by Ashish Chogle

Coauthors: Ashish Chogle (1), Jamie Janchoi (2), Wanda Rodriguez (3), Nicole Callas (1), Tammy Tran (1), Jennifer Hayakawa (3), Sandeep Godambe (4), Elisa Ornelas (2). 1Division of Pediatric Gastroenterology and Nutrition, CHOC, Orange, CA 2Research Institute, CHOC, Orange, CA 3Department of Nursing, CHOC, Orange, CA 4Medical Administration, CHOC, Orange, CA


Background: Each year, approximately one million medically complex children, dependent on devices such as gastric tubes, tracheostomy tubes, and central venous lines, transition from US hospitals to home care. A significant percentage of these children face unnecessary emergency visits and readmissions due to complications with their medical devices. A core issue identified is the lack of parental self-efficacy in handling their child’s medical devices. Currently, parents are taught about medical device use and care by bedside nurses in most hospitals. Parents are then sent home with printouts of instructions. This educational strategy usually leads to inconsistent information being provided to patients and their families. Parents may be overwhelmed, stressed, or fatigued, making it difficult to absorb and retain information about medical device care. To solve the problem with informed consent and adequate medical education for parents, we created a virtual reality-based education platform (CareXR) for children with medical devices. This platform includes procedure videos, educational videos by nurses, and virtual simulation modules where parents can practice the skills in a virtual environment.

Objectives: Our study aims to determine if the application of a novel virtual reality (VR) platform, designed for educating parents about medical device care, has a transformative impact on several outcomes in parents of children who had percutaneous endoscopic gastrostomy (PEG) tube placement. These include parental anxiety levels, competency, transition from hospital to home, post-discharge coping, and the incidence of device complications, compared to our current standard of care.

Methods: Parents of children between ages 0 and 21 years undergoing a PEG tube placement at CHOC Children’s Hospital participated in the study. Following the procedure, parents were randomized to either an experimental group (device care education via nurse instruction and VR platform) or a control group (standard nurse-led device care education). A series of questionnaires and scales were utilized at various time points pre- and post-discharge to measure parental anxiety, competency, coping difficulty, ease of transition to home from the hospital, and the incidence of PEG tube complications.

Results: So far thirteen parents (5 experimental and 8 control) participated in the study. These were parents of 8 male children and 5 female children, mean age 3.3 years. Significant improvements were observed in the experimental group compared to the control group. Specifically, these improvements manifested as reductions in anxiety levels, heightened competency, smoother transitions from hospital to home, less post-discharge coping difficulty, and fewer device complications.

Conclusions: Initial results signify that our VR intervention offers a transformative approach to inpatient education. It enhances parental capabilities in managing their child's medical devices, reduces anxiety, improves discharge experiences, and decreases complication rates, thus constituting a potential paradigm shift in pediatric care. Further participant recruitment is in progress to fortify our conclusions.