Evaluating Virtual Reality as an Adjunct in Procedural Preparation for Magnetic Resonance Imaging
Condition: Virtual Reality; Paediatrics; Radiology
Study type: Interventional

Summary: 
      This pilot project aims to establish evidence to investigate whether a virtual reality
      intervention can be implemented to reduce anxiety and efficiently prepare children for
      non-sedated MRI assessments. The study consists of comparing the current modes of delivery
      though a mock behavioural assessment and inquiry into the acceptability and utility of the
      intervention components, including potential barriers to adherence or behavioural change that
      could have unintended consequences.
    

Detailed description: 
      Approximately 50% of pediatric patients experience elevated anxiety and distress prior to new
      medical procedures. This issue is critically important because it not only impacts patient
      experience and is associated with psychological and physiological distress, but it can affect
      the efficiency of medical procedures, length of hospital stay, and resource utilization - all
      of which have economic impacts to both families and the health system. During medical
      procedures specifically, anxiety can cause non-compliance or unintentional movements which
      often leads to failure to complete the procedure or poor image quality, necessitating
      multiple attempts or the use of sedation to achieve the desired quality of imaging for
      diagnosis.

      The impact of sedating a patient has several downstream effects, including the increased
      potential for adverse events, as well as the need for specialized clinical staff (i.e.
      Anesthesiologists, Post-Anesthetic Care Nurses, etc), medications, and lengthier
      post-procedural monitoring. Studies have also indicated an increase in negative
      post-procedural clinical outcomes, such as increase pain perception, increased pharmaceutical
      consumption, reductions in sleep and eating, anxiety, and greater overall patient
      dissatisfaction.

      Child Life Specialists (CLS) are specialty trained individuals that work with patients and
      families to improve patient experiences during stress provoking medical procedures, such as
      medical imaging. Procedural preparation with a CLS for MRI involves exposure to an MRI
      simulator. The MRI simulator appears and sounds identical to the real MRI, but lacks a magnet
      and thus functionality to take real images. It's suggested that this type of non-sedated
      preparation program can reduce anxiety and distress, ultimately reducing sedation rates.

      While access to preparation programs with the CLS have improved, capacity limitations exist
      and there are socioeconomic costs of only having this support available on-site at BC
      Children's Hospital. Transportation barriers have been repeatedly identified in the
      literature and by parents as a source of unmet health needs for children in both rural and
      inner-city populations. This is significant because it a caregiver cannot get their child to
      the MRI simulator, they miss the opportunity for a non-sedated MRI. Consequently, resources
      and the risk for complications increase. As such, a virtual reality program has the capacity
      to increase access to patients who live afar, who are not mobile, and who need extra practice
      without the financial and physical limitations associated with the traditional hospital
      simulation.
    

Intervention name(s): Virtual Reality; Simulator Preparation; Preparation Booklet for Non-Sedated MRI
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The VR intervention is underpinned by experiential learning and social cognitive theory, such that user will observe successful performance and simulation to encourage imitation and reinforce success in the assessment. All participants will be undergoing a simulation assessment with the head coil.; The mock MRI is provided by the Child Life Specialist, according to the current care plan which consists of exposing children to the MRI simulator, medical devices, and procedures. The mock MRI is located within the medical imaging facility. All participants will be undergoing a simulation assessment with the head coil.; The standard MRI preparation booklet provides access to a series of printed photos and text showing the MRI experience step-by-step to help prepare for MRI. All participants will be undergoing a simulation assessment with the head coil.
Other intervention name(s): Mock MRI
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized, unblinded, controlled
Masking: None (Open Label)
Primary purpose: Prevention