'LIFEView' Audiovisual Technology: Virtual Travel to Support Wellbeing and Quality of Life at the End of Life

Study Overview
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Brief Summary
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This study is looking to assess the use of an audio-video technology called 'LIFEView' using a laptop and large-screen TV. This tool intends to support life review or reminiscence of past experiences, escape from current surroundings using virtual travel, or virtual visits to a location that one might have liked to visit in their lifetime but could not. We hope that by using this technology, we can support better wellbeing and quality of life for patients receiving palliative care services within the community and on an inpatient palliative care unit, or for patients at the end-of-life within Bruyère long-term care homes. Due to the potential for disorientation and reduced physical mobility, patients receiving palliative and end-of-life care may be unable to fully enjoy an immersive experience using a virtual reality (VR) headset. To reduce the possibility of disorientation that may arise from using a VR headset with 'LIFEView', our research team will use the 'LIFEView' prototype software loaded on a laptop and connected to a mobile high-definition 50 TV for inpatient PCU and LTC facility use, or to a patient's personal TV within their residence in the community. This setup will also improve accessibility to 'LIFEView' as a result of its relatively low-tech requirements (i.e. TV + laptop), and allows for an opportunity for patients and their loved ones to share cherished memories and stories.

Detailed Description
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This project is designed to address the psychosocial and existential suffering commonly experienced by palliative care patients. Technology-based reminiscence and dignity therapy interventions have been demonstrated to improve well-being and quality of life in older adults (Lazar et al, 2014), although little evidence exists to support the use of these technology-based interventions in a palliative care context. These technologies may require modification to meet the needs of PEOLC patients that are at risk for delirium, a neuropsychiatric condition characterized by fluctuating disruptions in awareness, focus and cognition (American Psychiatric Association, 2013). Delirium can be experienced by up to 88% of patients at the end of life (Hosie et al., 2013). Moreover, patients in PEOLC settings may also have limited mobility or may be bedbound. Due to the potential for disorientation and reduced physical mobility, patients receiving PEOLC may be unable to fully enjoy an immersive experience using a virtual reality (VR) headset. To reduce the possibility of disorientation that may arise from using a VR headset with 'LIFEView', our research team plans to use the 'LIFEView' prototype software loaded on a laptop and connected to a mobile high-definition 40-42 TV for inpatient PCU and LTC facility use, or to a patient's personal TV within their residence in the community.

Official Title
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'LIFEView' Audiovisual Technology: Virtual Travel to Support Wellbeing and Quality of Life at the End of Life

Conditions
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Palliative Care, Terminal Illness, Quality of Life, Psychological Distress

Intervention / Treatment
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* Other: 'LIFEView'


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Any patients who are able to complete the outcome measures (Section 5.0 Outcomes) and capable of consenting to participating in the research study will be included. Exclusion Criteria: Patients experiencing the following, as determined by the clinical care team: Delirium Severe cognitive impairment (as determined by the clinical care team) Known behavioural abnormalities (e.g. overtly aggressive behavior) that in the opinion of the clinical care team might impede any meaningful participation in the project A score of <30% on the Palliative Performance Scale (PPS) (Anderson et al., 1996) at the time of consent Individuals who are already currently using Motiview paired with a exercise bicycle in the LTC setting Those who are in the opinion of attending physician or clinical team too unwell to participate in the project Unable to complete outcome measures indicated

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: All eligible patients will be recruited to receive the intervention (LIFEView).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 'LIFEView' intervention<br>The 'LIFEView' session(s) involves the use of audiovisual software by Motitech AS (technology provided by and used with permission from Motitech AS). For its primary uses as Motiview, the audiovisual software was coupled to a mobile user-adapted cycle-trainer. Since a secondary benefit of the virtual cycle trip may include reminiscence which may in-turn facilitate conversation of past experiences, the audiovisual software is being adapted for use in reminiscence therapy for a palliative care population. As there is an extensive library available to participants and 'LIFEView' sessions could potentially be longer than feasible for research personnel to conduct, each 'LIFEView' session will be limited to up to 3 videos per session or up to 1 hour of videos per session, whichever is a shorter duration. Additional post-study 'LIFEView' sessions can be provided upon request from participants. | Other: 'LIFEView'<br>* A prototype audiovisual technology in development by Motitech AS.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in psychological and physical symptoms measured by the Edmonton Symptom Assessment System-revised (ESAS-r) (Bruera et al., 1991; Watanabe et al., 2011) | The ESAS-r is a 9-item symptom assessment tool that assesses pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and feeling of wellbeing. Each item is rated by patients on a 0-10 scale (0= best possible, 10= worst possible). | At least 24 hours before using 'LIFEView', and directly after and 48 hours after using 'LIFEView' (pre- and post-'LIFEView') | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in quality of life measured by the McGill Quality of Life-Revised questionnaire (Cohen et al., 2017) | The MQOL-R will be used to assess patient quality of life. There are 4 parts to the questionnaire on overall quality of life, physical symptoms, feelings and thoughts, and social aspects of the participant's life. Each statement is rated on a 0-10 scale (0= worst possible,10= best possible). | At least 24 hours before using 'LIFEView', and 48 hours after using 'LIFEView' (pre- and post-'LIFEView') | 
| Psychosocial effects and aspects of quality of life as determined by semi-structured interviews for consenting participants and their consenting family member(s) or caregiver(s). | These interviews will explore the impact of the 'LIFEView' intervention on patient quality of life, patient-family and patient-caregiver interactions, perceptions of the 'LIFEView' intervention as a tool to improve well-being and quality of life in palliative care settings, and feasibility of using volunteer services to support the long-term sustainability of this intervention across care settings. | Within 24 hours of using 'LIFEView' (post-'LIFEView') | 
| Change in heart rate | Heart rate (beats per minute; bpm) will be measured using a wireless cuff. | At least 24 hours before using 'LIFEView', and directly after using 'LIFEView' (pre- and post-'LIFEView') | 
| Change in blood pressure | Blood pressure (mm Hg) will be measured using a wireless cuff. | At least 24 hours before using 'LIFEView', and directly after using 'LIFEView' (pre- and post-'LIFEView') | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Life review, Reminiscence, Technology, Existential distress, Virtual travel, Well-being