessaryUnnecessaryUnnecessaryUnnecessaryUnnecessaryImage quality◎◎◎◎○○Ease of purchase△ (Need a high performance PC)○◎◎- (End of sale)◎Spatial recognitionYesYesNoneNoneNoneNoneSmaller risk of nausea◎◎◎○△△Comfortable to wear (from patient's impression)△ (A little heavy)○○△△○ - △Ease of mounting on the patient (if the patient can sit)VIVE…○Oculus Rift…△ (Patients must be hooked from the back of the head)△ (Patients must be hooked from the back of the head)○○ (Need to adjust the size at the back of the head)○○Ease of mounting on the patient (when unable to sit, for example: bedridden)△△◎△○○Ease of use at the bedside△○◎◎◎◎Ease of screen sharing with patients◎ (Reflected on PC screen)◎ (Mirror to smartphone, tablet under Internet connection environment)◎ (Mirror to smartphone, tablet under Internet connection environment)△ (Requires Internet connection and screencast accessories)△ (Requires Internet connection and screencast accessories)△ (Requires Internet connection and screencast accessories)Ease of operationVIVE…○Oculus Rift…△○◎◎◎◎Enrichment of VR content (apps)◎◎◎△△△Overall evaluationRecommended for patients who can move indoors by themselves (rehabilitation, etc.).However, funding is needed.Recommended for patients who can move indoors by themselves. Relatively inexpensive and can be used at the bedsideMost useful at the bedside because it is cheap, easy to operate, and lightSometimes this is better, but, Oculus Go is usually better in stand-alone headsets.Enjoy at the individual level, not recommended for patientsSome of them are inexpensive and disposable, meaning they are useful for preventing infections. However, the image quality is dependent on the performance of the smartphone or headset.Recommended rank in palliative care3rd2nd1st5th6th4th◎, good; ○, moderate; △, requiring consideration.VR, virtual reality.Connecting Hospital Rooms and Homes Using VR Live StreamingSome patients and families communicate through applications such as Skype, but some of them find it grueling not to share the same space and cuddle together. One of the possible solutions to this problem is VR live streaming. The video taken by a 360° camera placed in a hospital room or at home can be streamed live through platforms such as YouTube and Facebook. The 360° video can be viewed with a smartphone, allowing patients or families to experience the feeling of sharing the same time and space. This seems to be a versatile method because this can be done with a commercially available 360° camera, ordinary smartphones, and simple VR goggles.The use of highly adaptive technologies for telemedicine such as VR will be meaningful in the prolonged battle against COVID-19 and in the post-COVID-19 era. This approach can be useful in PCU and COVID-19 infectious wards, as well as in general wards. Thus, it is desirable that the Internet connection in hospitals be developed, and that COVID-19 subside as soon as possible without compromising the quality of medical care.References1. Guan WJ, Ni ZY, Hu Y, et al.: Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–1720. Crossref, Medline, Google Scholar2. Otani H, Yoshida S, Morita T, et al.: Meaningful communication before death, but not present at the time of death itself, is associated with better outcomes on measures of depression and complicated grief among bereaved family members of cancer patients. J Pain Symptom Manage 2017;54:273–279. Crossref, Medline, Google Scholar3. Wang SSY, Teo WZW, Teo WZY, Chai YW: Virtual reality as a bridge in palliative care during COVID-19. J Palliat Med. 2020 [Epub ahead of print]; DOI: 10.1089/jpm.2020.0212. Google Scholar4. Niki K, Okamoto Y, Maeda I, et al.: A novel palliative care approach using virtual reality for improving various symptoms of terminal cancer patients: A preliminary prospective, multicenter study. J Palliat Med 2019;22:702–707. Link, Google ScholarFiguresReferencesRelatedDetailsCited byHarnessing New and Existing Virtual Platforms to Meet the Demand for Increased Inpatient Palliative Care Services During the COVID-19 Pandemic: A 5 Key Themes Literature Review of the Characteristics and Barriers of These Evolving Technologies6 August 2021 | American Journal of Hospice and Palliative Medicine®, Vol. 39, No. 5Virtual Reality Therapy in Palliative Care: A Case Series16 March 2022 | Journal of Palliative Care, Vol. 30Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study21 March 2022 | JMIR Aging, Vol. 5, No. 1 Volume 23Issue 7Jul 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Kazuyuki Niki, Yoshiaki Okamoto, and Mikiko Ueda.Response to Wang et al., Virtual Reality as a Bridge in Palliative Care during COVID-19 (DOI: 10.1089/jpm.2020.0212).Journal of Palliative Medicine.Jul 2020.892-894.http://doi.org/10.1089/jpm.2020.0261Published in Volume: 23 Issue 7: June 9, 2020Online Ahead of Print:May 11, 2020 PDF download