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By Dr. Liji Thomas, MD Feb 1 2024 Reviewed by Danielle Ellis, B.Sc.

Palliative care is necessary to ensure comfort and an improved quality of life towards the end of one’s life when enduring chronic or fatal diseases. With the graying of the population in many developed countries, the importance of this segment of healthcare is growing rapidly. Study: Flourishing-Life-Of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) outperforms traditional relaxation therapy in palliative care: results from a randomized controlled trial. Image Credit: Chinnapong/Shutterstock.com

In this context, a new study published in Frontiers in Virtual Reality explored the effectiveness of a psychological strategy called Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT)® in helping people cope with their symptoms and achieve relaxation at the end of life. Background

While earlier studies that compared the use of virtual reality (VR) in palliative therapy have been reported, none have been randomized controlled trials (RCTs), driving the current experimental study.

It is known from prior research that palliative care leaves multiple areas of need unsatisfied, including pain relief, psychological distress over loss of autonomy, and limited opportunity for social interactions. This impacts the quality of life and promotes the progression of the illness.

Both pharmacological and non-pharmacological interventions are used in palliative care. Psychotherapy and other psychological tools are extensively used as they do not have the potential for adverse effects that medications have. Moreover, these are inexpensive and practical, especially when focused on helping the patient relax.

Most studies on relaxation in the field of palliative medicine look only at traditional techniques, largely ignoring the potential for VR to ease pain and facilitate relaxation. However, VR creates an immersive experience that makes patients feel they are present in another environment.

VR thus prevents the consciousness of the present, miserable surroundings while promoting a sense of being in a virtual environment that is controlled. This leads to distraction, a known cognitive-behavioral tool for pain relief. Moreover, this is improved by the chance for the patient to choose the preferred environment, even using this platform to fulfill deeply cherished longings.

This ability to virtually fulfill their wishes to travel to a relaxing destination or environment could bring happiness and relieve the discomfort and sadness of the terminal condition.

Building on earlier feasibilty and pilot studies, the current study seeks to document the impact of VR on patient symptoms in palliative care by simulating activities that are meaningful for the patient. The researchers built a structured psychological program for palliative care patients.

Called FLOW-VRT Relaxation, this is built upon various psychological theories, including flow theory (“completely absorbed in activity without reflective self-consciousness but with a deep sense of control”), self-determination theory (autonomy and a sense of control), stress coping theory, and the attention restoration theory that attributes renewed cognitive ability and greater wellbeing to exposures to natural environments. It is one form of the broader FLOW-VRT intervention, modified for relaxation, allowing patients to choose their relaxing experience. What did the study show?

The study included 128 patients recruited from a palliative care unit over ten months. About 93% completed the study, the mean age being 67 years, and 70% being female. The participants were administered the Chinese version of the Edmonton Symptom Assessment System (CESAS), consisting of a questionnaire exploring nine typically encountered symptoms among cancer patients. This was first done at baseline, followed by randomization and post-test assessment. Related StoriesUK Biobank research reveals significant impact of type 2 diabetes on COVID-19 outcomesNew research highlights regional variations in COPD prevalence according to diagnostic criteriaStudy shows how social media fuels unhappiness and materialism

At baseline, total, physical, and emotional subscale scores on the CESAS were comparable for test and control groups. After the Flow-VRT Relaxation intervention, total, physical, and emotional scores changed in both groups, those exposed to the FLOW-VRT –Relaxation therapy and those who underwent traditional relaxation therapy.

However, the scale of reduction in all three subscale scores was significantly greater with FLOW-VRT Relaxation, indicating that this intervention produced superior symptom improvement compared to traditional measures. This may be due to the individual’s freedom to choose meaningful content for the VR experience, promoting self-determination by supporting the person’s autonomy rather than forcing the individual to embrace an experience chosen by someone else.

The use of immersive VR technology could be another reason for the improved symptom control, as this induces flow, which is linked to physical and mental wellbeing. In addition, it may allow patients to explore and learn to use stress management strategies when going through stressful physical and emotional symptoms. Such emotion-focused coping is more easily managed for many patients undergoing the trauma of end-of-life after a terminal illness and are unable to exercise problem-focused coping strategies. What are the implications?

“Our results showed that following a FLOW-VRT-Relaxation session, the symptoms of distress that patients in palliative care have to endure significantly reduced.” Both physically and emotionally, patients reported that they did not feel the same level of distress. These promising results could point to the extending potential of this approach for elderly patients in long-term care homes and rehabilitation centers.

This sheds light on the scope for the use of this intervention in this area, considering its relatively low cost, scalability, and personalization potential. The use of this approach is especially suitable for those with terminal illnesses who are often bedridden or confined to hospital wards, unable to find pain relief, or suffering from the adverse effects of required medical therapy. Moreover, they are emotionally vulnerable as they have unfulfilled wishes of traveling or escaping their pain.

Further studies are required to follow up on the effects of FLOW-VRT Relaxation over time. However, this is not an essential feature in palliative care, where patient survival is typically expected to be short. In fact, against a background of unfulfilled wishes and a short lifespan, FLOW-VRT Relaxation provides a meaningful impact on the patient’s wellbeing as it can virtually satisfy some of these longings and provide a sense of control.

At the same time, the study brought out some potential risks of such technology, which may engender a greater sense of loss of past abilities or skills in contrast to the patient’s current situation. Further research should look at how VR content may be made still more personalized to have meaning for each individual and design training protocols to make sure the intervention is delivered as intended. Journal reference: Woo, O. K. L. et al. (2024). Flourishing-Life-Of-Wish Virtual Reality Relaxation Therapy (FLOW-VRT-Relaxation) outperforms traditional relaxation therapy in palliative care: results from a randomized controlled trial. Frontiers in Virtual Reality. doi: https://doi.org/10.3389/frvir.2023.1304155. https://www.frontiersin.org/articles/10.3389/frvir.2023.1304155/full. 

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Gillian Anderson warns UK homelessness ‘will only get worse’

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Gillian Anderson warns UK homelessness 'will only get worse'

Gillian Anderson has warned homelessness is a growing problem in the UK – one that will only get worse if we enter a recession.

The award-winning actress, who is playing a woman facing homelessness along with her husband in her latest film, The Salt Path, told Sky News: “It’s interesting because I feel like it’s even changed in the UK in the last little while.”

Born in Chicago, and now living in London, she explained: “I’m used to seeing it so much in Vancouver and California and other areas that I spent time. You don’t often see it as much in the UK.”

Her co-star in the film, White Lotus actor Jason Isaacs, chips in: “You do now.”

“It’s now becoming more and more prevalent since COVID,” said Anderson, “and the current financial situation in the country and around the world.

“It’s a topic that I think will be more and more in the forefront of people’s minds, particularly if we end up going into a recession.”

Pic: Steve Tanner/Black Bear
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Gillian Anderson and Jason Isaacs in The Salt Path. Pic: Steve Tanner/Black Bear

The film is based on Raynor Winn’s 2018 memoir, which depicts her and her husband’s 630-mile trek along the Cornish, Devon and Dorset coastline, walking from Minehead, Somerset to Land’s End.

Written from her notes on the journey, The Salt Path went on to sell over a million copies worldwide and spent nearly two years in The Sunday Times bestseller list. Winn’s since written two more memoirs.

Isaacs, who plays her husband Moth Winn in the movie, told Sky News that Winn told him she “hopes [the film] makes people look at homeless people when they walk by in a different light, give them a second look and maybe talk to them”.

With record levels of homelessness in the UK, with a recent Financial Times analysis showing one in every 200 households in the UK is experiencing homelessness, the cost of living crisis is worsening an already serious problem.

Pic: Steve Tanner/Black Bear
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Pic: Steve Tanner/Black Bear

The film sees Ray and Winn let down by the system, first by the court which evicts them from their home, then by the council which tells them despite a terminal diagnosis they don’t qualify for emergency housing.

Following the loss of their family farm shortly after Moth’s shock terminal diagnosis with rare neurological condition Corticobasal Degeneration (CBD), the couple find solace in nature.

They set off with just a tent and two backpacks to walk the coastal path.

Isaacs says living in a transient way comes naturally to actors, admitting like his character, he too “lives out of a suitcase” and is “away on jobs often”.

Read more:
Is this every actor’s bucket list job?

Pic: Steve Tanner/Black Bear
Image:
Pic: Steve Tanner/Black Bear

Shot in 2023 across Somerset, Devon, Cornwall and Wales, Anderson says as a city-dweller, the locations had an impact on her.

Anderson reveals: “As I’ve gotten older, I have become more aware of nature than […] when I was younger, and certainly in filming this film and being outside and so much of nature being a third character, it did shift my thinking around it.”

Meanwhile, Isaacs says he discovered a “third character” leading the film just the day before our interview, when speaking to Winn on the phone.

Isaacs says the author told him: “I feel like there’s three characters in the film,” going on, “I thought she was going to say nature, but she said, ‘No, that path'”.

Isaacs elaborates: “Not just nature, but that path where the various biblical landscapes you get and the animals, they matter.

“The things that happen on that path were a huge part of their own personal story and hopefully the audience’s journey as well.”

The Salt Path comes to UK cinemas on Friday 30 May.

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Politics

PM could lift controversial benefit cap in budget – as Farage makes two big election promises

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PM could lift controversial benefit cap in budget - as Farage makes two big election promises

Sir Keir Starmer could decide to lift the two-child benefit cap in the autumn budget, amid further pressure from Nigel Farage to appeal to traditional Labour voters.

The Reform leader will use a speech this week to commit his party to scrapping the two-child cap, as well as reinstating winter fuel payments in full.

The prime minister – who took Westminster by surprise at PMQs by revealing his intention to row back on the winter fuel cut – has previously said he would like to lift the two-child cap if the government could afford it.

There are now mounting suggestions an easing of the controversial benefit restriction may be unveiled when the chancellor delivers the budget later this year.

According to The Observer, Sir Keir told cabinet ministers he wanted to axe the measure – and asked the Treasury to look for ways to fund the move.

It comes after the government delayed the release of its child poverty strategy, which is expected to recommend the divisive cap – introduced by former Tory chancellor George Osborne – is scrapped.

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Why did Labour delay their child poverty strategy?

Ministers have already said any changes to winter fuel payments, triggered by mounting political pressure, would only be made when the government’s next fiscal event rolls round.

The Financial Times reported it may be done by restoring the benefit to all pensioners, with the cash needed being clawed back from the wealthy through the tax system.

The payment was taken from more than 10 million pensioners this winter after it became means-tested, and its unpopularity was a big factor in Labour’s battering at recent elections.

Before Wednesday’s PMQs, the prime minister and chancellor had insisted there would be no U-turn.

More from Sky News:
PM’s winter fuel claim ‘not credible’
Starmer vs Reeves – the ‘rift’ in Downing Street

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Will winter fuel U-turn happen?

Many Labour MPs have called for the government to do more to help the poorest in society, amid mounting concern over the impact of wider benefit reforms.

Former prime minister Gordon Brown this week told Sky News the two-child cap was “pretty discriminatory” and could be scrapped by raising money through a tax on the gambling industry.

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Brown questioned over winter fuel U-turn

Mr Farage, who believes Reform UK can win the next election, will this week accuse Sir Keir of being “out of touch with working people”.

In a speech first reported by The Sunday Telegraph, he is expected to say: “It’s going to be these very same working people that will vote Reform at the next election and kick Labour out of government.”

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Politics

Sir Alan Bates attacks ‘kangaroo court’ Post Office scheme after ‘take it or leave it’ offer

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Sir Alan Bates attacks 'kangaroo court' Post Office scheme after 'take it or leave it' offer

Sir Alan Bates has accused the government of presiding over a “quasi kangaroo court” for Post Office compensation.

Writing in The Sunday Times, the campaigner, who led a years-long effort for justice for sub-postmasters, revealed he had been given a “take it or leave it” offer that was less than half of his original claim.

“The sub-postmaster compensation schemes have been turned into quasi-kangaroo courts in which the Department for Business and Trade sits in judgement of the claims and alters the goal posts as and when it chooses,” he said.

“Claims are, and have been, knocked back on the basis that legally you would not be able to make them, or that the parameters of the scheme do not extend to certain items.”

More than 900 sub-postmasters were prosecuted between 1999 and 2015 after faulty Horizon accounting software made it look as if money was missing from their accounts.

Many are still waiting for compensation despite the previous government saying those who had their convictions quashed were eligible for £600,000 payouts.

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‘It still gives me nightmares’

After the Post Office terminated his contract over a false shortfall in 2003, Sir Alan began seeking out other sub-postmasters and eventually took the Post Office to court.

More on Post Office Scandal

A group litigation order (GLO) scheme was set up to achieve redress for 555 claimants who took the Post Office to the High Court between 2017 and 2019.

Sir Alan, who was portrayed by actor Toby Jones in ITV drama Mr Bates Vs The Post Office, has called for an independent body to be created to deliver compensation.

He added that promises the compensation schemes would be “non-legalistic” had turned out to be “worthless”.

It is understood around 80% of postmasters in Sir Alan’s group have accepted a full and final redress, or been paid most of their offer.

Read more:
Post Office scandal explained

Who are the key figures in the scandal?

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‘Lives were destroyed’

A Department for Business and Trade spokesperson told Sky News: “We pay tribute to all the postmasters who’ve suffered from this scandal, including Sir Alan for his tireless campaign for justice, and we have quadrupled the total amount paid to postmasters since entering government.

“We recognise there will be an absence of evidence given the length of time which has passed, and we therefore aim to give the benefit of the doubt to postmasters as far as possible.

“Anyone unhappy with their offer can have their case reviewed by a panel of experts, which is independent of the government.”

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