Usability Testing of an Interactive Virtual Reality Distraction Intervention to Reduce Procedural Pain in Children and Adolescents With Cancer

Purpose: Needle procedures are among the most distressing aspects of pediatric cancer-related treatment. Virtual reality (VR) distraction offers promise for needle-related pain and distress given its highly immersive and interactive virtual environment. This study assessed the usability (ease of use and understanding, acceptability) of a custom VR intervention for children with cancer undergoing implantable venous access device (IVAD) needle insertion. Method: Three iterative cycles of mixed-method usability testing with semistructured interviews were undertaken to refine the VR. Results: Participants included 17 children and adolescents (8-18 years old) with cancer who used the VR intervention prior to or during IVAD access. Most participants reported the VR as easy to use (82%) and understand (94%), and would like to use it during subsequent needle procedures (94%). Based on usability testing, refinements were made to VR hardware, software, and clinical implementation. Refinements focused on increasing responsiveness, interaction, and immersion of the VR program, reducing head movement for VR interaction, and enabling participant alerts to steps of the procedure by clinical staff. No adverse events of nausea or dizziness were reported. Conclusions: The VR intervention was deemed acceptable and safe. Next steps include assessing feasibility and effectiveness of the VR intervention for pain and distress.

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Feasibility, Acceptability, and Clinical Implementation of an Immersive Virtual Reality Intervention to Address Psychological Well-Being in Children and Adolescents With Cancer

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454220917859 ◽

2020 ◽

Vol 37 (4) ◽

pp. 265-277

Author(s):

Michelle Tennant ◽

Jane McGillivray ◽

George J. Youssef ◽

Maria C. McCarthy ◽

Tara-Jane Clark

Keyword(s):

Health Care ◽

Virtual Reality ◽

Therapeutic Intervention ◽

Health Care Professionals ◽

Well Being ◽

Ease Of Use ◽

Controlled Study ◽

Clinical Implementation ◽

Content Development ◽

Parent Caregivers

Objective: Virtual reality (VR), a novel and highly immersive technology, offers promise in addressing potential psychological impacts of cancer treatments and hospitalization. The primary aim of this study was to examine multiple key user perspectives on the acceptability and feasibility of an Immersive VR therapeutic intervention for use with hospitalized patients with cancer. Secondary aims were to identify issues and opportunities related to the adoption and clinical implementation of VR in pediatric oncology settings. Method: The study was conducted at The Royal Children’s Hospital (RCH), Melbourne, Australia. Thirty multidisciplinary oncology health care professionals participated in an initial test of VR intervention usability (Stage 1). Ninety oncology inpatients (7-19 years) and their parent caregivers participated in a pilot randomized controlled study to examine the effectiveness of an Immersive VR therapeutic intervention (Stage 2). This mixed methods study reports Stages 1 and 2 quantitative and qualitative data related to VR feasibility and acceptability. Results: Results indicate favorable perceptions from health care professionals with respect to ease of use and usefulness of VR, and had positive intentions to use it in the future. Parent caregivers reported high acceptability of VR for their hospitalized child. Patients reported high satisfaction of the VR intervention within minimal adverse effects. Barriers and facilitators to VR use with seriously ill children and specific recommendations for content development were elicited. Conclusion: This study shows that there are several potential clinical uses for Immersive VR intervention, beyond medical procedural distraction, to support psychological adjustment to hospitalization and patient quality of life.

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Feasibility, acceptability and clinical implementation of an Immersive Virtual Reality intervention to address psychological wellbeing in children and adolescents with cancer

10.31234/osf.io/d7jvh ◽

2020 ◽

Author(s):

Michelle Tennant ◽

Jane McGillivray ◽

George Joseph Youssef ◽

Maria McCarthy ◽

Tara-Jane Clark

Keyword(s):

Virtual Reality ◽

Therapeutic Intervention ◽

Ease Of Use ◽

Controlled Study ◽

Clinical Implementation ◽

Cancer Treatments ◽

Content Development ◽

High Satisfaction ◽

Parent Caregivers ◽

Stage 1

Objective: Virtual Reality (VR), a novel and highly immersive technology, offers promise in addressing potential psychological impacts of cancer treatments and hospitalization. The primary aim of this study was to examine multiple key user perspectives on the acceptability and feasibility of an Immersive VR therapeutic intervention for use with hospitalized oncology patients. Secondary aims were to identify issues and opportunities related to the adoption and clinical implementation of VR in pediatric oncology settings. Methods: The study was conducted at the Royal Children’s Hospital, Melbourne, Australia. Thirty multidisciplinary oncology healthcare professionals (HCPs) participated in an initial test of VR intervention usability (Stage 1). Ninety oncology inpatients (7-19 years) and their parent caregivers participated in a pilot randomized controlled study to examine the effectiveness of an Immersive VR therapeutic intervention (Stage 2). This mixed methods study reports Stage 1 & 2 quantitative and qualitative data related to VR feasibility and acceptability. Results: Results indicate favorable perceptions from HCPs with respect to ease of use and usefulness of VR, and had positive intentions to use it in the future. Parent caregivers reported highly acceptability of VR for their hospitalized child. Patients reported high satisfaction of the VR intervention within minimal adverse effects. Barriers and facilitators to VR use with seriously ill children and specific recommendations for content development were elicited. Conclusion: This study shows there are several potential clinical uses for Immersive VR intervention, beyond medical procedural distraction, to support psychological adjustment to hospitalization and patient quality of life.

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Evaluation of EMLA cream for relieving pain during needle insertion on totally implantable venous access device

The Journal of Vascular Access ◽

10.1177/1129729818768182 ◽

2018 ◽

Vol 19 (6) ◽

pp. 634-638 ◽

Cited By ~ 3

Author(s):

Lijuan Yin ◽

Shudi Jiang

Keyword(s):

Cancer Patients ◽

Rating Scale ◽

Venous Access ◽

Needle Insertion ◽

Numeric Rating Scale ◽

Access Device ◽

Emla Cream ◽

Group 2 ◽

Venous Access Device ◽

Numeric Rating

Purpose: Needle insertion is a routine procedure performed on cancer patients with totally implantable venous access device. Although this procedure is painful for most of the patients, it is regularly performed without topical application of local anesthetics. In our study, we assess the degree of pain associated with different duration times of EMLA cream. Methods: A total of 361 cancer patients with totally implantable venous access devices were randomly divided into three groups: group 1—placebo, group 2—30 min after application of EMLA, and group 3—60 min after application of EMLA. In this double-blinded prospective study, the efficacy of EMLA cream was compared with a placebo cream by comparing the degree of pain experienced by the patient who was evaluated during and after needle insertion on a numeric rating scale. Results: The mean ± standard deviation of pain experienced by the patients was significantly (p < 0.05) lower in group C (0.69 ± 0.98) than groups B (1.11 ± 1.14) and A (1.91 ± 1.40). No significant (p > 0.05) difference was found in mean scores from inexperienced and experienced procedures of needle insertions among three groups. Comparing male patients, the female patients in group 1 and group 2 had lower numeric rating scale (1.59 ± 0.94, 1.39 ± 1.35; p < 0.01). Conclusion: The present results review that the application of EMLA cream for 30 min is suitable, acceptable, and convenient in cancer patients with totally implantable venous access device undergoing needle insertion.

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Use of catheter with 2-methacryloyloxyethyl phosphorylcholine polymer coating is associated with long-term availability of central venous port

Scientific Reports ◽

10.1038/s41598-021-84885-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuuki Iida ◽

Kumiko Hongo ◽

Takanobu Onoda ◽

Yusuke Kita ◽

Yukio Ishihara ◽

...

Keyword(s):

Odds Ratio ◽

Polymer Coating ◽

Venous Access ◽

Preventive Effect ◽

Central Venous ◽

Factors Associated ◽

Central Venous Port ◽

Venous Port ◽

Venous Access Device

AbstractCentral venous port (CVP) is a widely used totally implantable venous access device. Recognition of risks associated with CVP-related complications is clinically important for safe, reliable, and long-term intravenous access. We therefore investigated factors associated with CVP infection and evulsion, including the device type. A total of 308 consecutive patients with initial CVP implantation between January 2011 and December 2017 were retrospectively reviewed, and the association of clinical features with CVP-related complications were analyzed. Intraoperative and postoperative complications occurred in 11 (3.6%) and 39 (12.7%) patients, respectively. The overall rate of CVP availability at six months was 91.4%. Malignancy and 2-Methacryloyloxyethyl phosphorylcholine (MPC) polymer-coated catheter use were negatively associated with the incidence of CVP infections. Accordingly, malignancy and MPC polymer-coated catheter use were independent predictors for lower CVP evulsion rate (odds ratio, 0.23 and 0.18, respectively). Furthermore, both factors were significantly associated with longer CVP availability (hazard ratio, 0.24 and 0.27, respectively). This retrospective study identified factors associated with CVP-related complications and long-term CVP availability. Notably, MPC polymer-coated catheter use was significantly associated with a lower rate of CVP infection and longer CVP availability, suggesting the preventive effect of MPC coating on CVP infection.

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Comparison of the Quality of Life of Patients with Breast or Colon Cancer with an Arm Vein Port (TIVAD) Versus a Peripherally Inserted Central Catheter (PICC)

Current Oncology ◽

10.3390/curroncol28020141 ◽

2021 ◽

Vol 28 (2) ◽

pp. 1495-1506

Author(s):

Brent Burbridge ◽

Hyun Lim ◽

Lynn Dwernychuk ◽

Ha Le ◽

Tehmina Asif ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Well Being ◽

Venous Access ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Access Device ◽

The Mean ◽

Venous Access Device

Introduction: Venous access is a crucial element in chemotherapy delivery. It remains unclear whether cancer patients prefer a port to a peripherally inserted central catheter (PICC). Our study aimed to assess cancer patients’ satisfaction with their venous access device and to compare the quality of life (QoL) of subjects with a PICC to those with a port. Methods: In this prospective cohort study, EORTC QLQ-C30, and a locally developed quality of life survey (QLAVD), designed to assess satisfaction with venous access devices, were administered to breast or colorectal cancer patients over a one-year period following the device insertion. Mixed effects models were used to assess changes on mean scores at different time points. Results: A total of 101 patients were recruited over a three-year period, (PICC group, n = 50; port group, n = 51). Survey response rates for months one and three were 72% and 48%, respectively. Overall, no significant differences were noted between the two groups in relation to EORTC QOL. At three months, the mean pain scores were 3.5 ± 2.3 for the port and 1.3 ± 0.75 for PICC (<0.001). The mean score for a negative effect of the venous access device on psychosocial well-being was 6.0 ± 4.1 for PICC and 3.0 ± 2.7 for the port (p = 0.005). Complications related to PICCs occurred in 38% patients versus 41% with a port (p > 0.24). Conclusions: Although subjects with a port experienced more pain during the device insertion or access for chemotherapy, it had a smaller negative impact on psychosocial scores than the PICC. No significant differences in complications rates were observed between the two devices.

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Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

European Journal of Pediatrics ◽

10.1007/s00431-021-03985-5 ◽

2021 ◽

Author(s):

Miguel García-Boyano ◽

José Manuel Caballero-Caballero ◽

Marta García Fernández de Villalta ◽

Mar Gutiérrez Alvariño ◽

María Jesús Blanco Bañares ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Vein Thrombosis ◽

Venous Access Device ◽

Deep Vein

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Thromboembolism in Patients With Advanced Gastroesophageal Cancer Treated With Anthracycline, Platinum, and Fluoropyrimidine Combination Chemotherapy: A Report From the UK National Cancer Research Institute Upper Gastrointestinal Clinical Studies Group

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.4274 ◽

2009 ◽

Vol 27 (23) ◽

pp. 3786-3793 ◽

Cited By ~ 122

Author(s):

Naureen Starling ◽

Sheela Rao ◽

David Cunningham ◽

Timothy Iveson ◽

Marianne Nicolson ◽

...

Keyword(s):

Combination Chemotherapy ◽

Treated Patient ◽

Controlled Trial ◽

Central Venous Access ◽

Locally Advanced ◽

Venous Access ◽

Gastroesophageal Cancer ◽

National Cancer Research Institute ◽

The Uk ◽

Venous Access Device

PurposeData concerning the prevalence of and outcomes related to thromboembolic events (TEs) in patients with advanced gastroesophageal cancer who are undergoing chemotherapy are limited.Patients and MethodsThis was a prospective, exploratory analysis of TEs in a randomized, controlled trial of 964 patients recruited between 2000 and 2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy for advanced/locally advanced gastroesophageal cancer. Regimens were epirubicin (E), cisplatin (C), fluorouracil (F; ECF); E, C, capecitabine (X; ECX); E, F, oxaliplatin (O; EOF); and EOX. Continuously infused F was administered via a central venous access device (CVAD) with 1 mg of warfarin for thromboprophylaxis. The principal outcome was the incidence of TEs (venous and arterial) in the whole treated patient cohort, according to chemotherapy, associated with CVADs and TE-related prognoses.ResultsThe incidences of any, of venous, and of arterial TEs among 964 treated patients were 12.1% (95% CI, 10.7 to 14.3), 10.1% (95% CI, 8.3 to 12.3), and 2.2% (95% CI, 1.4 to 3.4) respectively. There were fewer TEs in the O compared with the cisplatin groups (EOF/EOX v ECF/ECX: 7.6% v 15.1%; P = .0003). C was identified as a risk factor for TE in multivariate analysis (hazard ratio [HR], 0.51; 95% CI, 0.34 to 0.76; P = .001). There was no difference in the incidence of TEs for the F group compared with the capecitabine groups. The incidence of CVAD-related thrombosis was 7.0% (ECF/EOF arms). Overall survival was worse for patients who experienced TEs versus no TEs (median survival, 7.4 v 10.5 months; HR, 0.8; 95% CI, 0.64 to 0.99; P = .043).ConclusionThis analysis has prospectively quantified the incidence/pattern of TEs among patients with advanced gastroesophageal cancer who were treated with four triplet regimens, has demonstrated a differential thrombogenic effect according to platinum use, and has noted a poorer outcome associated with TE during treatment. Chemotherapy-related TE should contribute to the risk/benefit assessment of treatment.

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