Immersive Virtual Reality Simulation to Promote Empathy in Delirium Care: A Pilot Evaluation

Background Despite affecting one in four hospitalised older adults, delirium remains under-recognised and undertreated. One reason for this is that health professionals are unaware of patients’ lived experience of terror and disorientation. Immersive virtual reality (VR) provides an innovative medium for experiential education, supporting engagement, reflection, and understanding of complex real-world situations. Objective Building on earlier pilot study on VR-based empathy education, this study evaluated a VR delirium simulation created in partnership with delirium survivors and caregivers, focusing on its feasibility, safety, and educational impact. Methods Over two years, four Patient and Public Involvement (PPI) partners (one delirium survivor, two family caregivers, one advocacy expert) co-designed scenario language, safety protocols, and reflection prompts alongside researchers and clinicians. We evaluated a 10-minute VR simulation reproducing delirium phenomenology paired with 25-minute structured reflection. Fifteen clinicians and educators (physicians, nurses, researchers) participated in an international empathy-in-healthcare symposium. Quantitative outcomes (perceived realism, empathy, communication, behavioural intentions) were analyzed descriptively; qualitative reflections were thematically analyzed to explore educational mechanisms and ethical implications. Results Participants rated VR realism and emotional salience highly (means 4.1–4.5, 80-100% agreement). All participants reported stronger perspective-taking, with intended changes including slower speech, environmental control, and caregiver inclusion. Thematic analysis identified affective immersion and cognitive reframing as key mechanisms, alongside risks of emotional overload and oversimplification. PPI-informed safety protocols (pre-briefing, opt-out, quiet space) prevented adverse effects; no withdrawals occurred.