THE EFFECT OF VIRTUAL REALITY
DURING INVASIVE PROCEDURES ON
PEDIATRIC AND ADOLESCENT
ONCOLOGY PATIENTS: A REVIEW
NAME
DATE
HAN University of Applied Sciences, Verpleegkunde
Lint minor
Supervisor:
Examiner:
,Table of contents
ABSTRACT...................................................................................................................................................... 4
INTRODUCTION............................................................................................................................................. 5
RESEARCH QUESTION.................................................................................................................................... 6
METHODS...................................................................................................................................................... 6
Search Strategy....................................................................................................................................................6
In- & exclusion criteria.........................................................................................................................................6
Study selection procedure...................................................................................................................................6
Quality assessment..............................................................................................................................................6
Data extraction.....................................................................................................................................................7
Data synthesis......................................................................................................................................................7
Quality of this review...........................................................................................................................................7
RESULTS........................................................................................................................................................ 8
Study selection process........................................................................................................................................8
Study characteristics............................................................................................................................................9
Themes...............................................................................................................................................................10
Pain................................................................................................................................................................10
Fear and Anxiety............................................................................................................................................10
DISCUSSION................................................................................................................................................. 11
Comparison to literature...............................................................................................................................11
Strengths........................................................................................................................................................11
Limitations.....................................................................................................................................................11
Implications....................................................................................................................................................12
CONCLUSION............................................................................................................................................... 12
RECOMMENDATIONS................................................................................................................................... 13
Practical recommendations...............................................................................................................................13
Educational recommendations..........................................................................................................................13
Research recommendations..............................................................................................................................13
REFERENCES................................................................................................................................................. 14
Appendix..................................................................................................................................................... 16
Appendix A Search strategy...............................................................................................................................16
Research question.........................................................................................................................................16
Search terms..................................................................................................................................................16
In- and exclusion criteria...............................................................................................................................16
Search string PubMed....................................................................................................................................16
Search string CINAHL.....................................................................................................................................17
Appendix B Level of evidence pyramid..............................................................................................................18
,Appendix C Methodological quality assessment...............................................................................................18
Appendix D Extraction table................................................................................................................................1
Appendix E Peer letter for …................................................................................................................................0
Appendix F Peer letter received...........................................................................................................................2
Appendix G Rebuttal letter...................................................................................................................................4
, ABSTRACT
Objective
The aim of this paper is to systematically evaluate the effects of virtual reality (VR) on
pediatric and adolescent oncology patients.
Background
Cancer patients must undergo different invasive treatments such as IV insertion, gaining PIC
or PAC access, lumbar punctures and more. These procedures can be upsetting and painful,
especially for younger children. Therefore, many hospitals use different forms of distraction
methods during these procedures. Virtual reality is an up-and-coming distraction method.
Method
A search was performed on PubMed and CINAHL between September 2022 and December
2022. The studies were screened on the title and abstract and study design. Then the
researcher obtained full texts of the remaining studies. The included studies were assessed
using the Cochrane checklist. After that, data were extracted from the studies using a data
extraction table.
Results
Five studies were included in this review. Most of them studied the effect of VR during port
access, and another study tested VR during a lumbar puncture. The results of the studies
show a reduction in pain, anxiety, and fear scores when patients use the VR intervention,
even though there is no statistically significant difference. When compared to another
distraction method, the differences are also not statistically significant.
Conclusion
Virtual reality could be an effective distraction method for pediatric and adolescent oncology
patients. Studies show a reduction in pain, fear, and anxiety scores with the VR intervention.
Recommendations
More research is needed to optimize the effect of VR on pediatric and adolescent oncology
patients. But, even with the information available right now, VR should be implemented in
pediatric oncology departments as a distraction method. During education, more time
should be invested in the process of writing a review and doing research.
Keywords: Virtual reality, pediatric oncology, review
, INTRODUCTION
Cancer is still one of the deadliest diseases in the world. In 2020 the disease was responsible
for almost ten million deaths worldwide. Each year around 400 000 children get diagnosed
with cancer. Luckily the treatment options have advanced over the years resulting in fewer
deaths. However, these treatments are known to be brutal and sometimes painful, resulting
in traumatic experiences for children. Cancer pain can be caused by the tumour but also by
the different treatments, diagnostic procedures or even a combination of factors (PDQ®
Supportive and Palliative Care Editorial Board, 2022).
Invasive treatments are often necessary to treat different forms of cancer. The Southeastern
Regional Medical Center (2019) defines invasive procedures as "a procedure involving
puncture or incision of the skin, or insertion of an instrument or foreign material into the
body". Cancer patients must undergo different invasive treatments such as IV insertion,
gaining PIC or PAC access, lumbar punctures and more. As stated before, these procedures
can be upsetting and painful, especially for younger children. Therefore, many hospitals use
different forms of distraction methods during these procedures. Virtual reality is an up-and-
coming distraction method.
Virtual reality (VR) is a technology that immerses users in a computer-generated simulation
of a three-dimensional environment (Arane, 2017). The experience is often incredibly
realistic and can be used for entertainment, education, and various application such as
healthcare.
In her article Sascha Brodsky (2022) states that "virtual reality is increasingly being used to
train health care providers, assist with pain management and provide telemedicine across
the globe." Over the last few years, VR has become of utmost importance in healthcare. VR
is also used as a distraction tool during fear-provoking or rough procedures. Most of the
distraction methods available distract patients using only one of the senses. A distraction
technique is more effective when it stimulates different sensory signals. "VR involves the
active participation of the patients in a task requiring cognitive or behavioural functioning,
thereby distracting the brain from pain" (Dumoulin et al., 2019).
In the last couple of years, more and more research has been done on virtual reality,
especially on burn victims. Still, there needs to be more research on this specific patient
group, the pediatric and adolescent oncology patients. PDQ® Supportive and Palliative Care
Editorial Board (2022) states that younger cancer patients are more likely to have cancer
pain or flares. Children above six can use virtual reality (Gerçeker et al., 2020). Therefore,
this review focuses on the use of virtual reality on pediatric oncology patients between the
ages of six and twenty-five.
This review aimed to determine, before January 16, 2023, the effectiveness of virtual reality
on pediatric and adolescent oncology patients undergoing invasive procedures.
DURING INVASIVE PROCEDURES ON
PEDIATRIC AND ADOLESCENT
ONCOLOGY PATIENTS: A REVIEW
NAME
DATE
HAN University of Applied Sciences, Verpleegkunde
Lint minor
Supervisor:
Examiner:
,Table of contents
ABSTRACT...................................................................................................................................................... 4
INTRODUCTION............................................................................................................................................. 5
RESEARCH QUESTION.................................................................................................................................... 6
METHODS...................................................................................................................................................... 6
Search Strategy....................................................................................................................................................6
In- & exclusion criteria.........................................................................................................................................6
Study selection procedure...................................................................................................................................6
Quality assessment..............................................................................................................................................6
Data extraction.....................................................................................................................................................7
Data synthesis......................................................................................................................................................7
Quality of this review...........................................................................................................................................7
RESULTS........................................................................................................................................................ 8
Study selection process........................................................................................................................................8
Study characteristics............................................................................................................................................9
Themes...............................................................................................................................................................10
Pain................................................................................................................................................................10
Fear and Anxiety............................................................................................................................................10
DISCUSSION................................................................................................................................................. 11
Comparison to literature...............................................................................................................................11
Strengths........................................................................................................................................................11
Limitations.....................................................................................................................................................11
Implications....................................................................................................................................................12
CONCLUSION............................................................................................................................................... 12
RECOMMENDATIONS................................................................................................................................... 13
Practical recommendations...............................................................................................................................13
Educational recommendations..........................................................................................................................13
Research recommendations..............................................................................................................................13
REFERENCES................................................................................................................................................. 14
Appendix..................................................................................................................................................... 16
Appendix A Search strategy...............................................................................................................................16
Research question.........................................................................................................................................16
Search terms..................................................................................................................................................16
In- and exclusion criteria...............................................................................................................................16
Search string PubMed....................................................................................................................................16
Search string CINAHL.....................................................................................................................................17
Appendix B Level of evidence pyramid..............................................................................................................18
,Appendix C Methodological quality assessment...............................................................................................18
Appendix D Extraction table................................................................................................................................1
Appendix E Peer letter for …................................................................................................................................0
Appendix F Peer letter received...........................................................................................................................2
Appendix G Rebuttal letter...................................................................................................................................4
, ABSTRACT
Objective
The aim of this paper is to systematically evaluate the effects of virtual reality (VR) on
pediatric and adolescent oncology patients.
Background
Cancer patients must undergo different invasive treatments such as IV insertion, gaining PIC
or PAC access, lumbar punctures and more. These procedures can be upsetting and painful,
especially for younger children. Therefore, many hospitals use different forms of distraction
methods during these procedures. Virtual reality is an up-and-coming distraction method.
Method
A search was performed on PubMed and CINAHL between September 2022 and December
2022. The studies were screened on the title and abstract and study design. Then the
researcher obtained full texts of the remaining studies. The included studies were assessed
using the Cochrane checklist. After that, data were extracted from the studies using a data
extraction table.
Results
Five studies were included in this review. Most of them studied the effect of VR during port
access, and another study tested VR during a lumbar puncture. The results of the studies
show a reduction in pain, anxiety, and fear scores when patients use the VR intervention,
even though there is no statistically significant difference. When compared to another
distraction method, the differences are also not statistically significant.
Conclusion
Virtual reality could be an effective distraction method for pediatric and adolescent oncology
patients. Studies show a reduction in pain, fear, and anxiety scores with the VR intervention.
Recommendations
More research is needed to optimize the effect of VR on pediatric and adolescent oncology
patients. But, even with the information available right now, VR should be implemented in
pediatric oncology departments as a distraction method. During education, more time
should be invested in the process of writing a review and doing research.
Keywords: Virtual reality, pediatric oncology, review
, INTRODUCTION
Cancer is still one of the deadliest diseases in the world. In 2020 the disease was responsible
for almost ten million deaths worldwide. Each year around 400 000 children get diagnosed
with cancer. Luckily the treatment options have advanced over the years resulting in fewer
deaths. However, these treatments are known to be brutal and sometimes painful, resulting
in traumatic experiences for children. Cancer pain can be caused by the tumour but also by
the different treatments, diagnostic procedures or even a combination of factors (PDQ®
Supportive and Palliative Care Editorial Board, 2022).
Invasive treatments are often necessary to treat different forms of cancer. The Southeastern
Regional Medical Center (2019) defines invasive procedures as "a procedure involving
puncture or incision of the skin, or insertion of an instrument or foreign material into the
body". Cancer patients must undergo different invasive treatments such as IV insertion,
gaining PIC or PAC access, lumbar punctures and more. As stated before, these procedures
can be upsetting and painful, especially for younger children. Therefore, many hospitals use
different forms of distraction methods during these procedures. Virtual reality is an up-and-
coming distraction method.
Virtual reality (VR) is a technology that immerses users in a computer-generated simulation
of a three-dimensional environment (Arane, 2017). The experience is often incredibly
realistic and can be used for entertainment, education, and various application such as
healthcare.
In her article Sascha Brodsky (2022) states that "virtual reality is increasingly being used to
train health care providers, assist with pain management and provide telemedicine across
the globe." Over the last few years, VR has become of utmost importance in healthcare. VR
is also used as a distraction tool during fear-provoking or rough procedures. Most of the
distraction methods available distract patients using only one of the senses. A distraction
technique is more effective when it stimulates different sensory signals. "VR involves the
active participation of the patients in a task requiring cognitive or behavioural functioning,
thereby distracting the brain from pain" (Dumoulin et al., 2019).
In the last couple of years, more and more research has been done on virtual reality,
especially on burn victims. Still, there needs to be more research on this specific patient
group, the pediatric and adolescent oncology patients. PDQ® Supportive and Palliative Care
Editorial Board (2022) states that younger cancer patients are more likely to have cancer
pain or flares. Children above six can use virtual reality (Gerçeker et al., 2020). Therefore,
this review focuses on the use of virtual reality on pediatric oncology patients between the
ages of six and twenty-five.
This review aimed to determine, before January 16, 2023, the effectiveness of virtual reality
on pediatric and adolescent oncology patients undergoing invasive procedures.
