Over the centuries, medicine has become increasingly specialized and precision due to increased study and technological advancement. This has resulted in the transformation of many diseases considered fatal to chronic. An example indicative of our contemporary times is cancer. From being an incurable disease, it has become an increasingly common, but fortunately controllable condition so much so that patient life expectancy continues to improve.
State-of-the-art medical technology is being used throughout the entire course of treatment: from prevention, diagnosis, surgery, rehabilitation to palliation. This has led to a focus on the disease, often forgetting about the person as a whole and thus running the risk of depersonalization. As in every sphere of the human, in problems there are also opportunities. British researcher Daisy Fancourt in her book Arts in Health defines all the spheres in which culture can be applied in health care, and one of them is precisely technology. An emblematic precursor case was that of Professor McCann, a physician at St. James Hospital in Dublin; he worked in the inpatient wards of bone marrow transplants.
This condition involves isolation for a very long time and requires significant attention to cleanliness and hygiene care to avoid infection. In addition, the ward is located on the ground floor, and not every room had a window. McCann’s ingenious idea was to bring projectors inside for each room and give the option of giving each patient an open window. The project is called Open Windows, and not only did it plan with the city’s museums, but it also made sure to install projection cameras in some of the city’s iconic places including the harbour to give a glimpse of the outside, familiar world. In another case, it gave a new father the chance to experience the birth of his daughter live. Unique experience that he would have missed otherwise.
So what does it mean to deal with a chronic illness in the 21st century?
It usually has a very complex intake and, above all, constantly impacts the person’s daily life: visits, checkups, day hospital examinations and pharmacological treatment. Drug treatments can have side effects, including gastrointestinal, cardiovascular, metabolic problems, skin reactions or lead to addiction. And this is even before considering the cognitive and emotional aspects of the patient.
Add to this the contexts of prolonged inpatient stays, often in environments poor in sensory stimulation, and it becomes clear that the issue deserves proper attention.
Environments poor in sensory stimulation are defined as spaces devoid of change or interaction, such as bare rooms with low lighting with repetitive background noise and the absence of natural smells.
Psychological research has found that this leads to increased focus on one’s body sensation, which in the presence of illness results in increased perceived discomfort, and the development of intrusive negative thoughts resulting in increased perceived pain; often this state is accompanied by anxiety.
An integrative strategy to this scenario is the use of virtual reality (VR) or augmented reality (AR). The immersive experience positively impacts psychophysical parameters but also provides an opportunity for learning about emotion regulation and mental states. The use of this technology can be incorporated in different contexts such as an infusion therapy, or during rehabilitation. A program has also been developed to use RV for integrative interventions during psychotherapies to go to work on mental health conditions such as depression. The effects have been discussed in several studies. Regarding the psycho-physical impact for example, the validity of RV use on pain reduction, improved mobility and reduced muscle tension is verified. Psychological side on the other hand, a decrease in anxiety and stress is detected, promoting an increase in motivation, well-being and an overall improvement in quality of life. There is also relevance on reduced demand for the use of analgesics and consequently improved pain tolerance.
This phenomenon is referred to as positive distraction: attention is shifted to cultural or naturalistic content that promotes a state of relaxation.
The content that can be included in viewers is diverse in nature and falls into two main categories. The first category comes from Roger Ulrich’s studies on the positive impact of looking at the landscape and thus, applied to VR, green walks. The second, on the other hand, is related to culture, art and entertainment, such as visits to museums or video game activity.
This all falls under the concept of culture as integrated therapy. Thus, an ally, an adjunct to evidence-based medicine.
Another notable intervention worth mentioning is that of London’s Chelsea and Westminster Hospital in collaboration with the city’s zoo. The Zoo project is an interactive installation with digital animals that aims to reduce stress in children during blood draws. A study has shown that this form of positive distraction reduces anxiety and perceived pain, improving the hospital experience. In addition, due to the increased cooperation of children, there has also been a reduction in the time it takes to draw blood, making the procedure faster and more efficient for health care personnel and increasing the number of daily visits and care.
These technologies can be applied not only for patients, but also for health professionals. Certainly with similar functions to those presented, but mainly with educational purpose. The study of anatomy is one example; the possibility of being able to view organs with 3D models is a more interactive and realistic opportunity for study. Even in the field of surgery, simulation of surgical operations can help residents who are in their first experiences with the scalpel.
Thus, the integration of VR and AR into care pathways is part of those practices that fall under the umbrella term of humanization of care and is linked back to a work of improving patient-physician relationship. It is not just a technological innovation, but a real paradigm shift: care is no longer limited to the body like biosocial medicine but also embraces the patient’s experience and lived experience; therefore, it integrates with the thinking of a new holistic and bio-psychosocial medicine. Making a blood draw less traumatic, a hospitalization less distressing, or a treatment more engaging means humanizing medicine, turning fear and anxiety into curiosity, wonder, or an opportunity for knowledge. The future of healthcare is not only more technologically advanced but also more empathetic. The synergy between science and culture will help complete the moves toward an increasingly patient-centred medicine or, better yet, a medicine of alliance between the physician, with his or her knowledge and compassion, who works alongside the patient in the process of treatment and healing.
References:
-Agamanolis, S., Cullinan, C., Hegarty, F., Higgins, L., McCann, S., & Roche, D. (2004). Open window: A novel method of reducing isolation during stem cell transplantation or treatment of haematological malignancies. Cancer: UICC World Conference for Cancer Organisations.
-Chow, Howard, Joshua Hon, Wei Chua, e Alwin Chuan. 2021. “Effect of Virtual Reality Therapy in Reducing Pain and Anxiety for Cancer-Related Medical Procedures: A Systematic Narrative Review.” Journal of pain and symptom management, 61(2), 384-394. doi: 10.1016/j.jpainsymman.2020.08.016.
– Fancourt, D. (2017). Arts in health: Designing and researching interventions. Oxford University Press.
– Orisini Davide e Margherita Aglianò (a cura di). 2024. “A fianco del paziente: educare a prendersi cura del malato (anche negli ultimi giorni di vita).” Firenze University Press, USiena Press, Firenze, Siena. doi: 10.36253/979-12-215-0480-4
-Zeng, Yin-Chun, Jun-E Zhang, Andy S K Cheng, Huaidong Cheng, e Jeffrey Scott Wefel. 2019. “Meta-analysis of the efficacy of virtual reality–based interventions in cancer-related symptom management.” Integrative cancer therapies 18, 1534735419871108.
-Zhang, Bixia, Xiao Huan Jin, Xiaolin Kuang, Biyu Shen, Dingrong Qiu, Jinrui Peng, Erhui Chen, Xiping Dai, Xiaoling Chen, e Cho Lee Wong. 2024. “Effects of a virtual reality-based meditation intervention on anxiety and depression among patients with acute leukemia during induction chemotherapy: a randomized controlled trial.” Cancer Nursing 47(3), E159-E167.
Carolina Zarrilli – PhD in Medical Humanities and scientific curator