Co-Design and Development of a Virtual Reality Experience for Teenagers and Young Adults with Cancer

Project Aims
This project aims to investigate the potential use of virtual reality (VR) in assisting teenagers and young adults with cancer. This research will take a co-design approach where teenagers and young people with cancer will help researchers design a virtual reality intervention to assist in a specific part of the cancer pathway. Along with this, the project will involve engaging with clinicians and stakeholders from Great Ormond Street Hospital to help provide insight into the current challenges hindering the development and deployment of VR technologies within the NHS.

Background and Motivation
VR has shown great success in surgical training, rehabilitation, exposure therapy and as a distraction mechanism [1]. VR can simulate interactive 3D environments that immerse users in real-time with evidence demonstrating that the users physical, cognitive and behavioural states within VR are comparable to that in real life [2]. In recent years, researchers have implemented VR during different phases of cancer treatment [3]. VR has been used as an escapism for hospitalised patients and for people undergoing chemotherapy, showing success in lowering cancer-related symptoms such as anxiety, fatigue and depression [4]. Studies have also investigated the effects of using virtual reality as a distraction mechanism during painful or long procedures [3, 5].
Whilst many of the studies have explored the use of VR in assisting people with cancer throughout treatment, most of the interventions delivered are theory-driven and are not designed with the end user in mind. The interventions take a generalised approach and make sweeping judgments about people undergoing cancer treatment, a method which has shown to negatively affect psycho-oncological treatments [7]. There is mounting evidence, mostly from the Human Computer Interaction field, recommending that service users and stakeholders be included in the design and development process of health interventions. This ensures that products are fit for purpose, useful and ultimately empower the service users.
This project therefore aims to advance current research into the use of virtual reality interventions for teenagers and young people with cancer through co-design. We are keen to investigate uses of virtual reality that go beyond distraction interventions and explore applications that may offer clinical benefit to people with cancer. The co-design approach will involve actively engaging and designing with young people from the Teenage Cancer Trust in design workshops and focus group sessions. This will help identify if and where virtual reality could be of benefit and ensure that the application developed reflects the needs of the intended service users. By involving patients, clinicians and stakeholders across multiple
NHS facilities, the project will benefit from a diverse and holistic view of the cancer clinical pathway.

Project Structure
The research project will be divided into three key phases:
Phase 1 - Identify key intervention areas (desk research and stakeholder interviews)
Phase 2 - Iterative co-design workshops with young people with cancer.
Phase 3 - VR experience development and evaluation.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.