Background Cancer rehabilitation is central for helping patients and relatives create a functional everyday life based on the changes in life conditions. The needs are highly individual and include physical, mental, and social challenges. Cancer rehabilitation programs offer coping strategies, including guidelines on how to handle emotions. Objective This paper presents a participatory design activity where patients in cancer rehabilitation use a virtual smash room, which is a virtual environment where the user can break things, mainly porcelain or glass items such as vases or plates. The objective is to understand attitudes to, and some effects of, using this application, as well as eliciting ideas of other virtual environments that would be desired. Methods The virtual environment presented here, the virtual smash room, was designed at the request of a patient with cancer who wanted a tool for venting frustration. In this virtual environment, the user can break porcelain, vases, and plates. Patients participating in a week-long cancer rehabilitation program tested the virtual smash room and reported their experiences through a questionnaire. The questionnaire comprised three sections: (1) a subset of the Intrinsic Motivation Inventory (IMI), (2) a subset of the Virtual Reality Symptoms Questionnaire (VRSQ), and (3) a free-text response section. Results A total of 101 responses were gathered. The results from the IMI questions showed that the participants found the virtual experience enjoyable (mean 4.52, maximum 5, SD 0.73), and it helped them retain their focus (mean 4.44, maximum 5, SD 0.74). The VRSQ revealed that there were only minor symptoms related to general discomfort (5.9%, n=6), fatigue (5.9%, n=6), nausea (3.0%, n=3), and tired eyes (8.9%, n=9), while several participants experienced dizziness (22.8%, n=23). Since only postmeasurements were gathered, nothing could be concluded about the prevalence of these symptoms before testing. The free-text responses indicated that the user group had many ideas for other virtual environments to use in cancer rehabilitation. Conclusions This study presents a concept of using virtual reality in the cancer rehabilitation process and exemplifies activities of patient participation in the design process. Virtual reality has potential in being both distracting and enjoyable, while certain aspects of cybersickness might be especially important to consider for a user group already experiencing physical and mental issues. The results will act as input in the process of further designing virtual applications in digitally reinforced cancer rehabilitation.

Simulations are an important component of crisis preparedness, because they allow for training responders and testing plans in advance of a crisis materializing. However, traditional simulations can all too easily fall prey to a range of cognitive and organizational distortions that tend to reduce their efficacy. These shortcomings become even more problematic in the increasingly complex, highly dynamic crisis environment of the early 21st century. This situation calls for the incorporation of alternative approaches to crisis simulation, ones that by design incorporate multiple perspectives and explicit challenges to the status quo. As a distinct approach to formulating, conducting, and analyzing simulations and exercises, the central distinguishing feature of red teaming is the simulation of adversaries or competitors (or at least adopting an adversarial perspective). In this respect, red teaming can be viewed as practices that simulate adversary or adversarial decisions or behaviors, where the purpose is informing or improving defensive capabilities, and outputs are measured. Red teaming, according to this definition, significantly overlaps with but does not directly correspond to related activities such as wargaming, alternative analysis, and risk assessment. Some of the more important additional benefits provided by red teaming include the following: ▪ The explicit recognition and amelioration of several cognitive biases and other critical thinking shortfalls displayed by crisis decision makers and managers in both their planning processes and their decision-making during a crisis. ▪ The ability to robustly test existing standard operating procedures and plans at the strategic, operational, and tactical levels against emerging threats and hazards by exposing them to the machinations of adaptive, creative adversaries and other potentially problematic actors. ▪ Instilling more flexible, adaptive, and in-depth sense-making and decision-making skills in crisis response personnel at all levels by focusing the training aspects of simulations on iterated, evolving scenarios with high degrees of realism, unpredictability through exploration of nth-order effects, and multiple stakeholders. ▪ The identification of new vulnerabilities, opportunities, and risks that might otherwise remain hidden if relying on traditional, nonadversarial simulation approaches. Key guidance in conducting red teaming in the crisis preparedness context includes avoiding mirror imaging, having clear objectives and simulation parameters, remaining independent of the organizational unit being served, judicious application in terms of the frequency of red teaming, and the proper recording and presentation of red-teaming simulation outputs. Overall, red teaming—as a specific species of simulation—holds much promise for enhancing crisis preparedness and the crucial decision-making that attends a variety of emerging issues in the crisis management context.

BACKGROUND Cancer rehabilitation is central for helping patients and relatives create a functional everyday life based on the changes in life conditions. The needs are highly individual and include physical, mental, and social challenges. Cancer rehabilitation programs offer coping strategies, including guidelines on how to handle emotions. OBJECTIVE This paper presents a participatory design activity where patients in cancer rehabilitation use a virtual smash room, which is a virtual environment where the user can break things, mainly porcelain or glass items such as vases or plates. The objective is to understand attitudes to, and some effects of, using this application, as well as eliciting ideas of other virtual environments that would be desired. METHODS The virtual environment presented here, the virtual smash room, was designed at the request of a patient with cancer who wanted a tool for venting frustration. In this virtual environment, the user can break porcelain, vases, and plates. Patients participating in a week-long cancer rehabilitation program tested the virtual smash room and reported their experiences through a questionnaire. The questionnaire comprised three sections: (1) a subset of the Intrinsic Motivation Inventory (IMI), (2) a subset of the Virtual Reality Symptoms Questionnaire (VRSQ), and (3) a free-text response section. RESULTS A total of 101 responses were gathered. The results from the IMI questions showed that the participants found the virtual experience enjoyable (mean 4.52, maximum 5, SD 0.73), and it helped them retain their focus (mean 4.44, maximum 5, SD 0.74). The VRSQ revealed that there were only minor symptoms related to general discomfort (5.9%, n=6), fatigue (5.9%, n=6), nausea (3.0%, n=3), and tired eyes (8.9%, n=9), while several participants experienced dizziness (22.8%, n=23). Since only postmeasurements were gathered, nothing could be concluded about the prevalence of these symptoms before testing. The free-text responses indicated that the user group had many ideas for other virtual environments to use in cancer rehabilitation. CONCLUSIONS This study presents a concept of using virtual reality in the cancer rehabilitation process and exemplifies activities of patient participation in the design process. Virtual reality has potential in being both distracting and enjoyable, while certain aspects of cybersickness might be especially important to consider for a user group already experiencing physical and mental issues. The results will act as input in the process of further designing virtual applications in digitally reinforced cancer rehabilitation.