• Malisa Dang, Danielle Noreika, Semi Ryu, Adam Sima, Holly Ashton, Brianna Ondris, Felicia Coley, John Nestler, and FabbroEgidio DelEDDivision of Hematology, Oncology, and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA..
• Division of Hematology, Oncology, and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
• J Palliat Med. 2021 Apr 1; 24 (4): 520-526.

AbstractBackground: Life review, a narrative-based intervention, helps individuals organize memories into a meaningful whole, providing a balanced view of the past, present, and future. Examining how the content of memories contributes to life's meaning improves some clinical outcomes for oncology patients. Combining life review with other modalities may enhance therapeutic efficacy. We hypothesized a life review intervention might be enhanced when combined with a kinetic, digital representation (avatar) chosen by the patient. Our goal was to determine the feasibility of an avatar-based intervention for facilitating life review in patients with advanced cancer. Methods: We conducted an observational, feasibility trial in a supportive care clinic. Motion capture technology was used to synchronize voice and movements of the patient onto an avatar in a virtual environment. Semistructured life review questions were adapted to the stages of child, teenager, adult, and elder. Outcome measures included adherence, recruitment, comfort of study procedure, patients' perceived benefits, and ability to complete questionnaires, including the Edmonton Symptom Assessment System (ESAS) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Results: Seventeen patients were approached, with 11/12 completing the intervention. The total visit time of a single intervention averaged 67 minutes. The post-intervention survey found all patients agreed or strongly agreed (Likert Scale 1-5) they would participate again, would recommend it to others, and found the experience beneficial. After one month, ESAS scores were either unchanged or improved in 80% of patients. Conclusion: An avatar-facilitated life review was feasible with a high rate of adherence, completion, and acceptability by patients. The findings support the need for a clinical trial to test the efficacy of this novel intervention. Clinical Trial Number NCT03996642.

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