Literature so far shows VR is largely acceptable and feasible to use in palliative care settings, especially for improving patient wellbeing and mental health. However, limited research exists for understanding the effectiveness of VR, especially if sessions are repeated or offered jointly with patient carers or companions. We aim to investigate the effectiveness of VR for achieving personally meaningful goals (including but not limited to relaxation, bucket-list activities, and improving wellbeing). This study will be offered to patients and their companions receiving palliative care at a hospice in England. Informed consent will be acquired after a participant information sheet has been shared with interested participants. Personal goals of VR use will be established at the start of the study with baseline mental health and wellbeing data collection. Up to 3 VR sessions will be offered.

Before and after each session patients will be asked to complete questionnaires to track wellbeing and progression towards intended goals for utilising VR. A change interview will occur between 1 to 4 weeks after the final VR session to discuss their overall experiences of VR and will include repeated follow up questionnaires. Participants that which to engage with a joint-VR intervention with their companion (referred to as participant companions for the purposes of this study), will also require informed consent and completion of questionnaires and interview attendance to be involved with this study.

Results will be gathered and analysed by creating anonymous individual rich case records and shared with a panel of independent psychologists to conclude whether or not, from our findings, virtual reality is effective for achieving personally important goals. Findings will be shared with the hospice involved and form a Doctoral Thesis based at the University of Lincoln.

Patients who are accessing palliative care have progressive or terminal illness. Patients may also have co-occurring mental health difficulties or reduced wellbeing. There is emerging evidence for psychological wellbeing benefits of non-pharmacological interventions in palliative care. Also it is important for patient's receiving palliative care to have autonomy, dignity and respect in the care they receive (see Ambitions for Palliative and End of Life Care: A national framework for local action 2021-2026). One way to achieve such ambitions and offer an intervention for wellbeing is that of Virtual Reality (VR), whereby an individual is immersed in a digital world by wearing a headset. Immersive experiences can provide patients with a sense of being somewhere new which they may not be able to physically reach due to a decline in health or mobility inline with their palliative needs (Altman et al., 2024).

This study adopts a hermeneutic single case efficacy design (HSCED)series, which involves creating case studies that track up to 6 participants taking part in a 4-week VR intervention. The intervention offered for the study will be psychologically informed in that VR experiences and purpose for the intervention use will be chosen by the patient inline with their own personally important and meaningful goals. By ensuring that choice of the VR intervention offered will promote self-determination in care (e.g. autonomy and relatedness). While also acknowledging patient companion's experiences if patients choose to use VR jointly with their family member or companion, patient companions would also be interviewed about their experience of using VR.

Mixed-methods data collection will occur including quantitative data (questionnaires, number of sessions, time spent wearing VR) and qualitative data (interviews will occur to understand participant experience of using VR). Overall, this study will add to current literature about the effectiveness of VR for patients in palliative care.

Inclusion criteria:

Participants recieving palliative care must be:

• Aged 18 or over (no upper age limit due to the service being lifelong).
• Patients deemed to be palliative, receiving specialist care at the designated hospice as either an inpatient or outpatient.
• Willing and able to engage in VR interventions as determined by the patients' usual care team.
• Able to consent to the research, as assessed by the clinical psychologist supporting recruitment and the primary researcher delivering the VR intervention.

Participant companions (carers, relatives) must be:

• Aged 18 or over (no upper age limit).
• Willing and able to engage in VR interventions and travel to the designated hospice site.
• Able to consent to the research, as assessed by the clinical psychologist supporting recruitment and the primary researcher delivering the VR intervention.

Exclusion criteria:

• Lacking capacity to consent to take part in research as assessed by both the clinical psychologist supporting recruitment and the primary researcher delivering VR.
• Exhibiting contraindications as set out by care team including eyesight impairments or neurological conditions such as epilepsy or dementia.

To protect participant confidentiality due to sensitive nature of the palliative care setting.