Inclusion Criteria:  at least 18 years or older admitted to Hospice for Specialty Palliative Care  Exclusion Criteria:  Palliative Performance Scale (PPS) < 30% severe cognitive impairment leading to inability to provide ESAS scores for 5 key symptoms measured in this study severe visual and/or hearing impairment preventing use of VR (glasses and hearing aids may be worn during VR sessions and do not exclude participation) absolute inability to sit severe paralysis of an upper limb