Development of a virtual reality educational application for peritoneal dialysis training

Objectives
Undertaking training of patients/families in peritoneal dialysis can be stressful, and requires face to face availability of educators. In paediatrics, children often require inpatient admission for training to occur. The rarity of paediatric kidney disease limits opportunities for families to meet peers/others, so the decision to undertake peritoneal dialysis may not be truly informed or shared between clinicians and families.

We hypothesized that virtual reality could offer a supplemental route for training of patients, families, and staff in dialysis, and provide the ‘experience’ of undertaking PD.. We aimed to develop a prototype as proof of concept of VR in patient education.

Methods
Qualitative interviews were conducted with families, nursing staff, and educators to determine the key elements and main objectives of the VR program. A multimedia library was compiled to permit 3D modelling of all aspects of PD. A VR application was developed with stages of preparation/machine set-up, connection, and disconnection of a dialysis session. Two brief troubleshooting scenarios were included. Several iterations were completed with feedback from staff and patients at each stage, including addition of a tutorial, audio instruction, and control simplification. A technology acceptance model(TAM) tool was evaluated with patients, parents and nursing staff, scores of 0–7 allocated for meeting learning needs, and ease of use for each program section.

Results
A prototype VR peritoneal dialysis educational tool has been developed for the MetaQuest 2 VR headset. 8 patients/families and 12 nurses completed the TAM. Scores for ‘meeting needs’ were 5.88–6.67, for ‘ease of use’ were 6–6.83, demonstrating high acceptability and usability. Informal feedback sought from families familiar with PD has been generally positive. One parent had significant motion sickness and could not tolerate VR. One family with prior experience of both VR and PD reported the application was ‘epic’ Two families have used the tool before undertaking any PD training – both reported that the tool alleviated anxiety, and that they could relate the VR experience to their training or nurses setting up the machine on the ward. Both families have since completed training in three days (usually five to seven in our unit).

Conclusions
VR offers a useful supplement to training in medical technologies such as dialysis. Training duration for families may be shortened. Formal evaluation of the application’s utility as an educational tool is needed, as is objective evidence of benefit to patients/families. Multiple potential uses of VR in medical education exist.