Background Anxiety is a common experience among Children and Young People (CYP) attending hospital for a procedure under general anaesthetic, some of whom require anxiolytic medication. Methods to reduce anxiety, such as hospital tours, have not been possible during the COVID-19 pandemic prompting us to reimagine how these can be delivered. Use of Virtual Reality (VR) in Paediatrics has largely focused on distraction during a procedure but VR can be effectively used preoperatively to reduce anxiety. Preadmission use of VR to reduce anxiety has also demonstrated a potential health economic benefit. We describe progress in developing a VR environment to simulate hospital tours in a Paediatric Hospital in the United Kingdom. Objectives Improve the patient experience by reducing preprocedural anxiety in CYP attending for a planned procedure under general anaesthetic, using VR technology to simulate a tour of an anaesthetic room. The VR environment must be accessible and interactive for CYP aged 8-21 years using a smartphone or device and VR headset at home, the content and design of which is informed by the experience and opinions of CYP at every stage of development. Methods Initial input of CYP was sought at a Young People's Forum. Discussions informing both the content and design were facilitated by healthcare professionals and involved CYP aged 10-18 years. A VR developer then created a digitally rendered anaesthetic room to produce a minimum viable product (MVP) using 'Autodesk Maya' and 'Unity' software. A 360° video of an anaesthetic room was also developed. Information provided within the VR environment was produced by Paediatric Healthcare professionals with input from experts in acute Paediatric anxiety. Focus groups of CYP will provide qualitative feedback to drive improvement cycles of the VR environment on a regular basis along with integration of interactivity and gamification. Following this patients will be invited to experience the virtual environment. Results CYP felt that a VR environment could help reduce preprocedure anxiety. They identified reducing uncertainty, optimising comfort, familiarity and trust in healthcare professionals and understanding medical devices and the physical experience as key factors for consideration when developing the VR environment. A calm environment with a relatable character, interactivity and gamification were identified as design priorities. The initial focus group review of the MVP is scheduled imminently with a plan to complete improvement cycles on a three monthly basis. Patients will be offered the opportunity to explore the VR environment at their pre-assessment appointment if the healthcare team and parent/guardian believe they may benefit. Conclusions Preprocedure anxiety is a major factor affecting the experience of CYP. This project aims to counter that using VR technology. The engagement of key stakeholders to inform throughout development ensures constant relevance is maintained in design and delivery. Reducing uncertainty, optimising familiarity and trust in the healthcare environment and team were identified as key factors in reducing anxiety. Interactivity and gamification are important in enhancing engagement. Ongoing review with CYP will shape and extend this tool with a view to building an interactive VR hospital allowing exploration of the whole hospital journey.
Virtual reality hospital: Developing a patient centred virtual environment to reduce preprocedural anxiety in children and young people