Abstract
Dear Editor:
We read the letter by Kako et al., 1 “Response to Niki et al. (doi: 10.1089/jpm.2018.0233),” regarding our article. In their letter, Kako et al. agreed with our study on “a novel approach that aims to improve various symptoms of terminal cancer patients with palliative care using virtual reality (VR).” However, Kako et al. made a critical point in promoting the clinical application of VR, that is, “If patients could share an experience of virtual travel with their family and friends, they would likely experience more positive emotions and, hence, reduce any psychological symptoms related to their illness.” In the use of VR in palliative care, we have faced various challenges, including the one Kako et al. pointed out. Therefore, this response aims to clarify the issues in and proposed solutions for the use of VR in palliative care.
Issues to Be Solved to Promote VR Use in Palliative Care
Weight of the VR headset: Many terminal cancer patients tend to feel that a VR headset is heavy. Therefore, further weight reduction of the VR headset is desired. VR headsets in popular use weigh around 500 g. In our experience, some patients cannot continue their VR experience, despite enjoying it initially, owing to the pain or stiffness of their neck that is caused by the headset's weight.
Operability of VR content: Terminal patients are often unfamiliar with video games, and many patients cannot independently operate VR content satisfactorily. Thus, an easy-to-operate system is preferable.
Sharing VR space: Many patients' family members and medical staff want to share the VR space that the patients are experiencing. Currently, mirroring to a monitor can be done easily; however, there would be a large difference between three-dimensional (3D) and two-dimensional (2D) images. Tashjian et al. 2 reported that the influence of the immersive feeling generated by 3D is larger compared with 2D.
Internet environment: As hospital rooms often have a poor Internet environment, content that can be used offline would be ideal. Weingarten et al. 3 reported a case of a girl who could not leave her room under control infection associated with acute myelocytic leukemia and was granted her desire to ice skate by VR. They pointed out the necessity to prepare the Internet environment.
Our Suggested Solutions
Future product development through joint research by medical and engineering professionals is expected to solve the issues. VR applications “Oculus Gallery” or “Wander,” which can be used with the Oculus VR system, now allow sharing of 360° images in VR space. We have already experienced cases where patients and families can enjoy more using the VR space-sharing system, and we believe this is an important breakthrough in promoting VR application in palliative care.
VR systems have been able to outperform conventional treatment and care.2–4 Thus, it is highly desired that these issues be resolved as soon as possible.