{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:14:17Z","timestamp":1791540857488,"version":"4.3.4"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Fund of the Department of Medicine of the University Hospital and the Faculty of Medicine of Geneva","award":["Not available"],"award-info":[{"award-number":["Not available"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,20]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"\n Introduction<\/jats:title>\n Dyspnoea is an existentially burdensome symptom in patients with advanced and progressive diseases such as cancer, chronic obstructive pulmonary disease (COPD) and advanced heart failure. Recent studies have highlighted that symptomatic treatment of dyspnoea is often ineffective and may depend on the underlying disease. Immersive virtual reality (IVR) has emerged as a \u2018digital therapeutic\u2019 for conditions such as pain, anxiety, and dyspnoea. Brain functional MRI (fMRI) offers the opportunity to identify distinct patterns of dyspnoea. Current findings are mainly limited to healthy volunteers, but clinical data from patients with life-limiting conditions are needed. The aim of this study is to assess the feasibility of identifying dyspnoea patterns in different life-limiting conditions using fMRI and IVR.<\/jats:p>\n <\/jats:sec>\n \n Methods and analysis<\/jats:title>\n This is an observational monocentric feasibility study, conducted in a tertiary university centre. Healthy volunteers and patients diagnosed with advanced cancer, COPD, or heart failure and suffering from persistent dyspnoea will undergo an fMRI of the brain using IVR. The primary outcome of feasibility will be evaluated using descriptive statistics. Secondary outcomes include analysis of fMRI patterns of dyspnoea across populations, patient-reported burden of participation, and correlation between dyspnoea and psychological symptoms. These preliminary data will help determine the sample size required for a future study evaluating differences in dyspnoea patterns. Exploratory comparison between the characteristics of all four groups will be assessed with Fisher\u2019s test (for proportions) and either independent Student\u2019s t-test or Mann-Whitney test, depending on distribution. Correlations between variables will be tested using the Pearson\u2019s correlation coefficient. Statistical analysis will be performed using STATA.<\/jats:p>\n <\/jats:sec>\n \n Ethics and dissemination<\/jats:title>\n \n This study protocol received ethical approval on 23 April 2025 from the\n Commission cantonale d\u2019\u00e9thique de la recherche<\/jats:italic>\n in the Canton of Geneva, Switzerland. The identification number is 2024-02289. Submission to peer-reviewed journals and presentation in international congresses for the dissemination of the study findings are planned.\n <\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n Clinical Trials number is\n NCT07319039<\/jats:ext-link>\n ; Pre-results.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107472","type":"journal-article","created":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T19:30:21Z","timestamp":1771183821000},"page":"e107472","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Dyspnoea patterns in patients with advanced diseases: a functional MRI feasibility study protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07319039","registry":"10.18810\/clinical-trials-gov","type":"preResults"}],"author":[{"given":"Jan","family":"Gaertner","sequence":"first","affiliation":[{"name":"Palliative Care Center, Bethesda Spital AG, Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, Basel, Switzerland"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hentsch","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Guerreiro","sequence":"additional","affiliation":[{"name":"Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver A","family":"Kannape","sequence":"additional","affiliation":[{"name":"Virtual Medicine Centre, HUG-NeuroCentre, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Delahaye","sequence":"additional","affiliation":[{"name":"Virtual Medicine Centre, HUG-NeuroCentre, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Cantero","sequence":"additional","affiliation":[{"name":"Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Pautex","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Bergeron","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland"},{"name":"Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Olof","family":"Lovblad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland"},{"name":"Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix Tobias","family":"Kurz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland"},{"name":"Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6270-1035","authenticated-orcid":false,"given":"Tanja","family":"Fusi-Schmidhauser","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland"},{"name":"Palliative and Supportive Care Clinic, Ente Ospedaliero Cantonale, Bellinzona, Switzerland"},{"name":"Department of Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"2026021511301357000_16.2.e107472.1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201111-2042ST"},{"key":"2026021511301357000_16.2.e107472.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.06.013"},{"key":"2026021511301357000_16.2.e107472.3","unstructured":"World health organization . International statistical classification of diseases and related health problems (icd). 2025. Available: https:\/\/www.who.int\/standards\/classifications\/classification-of-diseases"},{"key":"2026021511301357000_16.2.e107472.4","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02277-2016","article-title":"Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness","volume":"49","author":"Johnson","year":"2017","journal-title":"Eur Respir J"},{"key":"2026021511301357000_16.2.e107472.5","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00252-2023","article-title":"Hiding in plain sight: the evolving definition of chronic breathlessness and new ICD-11 wording","volume":"61","author":"Kochovska","year":"2023","journal-title":"Eur Respir J"},{"key":"2026021511301357000_16.2.e107472.6","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01159-2017","article-title":"Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic","volume":"50","author":"Mor\u00e9lot-Panzini","year":"2017","journal-title":"Eur Respir J"},{"key":"2026021511301357000_16.2.e107472.7","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209908"},{"key":"2026021511301357000_16.2.e107472.8","doi-asserted-by":"crossref","first-page":"900","DOI":"10.21037\/apm-22-1304","article-title":"Interaction of panic and episodic breathlessness among patients with life-limiting diseases: a cross-sectional study","volume":"12","author":"Schloesser","year":"2023","journal-title":"Ann Palliat Med"},{"key":"2026021511301357000_16.2.e107472.9","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02682-2017","article-title":"Observing dyspnoea in others elicits dyspnoea, negative affect and brain responses","volume":"51","author":"Herzog","year":"2018","journal-title":"Eur Respir J"},{"key":"2026021511301357000_16.2.e107472.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.11.009"},{"key":"2026021511301357000_16.2.e107472.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.09.017"},{"key":"2026021511301357000_16.2.e107472.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2023-002029","article-title":"Disability and long-term breathlessness: a cross-sectional, population study","volume":"11","author":"Kochovska","year":"2024","journal-title":"BMJ Open Respir Res"},{"key":"2026021511301357000_16.2.e107472.13","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2022-322074"},{"key":"2026021511301357000_16.2.e107472.14","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1177\/02692163231194838","article-title":"Effectiveness and safety of opioids on breathlessness and exercise endurance in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials","volume":"37","author":"Liu","year":"2023","journal-title":"Palliat Med"},{"key":"2026021511301357000_16.2.e107472.15","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0416"},{"key":"2026021511301357000_16.2.e107472.16","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201101-0005OC"},{"key":"2026021511301357000_16.2.e107472.17","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/141.6.1516"},{"key":"2026021511301357000_16.2.e107472.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2022.03.013"},{"key":"2026021511301357000_16.2.e107472.19","doi-asserted-by":"crossref","first-page":"102962","DOI":"10.1016\/j.msksp.2024.102962","article-title":"Exploring the potential of virtual reality for the self-management of chronic pain: A scoping review of its use to address health literacy","volume":"72","author":"Skidmore","year":"2024","journal-title":"Musculoskelet Sci Pract"},{"key":"2026021511301357000_16.2.e107472.20","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jmir.2022.11.011","article-title":"Use of virtual reality for MRI preparation and technologist education: A scoping review","volume":"54","author":"Cataldo","year":"2023","journal-title":"J Med Imaging Radiat Sci"},{"key":"2026021511301357000_16.2.e107472.21","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/jan.15065","article-title":"Virtual reality interventions and the outcome measures of adult patients in acute care settings undergoing surgical procedures: An integrative review","volume":"78","author":"Wang","year":"2022","journal-title":"J Adv Nurs"},{"key":"2026021511301357000_16.2.e107472.22","article-title":"Virtual reality technology for pain management in advanced cancer","volume":"11","author":"Flanagan","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"2026021511301357000_16.2.e107472.23","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200902-0300OC"},{"key":"2026021511301357000_16.2.e107472.24","doi-asserted-by":"crossref","DOI":"10.1183\/23120541.00570-2022","article-title":"Virtual reality intervention alleviates dyspnoea in patients recovering from COVID-19 pneumonia","volume":"9","author":"Betka","year":"2023","journal-title":"ERJ Open Res"},{"key":"2026021511301357000_16.2.e107472.25","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1089\/jmxr.2024.0029","article-title":"A Personalized Approach Using an N-of-1 Trial of Virtual Reality Hypnosis for Persistent Dyspnea","volume":"1","author":"Siegenthaler","year":"2024","journal-title":"Journal of Medical Extended Reality"},{"key":"2026021511301357000_16.2.e107472.26","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/S2213-2600(14)70226-7","article-title":"An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial","volume":"2","author":"Higginson","year":"2014","journal-title":"Lancet Respir Med"},{"key":"2026021511301357000_16.2.e107472.27","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4062"},{"key":"2026021511301357000_16.2.e107472.28","unstructured":"Human Research Act (HRA). Available: http:\/\/www.admin.ch\/opc\/en\/classified-compilation\/20121176\/201401010000\/810.305.pdf"},{"key":"2026021511301357000_16.2.e107472.29","unstructured":"Declaration of helsinki. 2024 Available: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107472","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T19:30:24Z","timestamp":1771183824000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107472"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,15]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-107472"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107472","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}