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Evidence-Based Nursing Online First, published on November 25, 2017 as 10.1136/eb-2017-102780
Randomised controlled trial
Preoperative virtual reality experience
may improve patient satisfaction and
reduce anxiety
10.1136/eb-2017-102780
Axel Maurice-Szamburski
Department of Anesthesia, Clinique Juge, Marseille, France
Correspondence to: Dr Axel Maurice-Szamburski, Department of
Anesthesia, Clinique Juge, Marseille 13008, France; ​amszamburski@​
gmail.​com
Commentary on: Bekelis K, Calnan D, Simmons N, et al. Effect of
an immersive preoperative virtual reality experience on patient-
reported outcomes: a randomised controlled trial. Ann Surg
2017;265:1068–73.
Implications for practice and research
►► The assessment of patient experience is essential for evaluating sur-
gical outcomes.
►► Patient satisfaction with the perioperative experience depends on a
patient having experiences that match expectations.
►► By adapting patient expectations to real life, virtual reality (VR)
could improve their global experience.
Context
Most patients undergoing surgery are anxious.1 Addressing anxiety is
a serious concern for the improvement of patient experience during
the perioperative period. A previous study about anxiolytic premedi-
cation failed to demonstrate any improvement in patient experience,2
suggesting that treating surgery-induced anxiety as an illness may not
be the answer. Besides anxiety, a  patients’ need for information is an
important aspect that should be addressed because of its weight in the
patient global experience of the perioperative period. Delivering informa-
tion to patient through an immersive medium such as VR could improve
patient experience about the perioperative period.
Methods
The purpose of the study by Bekelis and colleagues was to determine
whether a VR experience of the surgical environment could improve
patient satisfaction when given preoperatively. Patients scheduled for
brain or spine surgery were recruited at a single-centre tertiary hospital.
More than 1000 patients were screened for eligibility. One hundred and
fifty patients were randomised to receive either VR or standard infor-
mation. Patient satisfaction was assessed by the means of the EVAN-G
scale, which was self-reported by the patient within the first 24 hours
after surgery. Preoperative anxiety was also assessed after the VR expe-
rience and before surgery.
Findings
The authors reported a statistically significant improvement in patient
satisfaction with a higher EVAN-G score in the group that received the
VR experience (adjusted difference, 20.5; 95% CI 11.9 to 21.0, P<0.001).
Evid Based Nurs Month 2017 | volume 0 | number 0 |
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Adult nursing
The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was
linearly transformed to a 0–100 scale, with 100 indicating the lowest
(best) possible level of anxiety and 0 indicating the highest (worst). The
transformed APAIS score was 90.7 after the VR and 60.8 after standard
preoperative experience (adjusted difference, 31.1; 95% CI 22.2 to 39.9,
P<0.001).
Commentary
Considering anxiety as a symptom of misinformation instead of an
illness is appropriate and concordant with literature.3 In the periopera-
tive period, anaesthesia and surgery lead to anxiety and stress. Patients
have to regain control of their emotions using coping efforts.4 By giving
patients an insight of the real experience they will have in the periopera-
tive period, the authors help them get accustomed to potentially stressful
events. According to expectation theory, patient satisfaction is defined by
the distance between expectations and real experience.5 Matching patient
expectations with real life by using VR could explain the important satis-
faction improvement that is reported in the study.
However, the author’s conclusions should be mitigated because of
methodological concerns. First, the authors needed to screen 1100 patients
to include only 150 in the study. This could mean that the tested treat-
ment, that is, VR, may not be suited to most patients. Second, numerous
patients were scheduled for brain surgery, which is known to poten-
tially impair cognitive function, especially in the first 24 hours. There
was also an over-representation of psychiatric diseases in the standard
group compared with the VR group, n=33 vs 11. Third, the study was
open labelled. Authors could have used a sham, such as an entertainment
film, to strictly compare the targeted VR experience with the distraction
provided by the device.
The study by Bekelis et  al  is nevertheless interesting by its design
and results. The article supports the novel approach of patient-centred
care. This new paradigm has been codified by the American Society of
Anaesthesiologists and other stakeholders in the perioperative surgical
home concept6 to improve perioperative healthcare in the era of shared
decision-making.
Competing interests  None declared.
Provenance and peer review  Commissioned; internally peer reviewed.
© Article author(s) (or their employer(s) unless otherwise stated in the
text of the article) 2017. All rights reserved. No commercial use is
permitted unless otherwise expressly granted.
References
1. Van den Bosch JE, Moons KG, Bonsel GJ, et al. Does measurement of preoperative
anxiety have added value for predicting postoperative nausea and vomiting? Anesth
Analg 2005;100:1525–32.
2. Maurice-Szamburski A, Auquier P, Viarre-Oreal V, et al. Effect of sedative
premedication on patient experience after general anesthesia: a randomized clinical
trial. JAMA 2015;313:916–25.
3. Kiecolt-Glaser JK, Page GG, Marucha PT, et al. Psychological influences on surgical
recovery. Perspectives from psychoneuroimmunology. Am Psychol 1998;53:1209–18.
4. Aust H, Rüsch D, Schuster M, et al. Coping strategies in anxious surgical patients.
BMC Health Serv Res 2016;16:250.
5. Campbell J, Einspahr K. Building partnerships in accountability: consumer
satisfaction. Washington, DC: American Psychiatric Publishing, Inc, 2001.
6. Vetter TR, Ivankova NV, Goeddel LA, et al. An analysis of methodologies that can be
used to validate if a perioperative surgical home improves the patient-centeredness,
evidence-based practice, quality, safety, and value of patient care. Anesthesiology
2013;119:1261–74.
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 Downloaded from http://ebn.bmj.com/ on November 26, 2017 - Published by group.bmj.com

Preoperative virtual reality experience may

improve patient satisfaction and reduce
anxiety
Axel Maurice-Szamburski

Evid Based Nurs published online November 25, 2017

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