Effect of the Format of a Video Game on Children's Experience During Venipuncture

Pain and anxiety experienced in the acute care setting remain a major global problem, resulting in high costs for those involved as well as for health care institutions. Pain and anxiety management techniques affect the quality of the care experienced by patients, relatives, and healthcare workers. Pharmacological procedures remain the most widely used approach, although they have important limitations, such as potential for adverse effects and dosing errors, especially in the most vulnerable populations such as young children. Non-pharmacological approaches to analgesia and anxiolysis have been explored, among which placebo, expectant, distraction, positive induction, reward, self-regulation, relaxation and hypnosis. Unfortunately, translational applications have been only partially successful, due to the limited and variable effectiveness of each approach, which often requires active and continuous patient cooperation. Hypnosis is an effective but incomplete approach that requires the presence of a specialist and can only be practiced from a certain age.

Virtual Reality (VR) is a promising technology that combines all of these methods above into an immersive and engaging tool for pain and anxiety relief that could equal or exceed the effectiveness of other existing non-pharmacological techniques. In addition, it is relatively inexpensive and provides a relevant alternative when hypnosis practitioners are not available.

The virtual reality contents (hereon ''games'') available on the market are varied. However, these tools are mainly based on distraction and often do not take into account the therapeutic communication and hypnosis principles proven useful in managing anxious children, as well as other psychological factors facilitating, for example, the "empowerment" of patients. Moreover, the quality of immersion in a virtual environment is essential for its effectiveness, and the tools currently available remain limited in this respect (mini-games, 360-degree video). Moreover, these tools have little external control and even fewer intelligent mechanisms to adapt content to the patient experience.

The investigators developed a prototype VR tool, which, unlike tools from other clinical studies of virtual reality, implemented a narration integrating several properties of hypnosis induction (in particular relaxation and regulation) with a gameplay designed to induce distraction and empowerment. The game was developed with the objective of engaging the child in an environment where he or she is first familiarized and reassured, then engaged in the missions of the game, and finally rewarded, all with the intent of decreasing anxiety and pain during a procedure. The investigators have carefully adapted the initial versions of this VR scenario to young, hospitalized children (starting from the age of 5 years of age) undergoing painful and anxiogenic procedures such as venipuncture. This population is ideal for our needs because they are often resistant to other non-pharmacological techniques (hypnosis susceptibility peaks between 8 and 12 years and, at the same time, have a good knowledge of artificial environments and computer games. A pilot study conducted in our department showed that children who played the VR game rated their pain and anxiety less high than children who received standard of care, during venipuncture. Venipuncture is some of the most common procedures in pediatric emergency departments and one of the most common sources of unrelieved pain and anxiety in hospitalized children.

To date, no study has attempted to isolate the added value of VR by comparing it with a similar game offered in a format such as a video tablet (ie.g.: iPad, etc.).

When used in a correct subset of patients (excluding patients with light-sensitive epilepsy), there are no risks anticipated aside from potential mild nausea or dizziness, which is rarely described in children using virtual reality, which would make this study a risk category A study.