Anne Dubin, MD, Professor of Pediatrics at Lucile Packard Children’s Hospital, Stanford, and Lauren Schneider, PsyD, Clinical Assistant Professor of Psychiatry at Lucile Packard Children’s Hospital, Stanford, talk about new virtual reality technology that could help calm patient anxiety before undergoing medical procedures or surgery.
Interview conducted by Ivanhoe Broadcast News in May 2017.
Explain to me what is Project Brave Heart?
Dr. Dubin: Project Brave Heart is the brain child of the two of us, as well as Walter Greenleaf who has been our consultant for this virtual reality; trying to minimize anxiety and stress prior to a procedure for a child. We basically will walk a child through the entire procedure that they’re going to be undergoing, with certain relaxation techniques embedded into this virtual reality platform to try to make it easier for them to have procedures done in the hospital and make it less scary.
This is a study so tell me about that, how many children are participating and how long and all that.
Schneider: So far we have sixteen participants who have enrolled and we are comparing them to a control group. Participants receive the virtual reality equipment, which is mailed to their home a week before the procedure so they are able to use it before the procedure. We’re tracking how much they’re utilizing it; to look at the effects of their use. We also have a control group who will be enrolled in the study and have their procedure preparation performed as usual. They won’t be utilizing the virtual reality technology ahead of time, instead they’ll be prepared by their physicians and other medical team members about what they’re about to undergo or experience.
What have you noticed so far from the patients who have participated?
Dr. Dubin: We haven’t actually done a lot of data analysis yet as the study is ongoing. We plan on an in-depth analysis looking at questionnaires and measure of anxiety as well as some biological measures, including heart rate and cortisol levels. However, the patients who participated to date say they really enjoy it, and felt that it really was a great tool for them to help relax them prior to their procedures.
So maybe each of you, since you are the brain child, the two of you, explain your part?
Dr. Dubin: My specialty is heart rhythm abnormalities. We routinely perform procedures to either cure or protect patients from these arrhythmias in the cath lab. It entails a visit to the catheterization lab, which can be very anxiety provoking. They don’t know what to expect; they’re expecting pain, and they are in a scary environment. So we were trying to think of a way to prepare children for these procedures that would decrease anxiety.
Schneider: My role as the psychologist on the team is to help patients with the emotional aspects of their illness and often that includes the anxiety that they’re experiencing ahead of the procedure. Often times before we had the virtual reality technology we would be preparing the children one at a time in person, maybe taking them to a part of the hospital that might be anxiety provoking or showing them the actual needle used for an IV… exposing them to the feared stimulus so that they became familiar with it. Now what we’re doing is leveraging the technology to expose them to those anxiety-provoking aspects of the procedure and parts of the hospital from their own homes. And the really amazing thing is that we’re equipping them with the skills and tools through the relaxation strategies that they can utilize, not only for this time in the hospital but other moments in their life that are stressful or anxiety provoking as well. So we’re basically trying to do the exposure, which is an evidence based treatment for anxiety, in a new way and present it to them so they can access it from home.
So tell me what the ultimate goal for project Brave Heart. I know you’re in the study now but do you want to take it across country?
Dr. Dubin: The first step was to see whether virtual reality was a good choice, I mean it’s always exciting to think about virtual reality, everybody gets excited when they hear the term virtual reality. But our first objective was to make sure that it actually worked. That is where the study comes in, it’s to see can we use this new technology to help us with our patients. If it is effective, we can expand this for other interventions within the hospital as a first step. Patients having other types of surgeries or procedures would also be able to see where they’re going, what’s going to happen, learn different relaxation techniques, and really learn what to do to help relax themselves. Once we accomplish that goal, we’d like to see this move out across the country if it’s found to be useful.
Schneider: I think an additional goal is to help kids feel empowered and in control with regards to their medical treatment. When they receive these diagnoses and undergo the procedures in this scenario, so much control is stripped away from them. By allowing them to learn these techniques and skills we hope to also give them back some control and empowerment in this journey or process.
Dr. Dubin: One of our next projects would address anxiety in patients and families when communicating with their physicians. We know that when physicians and health care professionals talk to patients in the clinic setting or in a high stress setting people don’t remember what is said. They probably remember about ten to fifteen percent of what was actually said in that visit. Using VR they have the information at their fingertips in a much less stressful scenario and they can go over it several times to really understand what’s going to happen, which they’re not going to necessarily retain from a clinic visit.
How did this idea come about?
Schneider: We were seeing a lot of anxiety with this patient population, not only with the procedure itself, but in general after the fact as well. They often receive these devices or have these procedures performed to improve their quality of life and help them get back to the life that they previously had. So we wanted to think of a way to enhance quality of life and maybe help them get back to their lives. When we started learning about this technology and got to experience it ourselves, we thought what a great way to offer the exposure therapy which often is done in a clinic setting. The standard method of working on anxiety issues with families can be time intensive; it’s difficult for families who come from a distance to access these therapies. This technology allows us to offer these treatments to all of our families, regardless of where they live or how far they are from our center. We happened to learn about the potential of VR around the same time as we were discussing how to address these psychological issues; we then learned more about the technology and connected with right people.
Dr. Dubin: It was kind of like a perfect storm. We had been kind of brainstorming about these children and their psychosocial issues. At the same time, we just happened, through the psychology and psychiatry department, to meet up with several of the leaders in virtual reality and suddenly understood the potential we could offer these patients using this technology.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Kate DeTrempe
KDeTrempe@stanfordchildrens.org
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