Feasibility of Delivering an Avatar-Facilitated Life Review Intervention for Patients with Cancer

Background: 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.

Better environmental decision making - recent progress and future trends

Recent trends in risk-based decision making are reviewed in relation to novel developments in comparative risk analysis, strategic risk analysis, weight of evidence frameworks, and participative decision making. Delivery of these innovations must take account of organisational capabilities in risk management and the institutional culture that implements decision on risk. We stress the importance of managing risk knowledge within organisations, and emphasise the use of core criteria for effective risk-based decisions by reference to decision process, implementation and the security of strategic added value.