{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:14:20Z","timestamp":1792782860783,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"MacKay Memorial Hospital","award":["MMH-MM-114-16"],"award-info":[{"award-number":["MMH-MM-114-16"]}],"id":[{"id":"https:\/\/ror.org\/015b6az38","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Growing evidence suggests that virtual reality (VR) can improve the physical and psychological health of patients with cancer; however, little is known about its effects on family caregivers of patients receiving palliative care. The aim of this study was to evaluate the effect of a VR-based education system on death literacy and health among family caregivers of patients at the end-of-life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted using a quasi-experimental design. A total of 66 family caregivers were recruited from a medical center in northern Taiwan and assigned to control (traditional consultation) or experimental (VR-enhanced education) groups according to the time of construction of the VR system for death education. All participants were assessed using the Death Literacy Index (DLI) and the Chinese Health Questionnaire-12 (CHQ-12) before and after the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant improvements in total DLI and related subscales were observed in the VR group. Interaction analyses indicated greater benefits for caregivers with lower baseline death literacy levels. The Johnson\u2013Neyman technique revealed that the conditional effect of VR-based education on improving death literacy becomes statistically significant when the pretest score of total DLI was lower than 117.94. The CHQ-12 scores did not change significantly following the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VR-enhanced education demonstrates feasibility and preliminary efficacy in enhancing death literacy among family caregivers in palliative care settings, particularly for those with lower baseline death literacy. However, its long-term impact on psychological health warrants further longitudinal investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-11318-1","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:20:22Z","timestamp":1791847222000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of virtual reality-based education on death literacy and health among family caregivers: an experimental study"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1221-5898","authenticated-orcid":false,"given":"Hsiao-Lan","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3715-0147","authenticated-orcid":false,"given":"Sheng-Miauh","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5071-3151","authenticated-orcid":false,"given":"Chun-Kai","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4694-6710","authenticated-orcid":false,"given":"Chen-Jung","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"11318_CR1","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1177\/10499091221075570","volume":"39","author":"HH Shih","year":"2022","unstructured":"Shih HH, Chang HJ, Huang TW (2022) Effects of early palliative care in advanced cancer patients: a meta-analysis. 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The Institutional Review and Ethics Committee of the Research Hospital (MacKay Memorial Hospital) determined that this study involved human subjects but did not include invasive procedures. The registered study number was 24MMHIS340e.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All study participants signed informed consent regarding publishing their data.","order":3,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing financial or non-financial interests that could have influenced the findings of this study.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":5,"name":"Ethics","label":"Clinical trial number","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1092"}}