Background & Aims
Virtual reality (VR) for distraction is effective in the management of procedural pain and anxiety in children1,2, but significantly lags in the implementation of this evidence into practice. Consequently, children continue to experience undertreated procedural pain and anxiety3,4, especially when children are unresponsive to other non-pharmacological interventions. Hence, our interprofessional team, with expertise implementing VR at Shriners Hospitals for Children®-Canada (SHC-Canada), partnered with key stakeholders to address this significant lag in Quebec, Canada. Our aims were to: assess healthcare professionals’ (HCPs) readiness to champion the use of VR, train HCPs and trainees in VR use, and co-develop tailored knowledge translation (KT) interventions. Our ultimate goal was to create a bilingual, open-access, infrastructure to facilitate the safe implementation of VR into children’s healthcare settings.
Methods
An organizational, participatory research design, guided by the Knowledge-to-Action framework was conducted5. A multi-pronged approach was used to recruit a cross-sectional sample of HCPs to complete the ADOPT-VR2, a 54-item survey that assesses determinants of prospective take-up of VR based on three dimensions: attitude, social norms, and perceived behavioural control6. Based on survey findings, the simultaneous planning for a free, one-day, hybrid, VR workshop, and the collaborative creation of KT interventions ensued. The VR workshop consisted of sharing the evidence for VR use, showcasing VR products, and creating an implementation plan. The KT interventions were co-developed with key stakeholders, and tailored to disciplines, procedures, processes, and contexts of use. Data were descriptively analyzed, and KT interventions were uploaded on an online platform for open-access sharing. Data implementation plans are presently being collected and analyzed to inform next steps.
Results
Prior to the VR workshop, 47 HCPs across Quebec completed the ADOPT-VR2 survey reporting an average score of 5.1/9 (s = 1.4). While HCPs had a positive attitude towards VR (m = 7.4; s = 2.0), their VR use may be influenced by social norms (m = 5.0; s = 2.3). Lower scores of behavioural control (m = 3.8; s = 2.3) and little confidence in using VR with patients (m = 38.8%) along with significant barriers (e.g. lack of support staff, set-up assistance, funds, knowledge, and space/storage issues), contribute to the lag of implementing VR into practice. To address these gaps, a VR workshop was hosted with 95 individuals including scientists, trainees, industry leaders, non-for-profits, and patient advocates. Attendees learned the latest VR evidence for procedural pain and anxiety management and mental health disorders, and received copies of the KT interventions, including policies and procedures, research evidence summaries, step-by-step guides, comic strips, and videos. Further, attendees learned about key theoretical frameworks in implementation, to create and share their own plans to integrate VR in their practice. These plans are presently being analyzed to prioritize the ongoing development of KT interventions to further support safe VR use and integration into practice.
Conclusions
Despite strong evidence and interest, several barriers remain to support VR use in children’s health care settings. As such, our team continues to co-develop KT interventions. These interventions include: map of available interactive and immersive VR systems, funding mechanisms for VR, implementation support, technical support, how to involve patients and families, keeping track of use, safety, project management, and patient-directed resources. All material developed, including video-recordings of the workshop presentations, are available via the McGill Virtual Reality for Child Care online hub (https://www.mcgill.ca/virtualrealityforchildcare/resources-0) for wide open-access use and dissemination.
References
1.Eijlers R, Utens EM, Staals LM, de Nijs PF, Berghmans JM, Wijnen RM, et al. Meta- analysis: systematic review and meta-analysis of virtual reality in pediatrics: effects on pain and anxiety. Anesthesia and analgesia. 2019;129(5):1344.
2.Tas, F. Q., van Eijk, C. A. M., Staals, L. M., Legerstee, J. S., & Dierckx, B. (2022). Virtual reality in pediatrics, effects on pain and anxiety: a?systematic review and meta-analysis update.?Paediatric Anaesthesia,?32(12), 1292–1304. https://doi.org/10.1111/pan.14546
3.Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. Cmaj. 2011;183(7):E403-E10.
4.Stevens BJ, Harrison D, Rashotte J, Yamada J, Abbott LK, Coburn G, et al. Pain assessment and intensity in hospitalized children in Canada. The Journal of Pain. 2012;13(9):857-65.
5.Graham ID, Tetroe JM. The knowledge to action framework. Models and frameworks for implementing evidence-based practice: Linking evidence to action. 2010;207:222.
6.Glegg SMN, Holsti L, Stanton S, Hanna S, Velikonja D, Ansley B, et al. Evaluating change in virtual reality adoption for brain injury rehabilitation following knowledge translation. Disabil Rehabil Assist Technol. 2017;12(3):217-26.
Presenting Author
Sofia Addab
Poster Authors
Sofia Addab
BSc, MSc
Shriners Hospitals for Children-Canada
Lead Author
Dilek Sayik
RN
Ingram School of Nursing, McGill University
Lead Author
Yu Tong Huang
MD
Faculty of Medicine and Health Sciences, McGill University
Lead Author
Laura Massochin
PhD
Shriners Hospitals for Children-Canada
Lead Author
Tina Athanasoulias
RN
Shriners Hospitals for Children-Canada
Lead Author
Juliana Marulanda
DDS
Shriners Hospitals for Children-Canada
Lead Author
Beatriz Ferraz dos Santos
DDS
Faculty of Dental Medicine and Oral Health Sciences, McGill University
Lead Author
Reggie Hamdy
MD
Shriners Hospitals for Children-Canada
Lead Author
Kelly Thorstad
MSc(A)N
Shriners Hospitals for Children-Canada
Lead Author
Argerie Tsimicalis
RN
Ingram School of Nursing, McGill University; Shriners Hospitals for Children-Canada
Lead Author
Topics
- Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science