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Communicate Heal-th: A Virtual Reality training tool for optimizing expectancy effects in patient-provider interaction

Periodic Reporting for period 1 - COMMUNICATE-HEAL-TH (Communicate Heal-th: A Virtual Reality training tool for optimizing expectancy effects in patient-provider interaction)

Période du rapport: 2021-05-01 au 2022-10-31

Patients’ expectancies about treatment can largely affect their health and treatment responses. These expectancies are key in placebo and nocebo effects. Placebo and nocebo effects are changes in patient outcomes that cannot be attributed to the active ingredients of a prescribed treatment or the natural course of a health condition, but can be explained by a persons’ expectations of their treatment. From previous studies it is clear that expectancies have great therapeutic potential for use in healthcare, and providers have a pivotal role to play in communicating the optimal expectations to their patients.
Provider-patient communication is the most promising avenue of enhancing expectancy effects; healthcare providers could, for example, enhance treatment if they outline the treatment mechanisms and expected benefits, or prevent side effects by fine-tuning the information they give patients. However, while experts agree on the importance and value of enhancing expectancy effects via provider-patient communication, no widely available training currently exists to teach healthcare providers how to do this. Given the importance of expectancy effects for health outcomes, the goal of this project was to develop an innovative communication training that trains healthcare providers to interact with patients in a way that optimizes placebo effects and minimizes nocebo effects. This communication training consists of two tools that connect to each other: an e-learning tool and a virtual reality (VR) tool.
The aim of the communication training was threefold: 1) to familiarize healthcare providers with state-of-the art theoretical knowledge on placebo and nocebo effects, 2) to raise awareness about the role of placebo and nocebo-effects in everyday clinical practice, 3) to obtain the communication skills needed to optimize placebo effects and minimize nocebo effects in clinical practice. In order to ensure that the communication training is successful and experienced as user friendly, there was structural collaboration with end users and experts in user-centered design in all developmental phases.
The e-learning tool contains five modules in which healthcare providers are taught to optimize their communication: 1) Optimizing the provider-patient relationship, 2) Asking about patient expectations, 3) Discussing treatment rationale, 4) Discussing risks and side effects, 5) Explaining placebo and nocebo effects to the patient. The information was given through various videos and texts. After completing the e-learning, healthcare providers can then practice the taught communication skills in the VR tool. The complete e-learning can be found on the following (Dutch) webpage: https://www.medicijngebruik.nl/scholing/e-learning/4942/behandeleffecten-verbeteren-via-communicatie
The VR tool encompasses all of the skills taught in the e-learning modules. Two patient cases (including realistic fictional VR patients) were developed in which healthcare providers can freely practice the learned skills. With the use of VR glasses, healthcare providers can have a conversation with the patient. Healthcare providers can talk aloud in the VR tool and the patient will also talk back. Artificial Intelligence (AI) tools such as Speech recognition and Natural Language ensure that the provider can freely interact with the patients in the VR environment and that they can explore the impact of different communication strategies on the patient. Moreover, the AI tracks and detects nonverbal body language and eye movements and also provides feedback on this.
The e-learning tool and the VR tool have been tested in terms of usability and feasibility. The usability tests took place halfway through the developmental process and the feedback from the testers (i.e. experts in the field of placebo/communication research and end users) was incorporated to further optimize the tools. In the feasibility tests, the tools were evaluated by end users (e.g. doctors, nurses).
Placebo/communication experts and healthcare providers overall assessed the e-learning very positively (usability phase: M=7.9 [scale 1-10], feasibility phase: M=7.9 [scale 1-10]). The testers perceived a good variation between the different ways of providing the information via videos and text. They also perceived the e-learning content as accessible and interesting and indicated that many concrete and useful tips were given. The healthcare providers also supported the feasibility of providing this e-learning in clinical practice.
When testing the VR tool, placebo/communication experts and healthcare providers described the VR environment as very realistic. The healthcare providers experienced this tool as a very safe way to train and explore their communication skills (e.g. they remarked that it feels safer than with an actor in front of a group, as is commonly done now). The personalized feedback provided by the tool was also experienced as very useful and of high quality. Experts and healthcare professionals indicated that they saw real potential in the product for the future. With further development of the product, the use of the VR tool can make an important positive contribution to optimizing the communication of healthcare providers. A by-product that was not initially the aim of this project, is that the training tools can also be followed and offered separately. In addition, we have developed a 2D version of the 3D VR tool that can be followed via an app on a mobile phone.
To conclude, this project has resulted in an innovative, professional and user-friendly communication training. The training is already in use in the Netherlands. The e-learning tool is already offered as an accredited training course for healthcare providers and it is expected that this will also be the case with the VR tool soon. The possibilities to further develop and implement the training tools are currently examined with collaborators. The results of this project will be used to further improve the training for further commercialization.