Abstract
BackgroundIn 2019, the Patient Autonomy Act went into effect, allowing Taiwanese citizens to establish legal advance decisions. In an effort to secure a more realistic and accurate perception of situations, a virtual reality video was developed by the palliative care team of Chi-Mei hospital in southern Taiwan for citizens to use before advance care planning. This study explores the change in participants’ preference and certainty regarding end-of-life decisions after using this tool.MethodsParticipants were at least 20 years old and capable of reading and understanding the information provided in the written handout with information about the legal process of making an advance decision. They completed pre-test questionnaires, viewed a six-minute 360-degree virtual reality video on a portable headset, and then completed a post-test questionnaire about their preference on the five medical options—CPR, life-sustaining treatments, antibiotics, blood transfusion, and artificial nutrition and hydration—followed by feedback on the helpfulness of the virtual reality. The control group included 40 participants who only read the handout and completed pre-test and post-test questionnaires.ResultsAfter viewing the virtual reality video, preference for not using CPR, life-sustaining treatment, antibiotics, blood transfusion, and artificial nutrition and hydration increased significantly in the virtual reality intervention group. Uncertainty regarding the five medical options mentioned above significantly decreased. The intervention was generally recognized by participants for its help in making decisions.DiscussionThe decrease in the number of participants who could not make decisions indicates that the virtual reality video may be helpful for users in making end-of-life decision. According to feedback, the virtual reality video helped equip users with better understanding of medical scenarios, and that it is a good decision tool for advance care planning.ConclusionThis is the first study since the Patient Autonomy Act has been passed that explores the effectiveness of using a virtual reality video as a decision tool in advance care planning and reveals decreased preference of CPR, life sustaining treatment, antibiotics, blood transfusion, and artificial nutrition and hydration after intervention. This decision aid proved to be an effective tool for clarifying their end-of-life care preferences.
Highlights
In 2019, the Patient Autonomy Act went into effect, allowing Taiwanese citizens to establish legal advance decisions
[4] To improve this situation, several video decision tools have been introduced to advance care planning (ACP) to improve the accuracy and certainty of end-oflife decision making, and have been found valuable in helping patients increase their knowledge of medical treatments and allow them to clarify their medical decision preferences with more certainty [5,6,7]
Participants This study had a total of 160 participants, 40 of whom were randomly assigned to the control group and 120 of whom were randomly assigned to the intervention group with the virtual reality (VR) video
Summary
In 2019, the Patient Autonomy Act went into effect, allowing Taiwanese citizens to establish legal advance decisions. In January 2019, the Patient Autonomy Act of Taiwan (hereafter, “the Act”), the first of its kind in Asia, officially went into effect, allowing Taiwanese citizens to establish a legally binding advance decision (AD). According to the Act, a patient must complete an advance care planning (ACP) consultation with a medical team before documenting their wishes with a formal AD The aim of this consultation is to ensure that the wishes, values, and preferences of a patient concerning future care and treatment are documented in their AD and will be respected when needed [2, 3]. Imagining medical treatments and future disease status merely based on reading materials and verbal communication is likely insufficient for patients to truly clarify their preferences for end-of-life decisions [4] To improve this situation, several video decision tools have been introduced to ACP to improve the accuracy and certainty of end-oflife decision making, and have been found valuable in helping patients increase their knowledge of medical treatments and allow them to clarify their medical decision preferences with more certainty [5,6,7]
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