Virtual reality interventions for mental health and well-being in palliative care: systematic review and narrative synthesis – outcomes, techniques, processes and mechanisms

Abstract Purpose This review systematically synthesises the evidence on changes in mental health and wellbeing observed in palliative care patients following virtual reality (VR) interventions. Methods In July 2024, systematic searches were conducted across five databases (Embase, PsycINFO, Medline, CINAHL Complete and Academic Search Complete), supplemented by hand searches and citation chaining. Search concepts included “virtual reality” and “palliative care”. Inclusion criteria were established for adults receiving VR interventions in palliative care settings, limited to English language articles published in peer-reviewed journals. Study designs, sample characteristics, key findings, participant experiences and author interpretations were extracted. Each study included in the narrative synthesis was quality appraised. Results Of the 1264 citations identified, 13 studies were deemed eligible for inclusion in this review. A narrative synthesis approach was used. Studies were evaluated of mixed quality. Reported changes include reduced pain, anxiety and depression, as well as improvements in mood and quality of life. While few changes reached statistical significance, qualitative reports corroborated the presence of meaningful change. Few participants reported adverse effects. Authors most frequently attributed the observed changes to distraction, with additional mechanisms proposed including cognitive processing, choice and immersion. Conclusions While distraction is often assumed to be the primary mechanism of action for VR interventions in palliative care, this claim lacks robust empirical evidence as few studies directly assess distraction or degree of immersion. Future research should investigate the efficacy of VR interventions and elucidate the underlying mechanisms of change in mental health and well-being in this population.