Digital Interventions to Reduce Distress Among Health Care Providers at the Frontline: Protocol for a Feasibility Trial

Binh Nguyen, Andrei Torres, Walter Sim, Deborah Kenny, Douglas M Campbell, Lindsay Beavers, Wendy Lou, Bill Kapralos, Elizabeth Peter, Adam Dubrowski, Sridhar Krishnan, Venkat Bhat, Binh Nguyen, Andrei Torres, Walter Sim, Deborah Kenny, Douglas M Campbell, Lindsay Beavers, Wendy Lou, Bill Kapralos, Elizabeth Peter, Adam Dubrowski, Sridhar Krishnan, Venkat Bhat

Abstract

Background: Stress, anxiety, distress, and depression are high among health care workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limited resources.

Objective: The purpose of this study is to develop and show the feasibility of digital platforms (a virtual reality and a mobile platform) to understand the causes and ultimately reduce the moral distress of health care providers during the COVID-19 pandemic.

Methods: This will be a prospective, single cohort, pre- and posttest study examining the effect of a brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during a scenario known to potentially elicit moral distress. To accomplish this, we have developed a virtual reality simulation that will be used before and after the digital intervention for monitoring short-term impacts. The simulation involves an intensive care unit setting during the COVID-19 pandemic, and participants will be placed in morally challenging situations. The participants will be engaged in an educational intervention at the individual, team, and organizational levels. During each test, data will be collected for (1) physiological measures of stress and after each test, data will be collected regarding (2) thoughts, feelings and behaviors during a morally challenging situation, and (3) perceptual estimates of psychological stress. In addition, participants will continue to be monitored for moral distress and other psychological stresses for 8 weeks through our Digital intervention/intelligence Group mobile platform. Finally, a comparison will be conducted using machine learning and biostatistical techniques to analyze the short- and long-term impacts of the virtual reality intervention.

Results: The study was funded in November 2020 and received research ethics board approval in March 2021. The study is ongoing.

Conclusions: This project is a proof-of-concept integration to demonstrate viability over 6 months and guide future studies to develop these state-of-the-art technologies to help frontline health care workers work in complex moral contexts. In addition, the project will develop innovations that can be used for future pandemics and in other contexts prone to producing moral distress and injury. This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress.

Trial registration: ClinicalTrials.gov NCT05001542; https://ichgcp.net/clinical-trials-registry/NCT05001542.

International registered report identifier (irrid): DERR1-10.2196/32240.

Keywords: COVID-19; mobile app; moral distress; moral injury; simulation; virtual reality.

Conflict of interest statement

Conflicts of Interest: VB is supported by an Academic Scholar Award from the UofT Dept of Psychiatry and has received research support from CIHR, BBRF, MOH Innovation Funds, RCPSC, DND, Canada, and an investigator-initiated trial from Roche Canada. All other authors have no conflicts to declare.

©Binh Nguyen, Andrei Torres, Walter Sim, Deborah Kenny, Douglas M Campbell, Lindsay Beavers, Wendy Lou, Bill Kapralos, Elizabeth Peter, Adam Dubrowski, Sridhar Krishnan, Venkat Bhat. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.02.2022.

Figures

Figure 1
Figure 1
Flow diagram of feasibility trial design. VR sim: virtual reality simulation. DiiG: digital intervention/intelligence group.
Figure 2
Figure 2
Overview of the virtual reality experimental set-up and data collection.
Figure 3
Figure 3
Diagram of experiment components. VR: virtual reality. MI: moral injury. IPQ: igroup presence questionnaire. MISS-HP: moral injury symptom scale: healthcare professionals version.
Figure 4
Figure 4
Patient’s room with a patient connected to a ventilator.
Figure 5
Figure 5
Nursing station, monitor station, and intensive care unit corridor.
Figure 6
Figure 6
Testing 2 characters with different clothing and body parameters.
Figure 7
Figure 7
User interface displaying the dialog and interaction panels, and the interaction ray from the right-hand index finger.
Figure 8
Figure 8
Oculus Quest 2 components.
Figure 9
Figure 9
Example of the physical set-up: researcher wearing the head-mounted display, controllers, and Biopac sensors during the virtual reality simulation.
Figure 10
Figure 10
Visual analog scale with a sliding bar for participants to score on the screen of their phones.
Figure 11
Figure 11
Physiological signal examples: respiration impedance (RI), photoplethysmography (PPG), electrocardiogram (ECG), and galvanic skin response (GSR).

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Source: PubMed

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