## 4 Patient Empowerment and Mindfulness  
### The Pivotal Role of Empowerment in Modern Healthcare  
The term \"empowerment\" is defined by the World Health Organization as \"a process through which people gain greater control over decisions and actions affecting their health\", which includes both an individual and a community perspective [35]. More specifically, patients' empowerment--sometimes referred to with the broader term \"participation\"--encompasses the concepts of knowledge (of the disease condition), awareness (of their active role in the care path) and the acquisition of specific skills in a facilitating environment. While oftentimes neglected, the environment plays an essential role, as it may promote active participation and recognize individual and cultural differences at a community level. Preliminary efforts to increase patients' awareness have mainly encompassed the use of leaflets or short educational videos, to provide general information on sample tumors and treatment plans. However, these approaches have several limitations, including the difficulty in visualizing the actual treating rooms, individual positioning and the targeted anatomical regions. Currently, several systems have been investigated, and developed, in the context of AR and VR applications, to foster patients' empowerment in RT, with the intent of alleviating psychological distress, promoting awareness and, ultimately, enhancing compliance and oncological outcomes. This derives from the concept that a well-informed and actively involved individual will be more likely to adhere to the treatment plan, comply with medical prescription and follow physicians' recommendations, thus incorporating health-promoting behaviors in their everyday life [11, 36]. As suggested by several studies, the use of AR/VR methods, such as the VERT and Patient Education and Radiotherapy Learning (PEARL) tools, could improve the delivery of complex information while decreasing patients' anxiety toward RT. As an example, [PERSON] et al. [37] reported their successful experience with the use of VERT in breast cancer patient candidates regarding RT to the mammary gland and/or to nodal areas. The efficacy of VERT as an educational tool was investigated through a control group, who had received conventional pre-RT information, and the efficacy of both methods (VERT vs. traditional) was assessed by the administration of questionnaires at four pre-defined time points. In both cases, the educational sessions aimed to provide information on CT simulation, treatment planning and RT delivery. While all patients showed the highest levels of anxiety following the first medical consultation with the referring Radiation Oncologist, the VERT group compared favorably with the control in terms of decreased apprehension towards the treatment, despite that the authors estimated a higher predisposition to anxiety in this group. Interestingly, the longitudinal assessment of knowledge on RT highlighted that the effect of the VERT approach was maintained throughout the treatment course, thus suggesting its educational efficacy [37]. A further step forward in the implementation of VR-based education for patients' empowerment was accomplished by [PERSON] et al. [11], who developed a software capable of rendering the 3D delivery of individual treatment plans on a life-size virtual human positioned on a treating machine, in a commercially available VR headset. The innovation behind this approach is that each patient is able to visualize their own treatment plan, rather than a standardized one, with the possibility of exploring the scene from multiple angles and getting close to the treatment table while the virtual treatment was being delivered. Additionally, the patient's radiation oncologist and caregiver(s) could follow the simulation on a separate 2D monitor, which offered the possibility of sharing the educational experience, on the one hand, and providing further information, on the other [11].