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.
VR and Empathy Building in Healthcare
Healthcare professionals must be well-trained and have competence and expertise in their chosen field. Even so, what sets the best healthcare systems apart from the rest are those whose staff show high levels of emotional intelligence. A critical feature of emotional intelligence is empathy.
Empathy encompasses the ability to understand and vicariously experience the feelings and thoughts of another. It requires much more than a cognitive understanding. Empathy is about an emotional, experiential and visceral understanding, as if you have “walked a mile in someone else’s shoes” and have shared their experiences. Empathy is also about behavior. Empathy is something that you can see in another’s action.
In this report, we show that traditional approaches to empathy training that rely on text or PowerPoint are ineffective because they target a cognitive, as opposed to an experiential, emotional and behavioral understanding of empathy. Although role-playing and simulation are better because they do target an experiential, emotional, and behavioral understanding of empathy, we show that this is not time- or cost-effective, and is not scalable. Instead, we argue that interactive storytelling with VR provides an effective empathy building solution that is time- and cost-effective, and is scalable in ways that role-play and simulation are not.
To train empathy in a person, we must understand the psychology and neuroscience of learning so that we can effectively engage the parts of the brain that matter. The human brain is comprised of at least four distinct learning systems.
The experiential learning system has evolved to represent the sensory aspects of an experience, whether visual, auditory, tactile or olfactory. Critical brain regions include the occipital, temporal, and parietal lobes. Every experience is unique, adds rich context to the learning and is immersive. Experience is at the heart of empathy training. The more one can vicariously experience the feelings, thoughts, and experiences of another, the more empathetic they will become.
The cognitive system is our information system. The critical brain region here is the prefrontal cortex. The cognitive system processes and stores knowledge and facts using working memory and attention. Critically, these are limited resources and form a bottleneck that slows learning with more information coming in than can be processed. A cognitive understanding of empathy is important, but not nearly as important as the experiential, emotional or behavioral components.
The behavioral system in the brain has evolved to learn motor skills. The critical structure is the striatum whose processing is optimized when behavior is interactive and is followed in real-time (literally within milliseconds) by corrective feedback. This system builds the “muscle memory” that drives empathetic behaviors. This system links rich experiential contexts (represented by the experiential learning system) and emotions with the appropriate behavioral responses. It is one thing to know the definition of empathy, to know that eye contact is important, and to know that you need to show understanding, but it is completely different (and mediated by different systems in the brain) to know how to show empathy with eye contact and behaviors that demonstrate true understanding.
More than anything, it is the emotional learning system in the brain that builds the interpersonal understanding, awareness, and sensitivity that are at the heart of empathy and an understanding of our and others’ behaviors. If one can “walk a mile in someone else’s shoes” and gain that vicarious understanding, awareness and sensitivity of another, they can build empathy. The critical brain regions are the amygdala and other limbic structures. Emotional learning, when combined with context rich experiences, builds rich repertoires of empathetic understanding and behavior.
Text and Powerpoint are ineffective methods for training empathy because they engage only cognitive systems. Role play and simulation are better because they are interactive, involve emotion-laden situations and behavior, but even here it is often difficult to suspend the reality of who you are and who your role-playing partner might be. In addition, people differ in their willingness and ability to role play. Finally, simulation and role play are time-consuming, costly, and not scalable.
Interactive storytelling with virtual reality, on the other hand, can address the shortcomings of traditional approaches to patient education and empathy building. With interactive storytelling in virtual reality you “learn through experience”. Experiential learning with VR is far superior to information learning with text because VR broadly engages multiple learning and memory systems in the brain in synchrony.
For example, as a nurse-in-training might don a VR headset and “walk a mile in the shoes of a patient”. They can obtain a first-person virtual experience of the stress and anxiety that a patient feels when someone is explaining a procedure to them and they don’t understand all of the jargon and terminology. They can experience what it is like to be a patient interacting and communicating with an empathetic nurse and with a nurse who shows little empathy. These “walk a mile in my shoes” experiences are visceral.
Analogously, a nurse-in-training might be transported into the middle of a busy emergency room and shadow a seasoned nurse explaining a patient’s condition to their distraught spouse. Using voice-over, the seasoned nurse might explain how they are showing empathy to soothe the concerns of the spouse. The nurse-in-training is in the situation and can feel the emotions. They can combine the information provided by the seasoned nurse with the behaviors they are observing, all within an emotion-laden, realistic experience. This engages multiple learning systems in synchrony and will build empathy quickly and effectively.
With emotion-laden, experiential empathy training via interactive storytelling with VR, a healthcare system can differentiate itself from the rest, but providing the top medical, but also emotional support for their patients. With VR training for healthcare professionals you can achieve this goal—one experience at a time.
The US is currently experiencing a shortage of nurses and this will only continue to grow with the aging population of the baby boomers.