1. Nalley, Catlin

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A recent prospective study demonstrated that 3D virtual reality imaging review was more effective than current methods when it comes to conveying and contextualizing complex information to patients, according to a presentation from the American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 2289). Further evaluation of virtual reality as a next-generation educational tool in cancer patient consultations is warranted.

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"A cancer diagnosis is often a very traumatic event that impacts patients along with their ability to process and retain information," noted study author Douglas E. Holt, MD, Radiation Oncologist at Eastern Idaho Regional Medical Center. "One of the biggest struggles for patients is simply just trying to understand what is happening to them.


"Studies show that up to 80 percent of the information that is presented to patients is forgotten nearly immediately after a consultation and up to 50 percent of the information that patients do retain can be inaccurate," he explained during a press briefing.


Why does this matter? "Poor understanding is associated with worse clinical outcomes as well as patient experiences," said Holt. "So, the big question is: How can we as providers help patients understand their disease and their treatment more fully?"


Evolution of Patient Education

The concept of patient education and the way physicians handle this aspect of care has changed significantly over time.


"It wasn't that long ago that we did nothing for patients," Holt explained. "Doctors are very paternalistic, and they didn't think the patients needed to know, but that has since changed and they are trying to inform patients of what's happening."


One of the most common tools used to educate patients is verbal description. And while this may seem like a good approach, studies suggest that it is the least effective method when used alone, said Holt, who also noted that this is predominately how patients are informed about their disease and treatment.


Illustrations, videos, and medical imaging can be helpful tools, but patients often still struggle to understand and providers have difficulty communicating this complex information effectively, according to Holt.


There has been some success with the use of 3D-printed models, but there are some problems, including that "they aren't scalable and come with a cost as well as limits to what you can look at," Holt said. "But this is where I think virtual reality can excel, because we can take this medical imaging that's not very interpretable and we can convey this information in a very simple and easy to understand format."


A New Approach

Virtual reality for patient education has the ability to personalize information for the individual. With this approach, you are able to present anatomical information in 3D versus 2D, which has been shown to reduce cognitive load and enable additional learning, according to Holt.


"This is supported by many learning theories," he elaborated. "Using virtual reality in this format, instead of a patient just seeing something or hearing something, they're experiencing something. They're interacting with themselves."


While there are limited studies, Holt noted that current research has shown high patient satisfaction, increased engagement, and a strong preference for using virtual reality.


"Virtual reality is a way to bridge that gap, to be a leveler for patients, [and] to help them actually understand and speak on the same level as their providers. But more importantly, it can allow them to be engaged in their own care [and] make decisions that they're fully informed of," according to Holt.


"What's really impressive about virtual reality is we can take those individual image slices and put them together and present a 3D representation of their own imaging and allow patients the chance to look inside themselves or their caregivers to look inside and see what's actually happening, to visualize their tumor, see why they're having certain symptoms, and understand why certain treatments are recommended."


Patient Impact

In an effort to see the impact of virtual reality for patients, Holt and colleagues conducted a single-arm, prospectively accrued, mixed-method study. During clinical visits in radiation oncology, the researchers showed 38 cancer patients and caregivers their own 2D planar medical imaging on a computer screen followed by a 3D virtual reality volumetric review of diagnostic imaging and radiation targets.


"Participants completed pre- and post-virtual reality Likert scale questionnaires and interviews," according to the study authors. "Survey analysis utilized Wilcoxon signed-rank test. Interview data was analyzed qualitatively."


The included patients ranged from age 11 to 95 years and there was a median of 5 months from diagnosis to virtual reality. The researchers found that patients typically had poor comprehension when using standard educational tools in clinical visits. Patients also reported that 2D imaging review was challenging to interpret, confusing, and nonintuitive.


Quantitatively, the researchers noted that patient and caregiver understanding of their own disease (0=none, 10=full) improved significantly from pre-virtual reality (mean 5.6) to post-virtual reality (mean 9.2). Eighty-three percent of patients rated virtual reality as the top educational tool over other methods and 97 percent preferred virtual reality over a 2D-computer screen in imaging review.


"In a head-to-head comparison, VR led to a higher level of understanding over 2D-imaging in every survey domain including tumor, symptoms, radiation target, treatment-related symptoms, and therapy rationale," the study authors reported. "VR was also superior to 2D imaging review in decreasing anxiety, increasing engagement, and providing higher satisfaction."


Concluding his presentation, Holt noted that the responses were better than expected and many patients expressed how powerful this tool was for them. In terms of next steps, he said his goal is to make this standard of care and offer a better way to interface between providers and patients.


Catlin Nalley is a contributing writer.