How effective is virtual reality technology in palliative care? A systematic review and meta-analysis

BACKGROUND: The efficacy of virtual reality for people living with a terminal illness is unclear. AIM: To determine the feasibility and effectiveness of virtual reality use within a palliative care setting. DESIGN: Systematic review and meta-analysis. PROSPERO (CRD42021240395). DATA SOURCES: Medline, Embase, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2021. Search terms included 'virtual reality' and 'palliative care'. Eligibility: (1) adult (>18 years old) with a terminal illness (2) at least one virtual reality session and (3) feasibility data and/or at least one patient outcome reported. The ROB-2 and ROBINS tools assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool assessed the quality of the evidence. Standardised mean differences (Hedges's g) were calculated from the pre- and post-data. A DerSimonian-Laird random effects model meta-analysis was conducted. RESULTS: Eight studies were included, of which five were in the meta-analysis. All studies had at least some concern for risk of bias. Virtual reality statistically significantly improved pain (p = 0.0363), tiredness (p = 0.0030), drowsiness (p = 0.0051), shortness of breath (p = 0.0284), depression (p = 0.0091) and psychological well-being (p = 0.0201). The quality of the evidence was graded as very low due to small sample sizes, non-randomisation methods and a lack of a comparator arm. CONCLUSIONS: Virtual reality in palliative care is feasible and acceptable. However, limited sample sizes and very low-quality studies mean that the efficacy of virtual reality needs further research

Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review

Abstract Background In palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases

How effective is virtual reality technology in palliative care? A systematic review and meta-analysis

How effective is virtual reality technology in palliative care? A systematic review and meta-analysis Show all authors Jiping Mo, Victoria Vickerstaff, Ollie Minton, ... First Published May 30, 2022 Review Article https://doi.org/10.1177/02692163221099584 Article information Article has an altmetric score of 17 No Access Article Information Article first published online: May 30, 2022 Jiping Mo1, Victoria Vickerstaff2, 3, Ollie Minton4, Simon Tavabie5, Mark Taubert6, 7, Patrick Stone2, Nicola White2 1UCL Division of Psychiatry, London, UK 2Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK 3Priment Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London (UCL), London, UK 4Sussex Cancer Centre University Hospitals, Sussex, UK 5St Joseph’s Hospice, Hackney, UK 6Palliative Medicine, Velindre Cancer Centre, Cardiff, UK 7Palliative Care, Cardiff University School of Medicine, Cardiff, UK Corresponding Author: Nicola White, Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Email: [email protected] Abstract Background: The efficacy of virtual reality for people living with a terminal illness is unclear. Aim: To determine the feasibility and effectiveness of virtual reality use within a palliative care setting. Design: Systematic review and meta-analysis. PROSPERO (CRD42021240395). Data sources: Medline, Embase, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2021. Search terms included ‘virtual reality’ and ‘palliative care’. Eligibility: (1) adult (>18 years old) with a terminal illness (2) at least one virtual reality session and (3) feasibility data and/or at least one patient outcome reported. The ROB-2 and ROBINS tools assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool assessed the quality of the evidence. Standardised mean differences (Hedges’s g) were calculated from the pre- and post-data. A DerSimonian-Laird random effects model meta-analysis was conducted. Results: Eight studies were included, of which five were in the meta-analysis. All studies had at least some concern for risk of bias. Virtual reality statistically significantly improved pain (p = 0.0363), tiredness (p = 0.0030), drowsiness (p = 0.0051), shortness of breath (p = 0.0284), depression (p = 0.0091) and psychological well-being (p = 0.0201). The quality of the evidence was graded as very low due to small sample sizes, non-randomisation methods and a lack of a comparator arm. Conclusions: Virtual reality in palliative care is feasible and acceptable. However, limited sample sizes and very low-quality studies mean that the efficacy of virtual reality needs further research

Cancer centre supportive oncology service: health economic evaluation

Objectives: There have been many models of providing oncology and palliative care to hospitals. Many patients will use the hospital non-electively or semielectively, and a large proportion are likely to be in the last years of life. We describe our multidisciplinary service to treatable but not curable cancer patients at University Hospitals Sussex. The team was a mixture of clinical nurse specialists and a clinical fellow supported by dedicated palliative medicine consultant time and oncology expertise. / Methods: We identified patients with cancer who had identifiable supportive care needs and record activity with clinical coding. We used a baseline 2019/2020 dataset of national (secondary uses service) data with discharge code 79 (patients who died during that year) to compare a dataset of patients seen by the service between September 2020 and September 2021 in order to compare outcomes. While this was during COVID-19 this was when the funding was available. / Results: We demonstrated a reduction in length of stay by an average of 1.43 days per admission and a reduction of 0.95 episodes of readmission rates. However, the costs of those admissions were found to be marginally higher. Even with the costs of the service, there is a clear return on investment with a benefit cost ratio of 1.4. / Conclusions: A supportive oncology service alongside or allied to acute oncology but in conjunction with palliative care is feasible and cost-effective. This would support investment in such a service and should be nationally commissioned in conjunction with palliative care services seeing all conditions

Online training improves medical students' ability to recognise when a person is dying : the ORaClES randomised controlled trial

BACKGROUND: Recognising dying is a key clinical skill for doctors, yet there is little training. AIM: To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying. DESIGN: Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The control group received no training. SETTING/PARTICIPANTS: Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival - 100% certain death) pre, post, and 2 weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants' and the experts' scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran-Weiss-Shanteau (CWS)). RESULTS: Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (δMAD = -3.43, 95% CI -0.11 to -0.34, p = <0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (δMAD = 1.50, 95% CI -0.87 to 3.86, p = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); p = 0.01). CONCLUSION: The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making

Seeking excellence in end-of-life care (SEECare UK): A UK multi-centred service evaluation

Context People dying in hospitals without specialist palliative care (SPC) input may suffer with significant unmet needs, unrecognised until case-note audit after death. Objectives To evaluate the care of dying hospital inpatients unknown to SPC services across the United Kingdom to better understand their needs and identify factors impacting care of this cohort. Methods Prospective one day UK-wide service evaluation including all dying adult inpatients, excluding those in Emergency Departments/Intensive Care Units. Holistic needs and use of recognised end-of-life care plans (EOLCP) were assessed for those unknown to SPC. Results 88 hospitals, 284 patients. Nearly all patients had unmet holistic needs (93%) which included physical symptoms (75%) and psychological, social and spiritual needs (86%). A dying patient was more likely to have unmet needs and require SPC intervention at a District General Hospital (DGH) compared to a Teaching Hospital/Cancer Centre (Unmet need 98.1% v 91.2% p0.02; Intervention 70.9% v 50.8% p0.001) and when an EOLCP was not utilised (Unmet need 98.3% v 90.3% p0.006; Intervention 67.2% v 53.3% p0.02). Multivariable analyses demonstrated that teaching/cancer hospitals (aOR 0.44 CI 0.26–0.73) and increased SPC medical staffing (aOR 1.69 CI 1.04–2.79) independently influenced need for intervention. However, integration of the use of an EOLCP within the model reduced the impact of SPC medical staffing. Conclusion People dying in hospitals unknown to SPC have significant unmet needs. Further evaluation is required to understand the relationships between patient, staff and service factors in best meeting dying peoples’ needs. The effective content and implementation of EOLCP warrants further investigation

An investigation into the biological pathogenesis and clinical correlates of cancer-related fatigue in disease-free breast cancer patients

Background: 30-40% of women successfully treated for breast cancer experience chronic fatigue for up to five years after the end of therapy. They experience a number of associated problems including reduced quality of life, lower mood and concentration difficulties. The causes of these problems and the underlying biological pathogenesis of these symptoms are unclear. The primary objective of this research was to identify whether there were differences in objective activity, cognitive function and inflammatory cytokines between fatigued and non-fatigued women post-treatment. Methods: This was a cross-sectional observational study. Women were recruited from a nurse-led follow-up clinic at St George's hospital over a two-and-a-half-year period. These women were categorised on the basis of a semi-structured interview as to whether they met the criteria to be a case of cancer-related fatigue syndrome (CRFS) or acted as a control. All participants completed a set of questionnaires, activity recording, cognitive testing and had blood taken for analysis. Samples were sent to a commercial company for analyte panel testing (88 markers) and were also analysed using proteomic techniques (including mass spectrometry) to identify any differences in plasma proteins between groups. Results: 114 women were recruited; 45 cases and 69 controls. A between group analysis demonstrated statistically significant differences in sleep quality (p=0.02) and daytime activity (p=0.03) on activity recording, and slower processing speed (p=0.009) and impaired verbal memory (p=0.03) on cognitive testing. Blood analysis demonstrated statistically significant differences (p<0.03) with raised inflammatory cytokines on commercial testing (interleukin 18, vascular endothelial growth factor and macrophage inflammatory protein 1) and increased non-specific inflammatory markers on an exploratory proteomic analysis (serum amyloid A and collectin). Conclusions: Statistically significant differences in subjective symptoms, e.g. difficulty concentrating, and linked objective data, e.g. reduced cognitive processing speed, were identified. These differences were associated with evidence of an underlying prolonged inflammatory response (indicated by raised cytokine levels) in the CRFS group. Future work should examine these observed differences prospectively before, during and after treatment.EThOS - Electronic Theses Online ServiceGBUnited Kingdo