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The Neuroscience and Four Use Cases

For the past few years, we have been watching, and working to facilitate, the evolution of virtual reality (VR) in healthcare. We even built a Learning Hub on the IKONA Health website where we collect and curate peer-reviewed basic science research. In that time, we have witnessed the expansion of VR across healthcare as the number of use cases and success stories seemingly grow by the month, day, and experience.

Why Virtual Reality Provides an Ideal Tool for Kidney Care Education | Speeding the Time to Dialysis Modality Switch

Kidney disease ranks as the ninth leading cause of death in America. Approximately 20% of dollars in traditional Medicare—$114 billion a year—are spent on Americans with kidney disease. For patients who require dialysis, which typically happens when you have only 10 to 15 percent of your kidney function left, hemodialysis is the most common modality. In fact, approximately 90% of kidney dialysis patients are on hemodialysis in a hospital or dialysis center setting.

There is a second dialysis option available to patients called peritoneal dialysis that is done at home. Peritoneal dialysis is more cost effective than hemodialysis and often provides patients with more flexibility and freedom when compared to the hemodialysis regimen. Despite the cost and quality of life advantages of peritoneal dialysis, only 10% of kidney patients use peritoneal dialysis.

Federal Governments around the world have long been aware of the cost and quality issues associated with providing dialysis treatment options — for most patients in the United States, Medicare pays 80 percent of all dialysis charges. A recently announced mandate aims to improve care quality and reduce costs in part by drastically increasing home dialysis usage. From an education, training and decision-making standpoint the current modality imbalance is problematic. Since patients frequently start in a hospital or in-center setting, they become biased to follow the path of least resistance and remain on the modality and routine where they began. Add to this the fact that all decisions in kidney care are multilateral, involving nephrologists, patients and care providers, and depend greatly on patient motivations. It is for all of these reasons that education is so critical to quality in kidney care.  Patients need high-quality and highly-effective educational experiences in order to make the decision to switch modalities.

By far the most common approach to dialysis education, like in most other domains of care, is to have patients read documents describing the treatment. For example, the kidney  patient might read a document that provides a general overview of in-center hemodialysis (HD) and aspects of the patient’s lifestyle that might change as a result of the HD treatments. Similarly, the patient might read another document that provides a general overview of peritoneal dialysis (PD), including the steps associated with performing a PD treatment, certain safety measures that are specific to conducting dialysis treatments at home, and the dispelling of common myths associated with PD.

From a psychology and neuroscience perspective, this text-based approach engages only the cognitive skills learning system in the brain. From this 2D static, abstract, text-based information, the cognitive skills learning system in the brain must attempt to construct a rich 3D dynamic visual and emotional representation of what in-clinic and in-home dialysis are like “in real life”. Even when supplemented with drawings or 2D video, this is a nearly impossible task and one that is prone to error.

Thus, modality switches from expensive and restrictive hemodialysis to the less expensive and more flexible peritoneal dialysis will be infrequent, and the time to decision will be long.

Now consider an interactive storytelling with VR approach to dialysis modality education. Suppose that a 360 VR experience was created in which the patient could experience in-clinic and in-home dialysis from a first-person perspective (i.e., that of the patient) and a third-person perspective (i.e., that of a loved one). While immersed in this experience, a narrative unfolds for the patient that describes the relevant steps while the patient is experiencing them, and includes narrative regarding the strengths and weaknesses of each approach.

From a psychology and neuroscience perspective, this approach engages the cognitive, experiential and emotional learning systems in the brain. Critically, a VR approach like this engages all three brain systems simultaneously and in concert. The cognitive learning system is being engaged and is storing the procedural overview and step-by-step procedure. Experiential learning takes place simultaneously because the patient is experiencing first-hand and third-person the dialysis procedure. Emotional learning is occurring because the patient is “walking a mile in a dialysis patient’s shoes” during the VR experience. Supplement this with a strong narrative and compelling storytelling, and VR offers the highest quality information for patient decision making.

This is a perfect use case for interactive storytelling with VR. Kidney dialysis providers can use this tool to more quickly meet the federal mandate to increase peritoneal dialysis utilization, while patients simultaneously reap the benefits of improved care quality along with the ability to make faster and more confident modality switch decisions — one experience at a time.

The SOAP Note: how to gather the information and create a note. 

The SOAP note is an acronym for Subjective, Objective, Assessment and Plan.

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