To assess the feasibility of using computer-generated VR (CG-VR) and film-based VR (FB-VR) in seriously ill older adults

Background and Significance

Seriously ill older adults frequently harbor unfulfilled end-of-life aspirations, commonly referred to as "bucket list" experiences. Advanced illness, functional decline, and the constraints of institutional living typically render travel and other real world experiences largely unattainable for this population. Virtual reality (VR) technology, now widely commercially available, may offer an accessible means of delivering immersive surrogate experiences at the bedside. However, the feasibility of VR engagement among seriously ill nursing home residents - including their capacity to tolerate head-mounted display use, sustain attention during immersion, and derive meaningful benefit - has not been adequately established. The present study seeks to address this gap.

Specific Aims:

1. To determine the feasibility of administering immersive VR experiences to seriously ill older adult nursing home residents using a commercially available head-mounted display.
2. To compare participant ability to tolerate two distinct VR delivery modalities: computer-generated virtual reality (CG-VR) and film-based virtual reality (FB-VR).
3. To explore, through qualitative inquiry, participant perceptions of VR as a vehicle for fulfilling personally meaningful experiences (virtual bucket-listing).

Study Design

This is a feasibility study employing a randomized, two-arm parallel-group design with an optional crossover component and embedded qualitative interviews.

Study Population: Seriously ill older adult residents of the participating nursing home facility.

Study Procedures

Following written informed consent, each participant will be invited to articulate a personal bucket list. Participants who identify one or more bucket list items will be randomly assigned in a 1:1 ratio to one of two arms:

• Arm A: A three-minute immersive waterfall experience delivered via CG-VR.
• Arm B: A three-minute immersive waterfall experience delivered via FB-VR. All VR content will be delivered using the Meta Quest Pro head-mounted display. Following the initial experience, participants will be offered the option to engage in a second VR session - either the alternate modality (CG-VR or FB-VR) or an alternative VR environment of personal significance to the participant.

Outcome Measures:

Primary outcomes (feasibility): Consent, completion of the assigned VR experience, and adverse events (including cybersickness, agitation, or discomfort).

Secondary outcomes:

• Change in symptom burden as measured by pre- and post-experience scores on the Edmonton Symptom Assessment System-Revised (ESAS-r).
• Participant-reported relaxation ratings obtained immediately following the VR experience.
• Qualitative data derived from post-experience semi-structured interviews for thematic analysis.

Risks and Anticipated Benefits:

Risks are anticipated to be minimal and primarily limited to transient cybersickness, mild disorientation, or emotional response to the experiential content. Participants may benefit from symptom relief, relaxation, and engagement with personally meaningful imagery, although direct benefit is not assured. Findings will inform the design of subsequent efficacy trials evaluating VR as a palliative intervention.

Statistical Considerations:

Given that this is a feasibility pilot study, there is no hypothesis testing and the study is not powered to detect efficacy.Descriptive statistics will be employed to characterize feasibility metrics and outcome distributions.

Inclusion Criteria: Seriously ill nursing home residents identified by their care team as able to participate.

-

Exclusion Criteria: <65 years of age

-

Will not be available as participants are vulnerable and did not wish to share.

Participants were randomly assigned to a virtual waterfall experience (computer generated or film-based) for three minutes.