Evaluation of a nature-based virtual reality intervention to support hospice caregivers: a pilot feasibility study

Objectives Hospice family caregivers (CGs) may experience poor emotional health and diminished quality of life (QOL) secondary to stressors that accompany home-based end-of-life caregiving. Innovative flexible strategies are needed to support hospice CGs in their homes. Being outdoors in nature enhances well-being but is often not accessible to home-based CGs. The purpose was to evaluate the feasibility/acceptability, and preliminary emotional health and QOL outcomes of a 5-day nature-based virtual reality (VR) intervention. Methods A pre-post design was used. Hospice CGs engaged in self-selected 10 min nature experiences via VR headset over 5 days. Preintervention surveys included demographics and the PROMIS-29 QOL measure (physical/social function, anxiety/depressive symptoms, fatigue, sleep and pain). Postintervention surveys included acceptability/feasibility surveys, PROMIS-29 and a VR-related symptom checklist. Data analysis included descriptives and paired t-tests. Results 15 CGs (mean 61.13 +/- 12.47 years; 12 females) completed the study. Findings demonstrated high acceptability (14.46 +/- 1.77; range 0-16); feasibility (13.93 +/- 2.43;range 0-16). Adverse VR symptoms were minimal. PROMIS-29 overall scores were significantly improved following the 5-day intervention (pre: 66.33 +/- 8.47; post: 61.07 +/- 7.83,p=0.01). Paired t-tests showed significant pre-post changes in anxiety (t=2.206, p<0.05) and favourable trends on other QOL dimensions. Conclusions Feasibility/acceptability and QOL data support further testing of VR nature immersive experiences in the home environment with larger more diverse representative samples.