What Is Known/What Is New
What Is Known
- The standard practice of delivering medical information via text-based information may not elicit a high level of patient comprehension or satisfaction.
- Interactive virtual reality can improve patients’ medical knowledge and understanding.
What Is New
- This study examines a newly developed customizable virtual reality technology for demonstrating procedural results for gastrointestinal conditions.
- The virtual reality technology generated significantly higher satisfaction in patients when learning about their procedural results compared with the standard practice.
Gastrointestinal (GI) diseases affect an estimated 70 million Americans annually, and account for substantial morbidity, mortality, and cost in the United States (1). GI diseases in the United States are associated with nearly $136 billion per year in direct and indirect costs (1). Following GI procedures, gastroenterologists need to meet with patients and families to explain endoscopic findings, start or modify a treatment plan, and plan appropriate postprocedure follow-up visits. Unfortunately, most patients recall very little information of what is discussed during a typical medical encounter, particularly after anesthesia (2). As medical information is usually complex, it can be difficult for the healthcare provider (HCP) to translate that knowledge to the patient or family member in a way that is easy to understand during the brief postprocedure interaction (3). This process can be particularly challenging when delivering medical information to pediatric patients.
Providing patients with a better understanding of their own medical condition can lead to enhanced patient satisfaction, better physician-patient relationships, increased likelihood of treatment adherence, and improved health outcomes (4,5). A possible solution to improve patients’ medical knowledge and understanding is through interactive virtual reality (VR) technology and video-gaming techniques (6–8). Recently, we developed and described a new VR platform, called HealthVoyager (9), which is a customizable software system utilizing a smartphone or tablet to portray personalized procedural findings and anatomy representations to patients. The platform recreates a real-world scenario and is designed to assist clinicians in transferring medical knowledge to patients in a more engaging way to increase their overall satisfaction and patient experience. The purpose of this research was to examine the effects of HealthVoyager for improving patient engagement, satisfaction, and understanding of their GI condition after undergoing an endoscopy or colonoscopy. Participants were randomly assigned to either the HealthVoyager (ie, test) condition or the standard practice (ie, control) condition, which involved reviewing printed endoscopy/colonoscopy reports and a physician debriefing after a procedure.
A total of 41 participants (17 test; 24 control) completed the study (Table 1), which took place in the Division of Gastroenterology at Boston Children's Hospital (BCH). All participants signed informed written consent and freely volunteered their time with no compensation. The study was performed in accordance with relevant guidelines and regulations, and received full ethics approval from the BCH internal review board.
The HealthVoyager software platform (Fig. 1) allows clinicians to generate personalized patient procedure reports using drag-and-drop functionality on digital illustrations of the upper or lower GI tract for both discrete and diffuse clinical findings. In less than 2 minutes, the physician can create a patient report, which then gets translated into a customized VR experience. In comparison to the standard of care, it takes roughly a minute to fill out a report for a typical esophagogastroduodenoscopy and another minute to fill out a typical colonoscopy report. With this timing in mind, the goal of HealthVoyager was to create a more satisfying, engaging, and educational experience for patients compared with the standard practice, while not having a considerable burden on busy, time-crunched physicians.
HealthVoyager also allows patients to use their mobile phone to create their own personalized avatar and interactively view a VR representation of their own internal anatomy, based on their unique procedural findings [for a more comprehensive overview of the HealthVoyager technology, see (9)].
A customized self-report survey was designed uniquely for this study to evaluate patients’ experience with receiving medical information in the form of perceived understanding, engagement with the technology and materials, satisfaction, and value of the information (Appendix A, https://links.lww.com/MPG/B747). The survey items were derived from other validated patient satisfaction questionnaires in the medical literature, but tailored specifically to this context. This patient experience survey contained 10 items with responses based on a 7-point Likert scale from 1 = “Strongly disagree” to 7 = “Strongly agree.”Total scale scores range from 10 to 70, with higher scores indicating a more satisfied overall experience for patients learning about their procedural results.
Patients were recruited by a research assistant in the gastroenterology clinic during follow-up after endoscopic/colonoscopy procedures, and were randomly assigned to receive either the existing standard of care or the test intervention. After the endoscopy/colonoscopy procedure, the clinician built a customized report noting the specific findings and morphologies for each GI segment to create the written information (standard practice) or virtual representation of the patient's clinical findings (HealthVoyager). All test and control patients were surveyed with identical questionnaires following their initial post-procedure debriefing.
For the purposes of this clinical trial, only 1 clinician (the last author of this article, M.J.D.) and 1 research assistant (the second author of this article, M.L.) were predominantly involved in the execution of HealthVoyager (and control survey) for study participants. However, across both conditions of the study, there were 25 different HCPs (including M.J.D.) who provided an initial explanation of the medical procedure to participants as part of the standard-of-care protocol.
Total scores for the Patient Experience Survey were summed across all 10 question items to produce 1 composite score for each patient in the HealthVoyager and Control conditions. The survey revealed high internal consistency, yielding a Cronbach alpha of 0.92. Survey scores were compared using an independent samples t-test (2-tailed) between the test and control groups. Preliminary analyses revealed no significant effects of age, sex, ethnicity, amount of first-time procedures, or amount of new diagnoses or findings between conditions.
Scores for the patient experience survey revealed a significant difference between HealthVoyager (M = 63.24; SD = 5.78) and control (M = 56.96; SD = 11.28) participants (t(39) = 2.33, P = .026), yielding an effect size of Cohen d = 0.70. Overall, this showed that patients were more satisfied in learning about their GI condition and procedural results using HealthVoyager rather than with the standard practice.
This study demonstrated that a customizable VR system can enhance the overall learning experience and enjoyment when learning about personal, and often complicated, medical procedures of gastrointestinal conditions. Importantly, this system is easily adaptable to a wide range of disease states and patient populations to support a myriad of patient journeys. Future research could also measure the longitudinal impact of HealthVoyager on treatment adherence in patients and any sustained behavior change of disease management. If it is possible to improve patients’ medical knowledge and engagement with their own physiology, this could enhance overall health outcomes by giving patients a sense of ownership and autonomy.
Additionally, this VR system does not impede or interfere with physicians’ occupational roles, but rather, it alleviates some of their work duties by allowing an efficient platform to translate complex language and information to patients who may not have any medical or science education. One limitation of this study is that no formal survey was administered to the many other physicians or nurses that acted as primary HCPs for patients’ medical procedures, in order to gain their perspectives on HealthVoyager. In total, patients had 1 of 25 different HCPs to provide an initial explanation of the medical procedure to participants as part of the standard of care protocol. Thus, there was a lot of variability in the initial interactions with participants, before the use of HealthVoyager or control condition survey. This suggests that a strength of the HealthVoyager technology is providing a generalizable enhancement of satisfaction for receiving a VR representation of medical findings in comparison to the standard of care.
The platform could also engage young patients and families who might otherwise be disinterested or fearful of viewing actual images from medical procedures. HealthVoyager has the potential to produce valuable savings of long-term physician consulting costs, and ultimately lead to enhanced patient health and well-being.
Thank you to all of the patients, healthcare providers, supporters, and researchers at Boston Children's Hospital and at Klick Inc. for the successful development, implementation, and evaluation of this research.
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