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One hundred twenty-eight patients with cancer from palliative care wards of a public hospital in Hong Kong were randomly assigned to either the experimental virtual reality-assisted psychological intervention or control group receiving a conventional psychological intervention. Outcomes on palliative symptoms, loneliness, peace, and engulfment were measured, with analysis of covariance conducted. Mediation analysis was performed to examine if the mechanistic outcomes of presence, flow, and restoration mediated the treatment effects. Significant group by time interaction effects were found, indicating improvement in overall palliative symptoms, physical symptoms, emotional symptoms, peace, and engulfment. However, no significant difference was found in loneliness. Mediation analyses revealed that flow, but not presence and restoration, mediated the relationship between VR-assisted psychological intervention and symptom control.<\/jats:p>","DOI":"10.1177\/13591053261462439","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:53:31Z","timestamp":1785394411000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT) as a novel psychological intervention in palliative care: A randomized controlled trial with mediation analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5513-4140","authenticated-orcid":false,"given":"Olive Kit Ling","family":"Woo","sequence":"first","affiliation":[{"name":"The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6829-7822","authenticated-orcid":false,"given":"Wai Sze","family":"Chan","sequence":"additional","affiliation":[{"name":"The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette Marie","family":"Lee","sequence":"additional","affiliation":[{"name":"The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Axelsson L Alvariza A Lindberg J et al (2018) Unmet palliative care needs among patients with end-stage kidney disease: A national registry study about the last week of life. 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