Virtual Reality Intervention for Symptom Management in Stem Cell Transplantation

This study is a randomized controlled pilot trial designed to evaluate the effectiveness of a virtual reality (VR) intervention, based on the Symptom Management Model (SYM), in managing physical and psychosocial symptoms during allogeneic hematopoietic stem cell transplantation (HSCT). The intervention is nurse-led and grounded in Attention Restoration Theory (ART), utilizing immersive 360° nature-themed videos created or selected by the research team. These videos are intended to support psychological relaxation, reduce distress, and shift patients' focus away from treatment-related discomfort.

Eligible participants will be adult patients scheduled for allogeneic HSCT using peripheral blood stem cells. Patients will be randomly assigned to either the intervention or control group using stratified block randomization. The intervention group will receive standard clinical care in addition to watching a 15-minute VR video during the stem cell infusion procedure, delivered via Meta Quest 3 headsets. The control group will receive standard care only.

One day before the HSCT procedure, the researcher will meet with the eligible patients to introduce the study, answer questions, and familiarize them with the VR equipment and video content. Patients in the intervention group will be allowed to choose one of five pre-approved nature-themed VR videos. On the day of transplantation, baseline data (distress, anxiety, symptoms, vitals) will be collected approximately 15 minutes before the procedure. The VR headset will be applied 3 minutes before the infusion begins, and the video will start 1 minute prior to the procedure. The infusion will proceed according to the institution's standard protocols. Vital signs will be recorded during the intervention by the researcher. Patients will be reminded that they can request to remove the headset at any point if they feel uncomfortable.

At the 15th minute of the HSCT infusion, the video will end. Post-intervention assessments will include distress, anxiety, symptom severity, and satisfaction. If the patient does not feel well enough immediately after the session, additional time will be provided before collecting post-test data. To prevent infection risks, VR equipment will be disinfected after each use.

In addition to psychological and symptomatic outcomes, physiological parameters (blood pressure, heart rate, body temperature, oxygen saturation, respiratory rate) will be tracked. Neutrophil and platelet engraftment status will be assessed on Day +28 post-transplant. Patient satisfaction with the intervention will be measured using a visual analog scale and open-ended feedback.

This is the first known Turkish study to implement a theory-based, nurse-led virtual reality intervention during HSCT with the goal of symptom management. It is expected to provide valuable insight into the integration of digital care tools in supportive oncology nursing practice.

• Change in Systolic Blood Pressure [Срок оценки: Baseline (pre-HSCT infusion), during HSCT infusion, and immediately post-infusion (within 30 minutes)]
• Change in Diastolic Blood Pressure [Срок оценки: Baseline (pre-HSCT infusion), during HSCT infusion, and immediately post-infusion (within 30 minutes)]
• Change in Heart Rate [Срок оценки: Baseline (pre-HSCT infusion), during HSCT infusion, and immediately post-infusion (within 30 minutes)]
• Change in Body Temperature [Срок оценки: Baseline (pre-HSCT infusion), during HSCT infusion, and immediately post-infusion (within 30 minutes)]
• Change in Oxygen Saturation [Срок оценки: Baseline (pre-HSCT infusion), during HSCT infusion, and immediately post-infusion (within 30 minutes)]
• Change in Respiratory Rate [Срок оценки: Baseline (pre-HSCT infusion), during HSCT infusion, and immediately post-infusion (within 30 minutes)]
• Neutrophil Engraftment Time [Срок оценки: Assessed on Day +28 post-transplant]
• Platelet Engraftment Time [Срок оценки: Assessed on Day +28 post-transplant]
• Patient Satisfaction (Visual Analog Scale) [Срок оценки: Within 15 minutes after HSCT infusion]
• Patient Satisfaction (Qualitative Feedback Form) [Срок оценки: Within 15 minutes after HSCT infusion]