“Doc McStuffins: Doctor for a Day” Virtual Reality (DocVR) for Pediatric Preoperative Anxiety and Satisfaction: Pediatric Medical Technology Feasibility Study

Abstract

Background Preoperative anxiety is a common occurrence among children and is associated with a host of maladaptive postoperative behaviors. Consequently, increased attention has been placed on interventions to reduce preoperative anxiety and its associated outcomes. Child Life preparation prior to surgery includes evidence-based practices such as age-appropriate distraction and therapeutic play. Virtual reality (VR) is a promising addition to the Child Life toolbox to address anxiety prior to surgery. The current study evaluates the implementation and feasibility of a VR experience, “Doc McStuffins: Doctor for a Day Virtual Reality Experience” (DocVR), developed by Disney Junior in collaboration with Children’s Hospital Los Angeles, to target pediatric preoperative anxiety. Objective The primary aim of this study was to examine the feasibility and efficacy of DocVR for preoperative anxiety. A secondary aim was to improve patient, caregiver, and health care provider satisfaction with the preoperative experience. Methods In this study, 51 patients (age 6-14 years) scheduled for surgery in the ambulatory surgery center and the main operating room at Children’s Hospital Los Angeles were approached to participate in Disney’s DocVR experience. The patients played the DocVR experience for an average of 18 minutes (3-55 minutes). Irrespective of surgical procedure, patients and their families were eligible, as long as they had no known marked cognitive or visual impairments that would interfere with completing the survey and engaging in the DocVR experience. Results Patients who tried the DocVR experience (n=51) responded overwhelmingly positively to both the VR technology and to the game itself. Patients experienced a statistically significant decrease in anxiety following DocVR game play (Z=–3.26, P=.001). On the Facial Affective Scale, the percentage of patients who chose the face with the most positive facial expression to represent their affect increased from 23% (12/51) pre-VR to 49% (25/47) post-VR. Furthermore, 97% (38/39) of patients reported feeling more comfortable at the hospital, and 74% (28/38) reported feeling less scared at the hospital after playing the game. The game was enjoyed by 94% (46/49) of patients, and 88% (30/34) of patients reported feeling both “Interested” and “Involved” in the game. Conclusions DocVR is a feasible and beneficial VR experience to relieve pediatric preoperative anxiety and improve satisfaction in the preoperative area. The VR experience resulted in a decrease in overall anxiety and an increase in overall positive affect during the preoperative time. Patients also responded positively to the game, confirming their interest in the content and affirming the quality of the DocVR experience. The positive response to the game indicates that DocVR has the potential to make the overall preoperative experience less anxiety-producing and more comfortable, which leads to improved patient satisfaction. Naturally, improved patient outcomes lead to improved caregiver and health care provider satisfaction.

“Passive or interactive virtual reality? The effectiveness for pain and anxiety reduction in pediatric patients”

“…In the study of anxiety levels expressed by pediatric patients who used the ReVi Technique procedure for blood collection, a clear reduction in their level was shown, compared to other studies (Gold et al 2021;Han et al 2019). According to the type of the technique used, the level of anxiety experienced by the child and measured by the PACBIS scale through the use of interactive virtual reality was significantly lower compared to passive VR (Figueroa Jaramillo, 2015;Hedén et al 2020).…”

Complementary Care Interventions to Reduce Perioperative Anxiety

“…Overall, 97% also indicated feeling more comfortable at the hospital and 74% indicated feeling less scared. 3 "When using a game, it should be age-appropriate and geared toward the child's developmental age," Anderson said. "You also will need to make sure that they know how to use whatever device is selected, so that they do not become frustrated, which would be counterproductive.…”

“…Patients had a statistically significant decrease in anxiety with use of the experience (decrease in median VAS score of 3.26), and most patients (94%) reported enjoying the experience. Overall, 97% also indicated feeling more comfortable at the hospital and 74% indicated feeling less scared 3 . “When using a game, it should be age‐appropriate and geared toward the child’s developmental age,” Anderson said.…”

“…Although preoperative sedatives can be used to decrease anxiety, they also can cause adverse effects, such as delayed recovery. 3,4 Evidence points to the benefits of a variety of complementary care interventions (Sidebar 1) to reduce perioperative anxiety in adult and pediatric patients. 5…”

“…“You end up taking more medication, you do not emerge from anesthesia as quickly, and you can stay longer in the hospital,” she said. “All of this could potentially be lessened by just reducing anxiety.” Although preoperative sedatives can be used to decrease anxiety, they also can cause adverse effects, such as delayed recovery 3,4 . Evidence points to the benefits of a variety of complementary care interventions (Sidebar 1) to reduce perioperative anxiety in adult and pediatric patients 5…”