Relieving Anxiety in Children Undergoing Radiation Therapy Through Virtual Preparation

Although radiation therapy (RT) is pain-free, pediatric patients with cancer find it anxiety provoking and difficult due to misunderstandings about radiation therapy, having to transition to an unfamiliar treatment setting and medical team, feeling intimidated by the large and noisy equipment, and being required to remain alone and motionless throughout the procedure.

To ensure that children do not move during RT, sedation might be needed, which invites additional risks and costs. Data indicate that patient preparation programs can improve the success of conducting RT without sedation and decrease child and parent anxiety. A critical barrier to progress in conducting radiation without sedation and decreasing anxiety is that the current standard form of preparation requires extensive time, space, funding, and personnel. The research team developed RadWorld, an interactive and engaging virtual program, to prepare children with cancer for RT.

The specific aims of the research were as follows:

• Develop RadWorld, an interactive, computer tablet-based, virtual world program designed to prepare children and their parents for pediatric RT. 
• Evaluate RadWorld’s effectiveness on pediatric patients’ knowledge, ability to remain still, need for sedation, fear, and anxiety associated with RT. 
• Determine RadWorld’s effectiveness on parents’ knowledge and anxiety. 
• Assess children’s and their parents’ satisfaction with RadWorld. 
• Quantify and compare the cost of RadWorld to that of standard care. 

After developing the RadWorld art, storyboards, and scripts, researchers held semi-structured interviews with 4- to 18-year-olds who recently completed RT along with their parents. Based on feedback, they incorporated animation and videos of child actors undergoing both simulation and RT. Pilot-testing of RadWorld led researchers to develop slightly different scripts for younger (4–11 years old) and older (12–18 years old) patients, and to develop a separate RadWorld program with similar components for parents.

A planned randomized controlled trial was delayed because of the development of the three versions of RadWorld. For the trial, 50 patients were randomized to either standard care or the use of RadWorld. Patients and parents completed measures of knowledge, anxiety, and satisfaction during their consultation, simulation, first RT, and second RT. Analyses of findings were ongoing at the end of the grant period.