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Improving the Outpatient Infusion Experience with
What was the opportunity, issue or challenge you were trying to address and in what setting?
Outpatient infusion patients can be seated in the same chair for hours at a time while receiving treatment. Patient mindset and physical condition can vary, as well as the treatment environment. Virtual Reality has been shown to create an immersive experience that enables users to have modified experiences of reality, thus creating distraction from their situation.
What process did you use to develop a solution?
We knew virtual reality had powerful outcomes in patient care. However, we didn’t know what extent it would have in an outpatient setting and wanted to explore potential benefit on overall experience. We talked about the best place to run a pilot – one where we could offer a new, potentially exciting experience regardless of our findings. Outpatient oncology infusion fit the criteria and we teamed up with a couple of our market research folks to setup a quality improvement project.
What outcomes were you looking to achieve?
We explored the use of VR in outpatient oncology infusion with patients, staff and caregivers, and its impact on the patient experience. We wanted to learn:
- What is the current outpatient infusion experience?
- How effective is virtual reality for improving the outpatient infusion experience?
- How might virtual reality reduce discomfort and anxiety during treatment?
- What programs and modules of virtual reality work best for the outpatient infusion care environment?
The research objectives were as follows:
- Investigate patient perceptions and affinity toward virtual reality offerings.
- Evaluate effectiveness of virtual reality interaction during patient care in reducing discomfort.
- Understand what programs/modules of virtual reality work best for the UCHealth patient care environment.
- Explore other virtual reality offerings that would be of value to patients.
Additional topics for exploration:
- Emotional response: benefits, challenges, modifications
- Physical response: motion sickness and concentration
- Curating the experience: additional
What specific steps did you take to address the problem?
A qualitative-based study was conducted in three outpatient infusion clinics across the Colorado Front Range over a two month period.
The primary focus of this research was on the patient experience. However, it was also important to understand a holistic perspective of the experience with caregivers (those who accompany patients during their outpatient infusion treatments) and with internal staff members (those who administer the care of these patients).
The market research and innovation team conducted 15 to 20 minute interviews with each participant. The interview process included pre-demonstration questions, a 2 to 3 minute demonstration of virtual reality via Rendever content platform and Samsung GearVR equipment, and post-demonstration questions.
To reduce the number of variables, participants were given a choice to interact with one of two program offerings – an animated virtual reality program called Vincent Van Gogh: A Starry Night, taking participants inside the famous painting, or a realistic virtual reality program called Angel Falls, taking participants to the Angel Falls waterfall in Venezuela. Both programs were 2 to 3 minutes in length and included music as part of the experience.
What resources, if any, did you engage – either internally or externally – to address the problem?
Many people feel technology can decrease human connection and personal experiences. We strive for the opposite. We view technology as a way to bring a more personalized experience to each patient by making sure it is simple to use while enhancing meaningful conversations
For this pilot, we used our virtual reality content platform, created by Rendever, and Samsung GearVR mobile virtual reality hardware. The Rendever platform is different from other VR platforms in that it allows a caregiver to control the experience for each patient, allowing the patient to sit back and escape, rather than having to figure out how to use the equipment.
The platform also allows family members to escape and experience the content with their loved one, building a unique conversational opportunity during treatment.
What measures did you establish to determine the success of this effort?
Participants were asked pre-demonstration questions related to their background, condition, and treatment. They were also asked to describe their current outpatient infusion experience (physical and emotional).
After interacting with the virtual reality headset, participants were asked post-demonstration questions regarding the benefits, challenges, and potential programs of interest. They were also asked to describe their virtual reality experience (physical and emotional).
Although the measures for this study are primarily qualitative in nature, we did ask patients, caregivers and staff to rate their outpatient infusion experience both before and after experiencing the virtual reality offering. This was evaluated using a five-point Likert scale where 1 is negative and 5 is positive. Patients and caregivers were also asked whether or not they would like to use a virtual reality offering in this setting again.
What was the ultimate outcome of your effort?
There were a total of 60 patients, 18 caregivers and 18 staff members that participated in the study (n=96). Among patients, there were a range of different conditions, length of condition, types of treatment and length of treatment. Both the patient and caregiver groups skewed to a slightly older age range. However, this skew is reflective of the population in the outpatient infusion setting.
The median score for the current experience with UCHealth outpatient infusion clinics is a 5 among patients and a 4 among caregivers. After receiving the virtual reality demonstration, the patient score remains at a 5 while the caregiver score increased to a 5. With the current experience being so highly rated already, we cannot rely solely on these quantitative measures to evaluate the potential benefit of virtual reality.
For patients, 92% rated their virtual reality experience as positive to extremely positive (top two box on a 5 pt. Likert scale) and 88% stated that they would use virtual reality again.
For caregivers, 95% rated their virtual reality experience as positive to extremely positive (top two box on a 5 pt. Likert scale) and 94% would use virtual reality again.
Lastly, for employees, 100% projected offering virtual reality to outpatient infusions would have a positive to extremely positive impact on their care experience (top two box on a 5 pt. Likert scale) and 100% were willing to implement virtual reality program offerings to outpatient infusion patients.
In analyzing the interviews, six themes were found in relation to the VR experience:
- Gave patients something to look forward to
- Created an atmosphere where the concept of time disappeared
- Was not just a distraction, but an escape from their environment
- Was also an escape from their illness – even if for a brief moment
- Altered mood and, in some cases, reduced anxiety
- Gave patients the freedom to live extraordinary lives
Virtual reality programs of interest varied by patient and caregiver. While some preferred a more observatory experience like a beach or ocean, movies, space, meditation and nature scenes, others preferred a more active experience like hiking, extreme sports, racing and hiking.
Programs of interest were found to be varied not only by patient interest, but how they were feeling that day and what type of social interaction they were looking for. If virtual reality were to be implemented into the outpatient care experience, offering a range of programs to interact with is suggested.
The functionality of virtual reality has the potential to negatively alter the patient experience. Because virtual reality is a relatively new technology, there can be issues or glitches that occur. Connectivity and access to Wi-Fi must be secured prior to implementation.
Patients that rated the virtual reality experience as neutral to extremely negative (3 or lower on a 5 –point Likert scale) shared that it was due to the size and weight of the headset, the inability to utilize the headset properly with glasses, and lack of clarity or focus capability of the headset.
The implementation of virtual reality has executional limitations as well. Firstly, because nurses are focused on providing care, it is suggested to assign a designated employee for virtual reality setup with patients. Nurses are focused on providing care and may not always have the time to help with the headset or troubleshoot technology issues.
Secondly, the availability and accessibility of virtual headsets must be assessed. If a patient becomes accustomed to using virtual reality during their treatment and a headset is not available for them to use, their experience could be negatively impacted.
Thirdly, when patients are using virtual reality they must be able to communicate with the nurses and other employees if the need arises. Virtual reality must not compete with the care they require. During the virtual reality demonstrations, the team observed a few patients that were so immersed in the experience that it was difficult for the nurses to bring them back to reality for care-related reasons.
Note: This is an excerpt of the full report. View full report.
What lessons did you learn you would share with others as they consider addressing a similar issue?
If a careful and thoughtful plan is created to overcome functional and executional limitations, the results of this study show a tremendous benefit to offering virtual reality in the outpatient infusion setting, particularly on reducing discomfort and anxiety, providing an escape mechanism during care and enhancing the overall patient experience.
It is very important to assess the potential impact on staff during any pilot phase. To be successful, a patient experience virtual reality program will need full staff support and acceptance as it will add another function to their daily work. Make sure to include staff in the pilot to get a good understanding of their thoughts to make sure implementation goes smoothly and efficiently.
From the pilot, we also used the results, and other published studies with similar objectives, to create a program protocol. This protocol will be used by staff as a process flow for patient use, proper cleaning and best use cases we found in the pilot. The infusion staff was encouraged to add their own use cases as the program progresses and share broadly.
This study solely examined outpatient infusion patients. However, there may be opportunities to explore the benefits of virtual reality with patients in other settings and environments and to measure the quantitative impact on reducing anxiety and improving overall patient wellbeing.
UCHealth is an innovative, nonprofit health system that delivers the highest quality medical care with an excellent patient experience. UCHealth combines Longs Peak Hospital, Yampa Valley Medical Center, Memorial Hospital, Poudre Valley Hospital, Medical Center of the Rockies, UCHealth Medical Group, Broomfield Hospital, Grandview Hospital and University of Colorado Hospital into an organization dedicated to health and providing unmatched patient care.
Separately, our institutions provide superior care to patients and are committed to service the communities we are honored to serve. Together, we push the boundaries of medicine as we improve health through innovation. Our specialty practices have rapidly gained a reputation for excellence nationwide. Our unique combination of academic-based and community-focused medicine, brings innovative and leading-edge care to patients.
Case Study Authored by: Nicole Caputo, MS, Director, Experience and Innovation, Sonica Rooke, Manager, Market Research and Ciarra Halaska, Market Research Analyst