{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:31:52Z","timestamp":1792524712279,"version":"4.5.0"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Nursing"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Virtual reality (VR) is increasingly recognized as a valuable adjunct in cancer supportive care, but evidence for its efficacy in reducing psychological distress during chemotherapy in Middle Eastern settings remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of immersive virtual reality as an engaging distraction on stress and anxiety among cancer patients during chemotherapy in Palestine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Between June and September 2023, 150 cancer patients were randomly assigned to an intervention group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200975) receiving VR during chemotherapy or a control group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200975) receiving standard care. Outcomes were measured using the Generalized Anxiety Disorder scale (GAD-7) and Perceived Stress Scale (PSS-10) before and after intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Postintervention analysis revealed potential benefits with significantly lower stress levels in the experimental group (\n                      <jats:italic toggle=\"yes\">M\u2009<\/jats:italic>\n                      =\u200917.7\u2009\u00b1\u20092.8) compared to controls (\n                      <jats:italic toggle=\"yes\">M<\/jats:italic>\n                      \u2009=\u200919.2\u2009\u00b1\u20092.5; mean difference: 1.5 points, 95% CI 0.6, 2.4,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.05, Cohen's\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      \u2009=\u20090.58, 95% CI 0.25, 0.91). Mean GAD-7 scores were significantly lower in the VR group (\n                      <jats:italic toggle=\"yes\">M\u2009<\/jats:italic>\n                      =\u20096.2\u2009\u00b1\u20093.1) versus controls (\n                      <jats:italic toggle=\"yes\">M\u2009<\/jats:italic>\n                      =\u200910.8\u2009\u00b1\u20094.2; mean difference: 4.6 points, 95% CI 3.3, 5.9,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001). 54.7% of VR participants (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200941) achieved minimal anxiety compared to 26.7% of controls (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200920) (Risk Ratio=2.05, 95% CI 1.35, 3.12). Effect sizes were moderate to large for both outcomes. The observed stress reduction of 1.5 points exceeds the established minimal clinically important difference (MCID) of approximately 1.0\u20131.5 points for the PSS-10, while the anxiety reduction of 4.6 points meets the MCID threshold of 4 points for the GAD-7.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Engaging distraction via virtual reality demonstrates potential benefit in reducing stress and anxiety among cancer patients during chemotherapy. However, this study design cannot isolate VR-specific immersive effects from general distraction. Future research with active control conditions is needed to establish VR's unique value proposition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23779608261418588","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:20:32Z","timestamp":1770225632000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["The Effect of Using Engaging Distraction via Virtual Reality on Stress and Anxiety among Patients with Cancer Undergoing Chemotherapy in Palestine: A Randomized Controlled Trial"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4193-4091","authenticated-orcid":false,"given":"Farid","family":"Abu Liel","sequence":"first","affiliation":[{"name":"Arab American University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1372-7199","authenticated-orcid":false,"given":"Basma","family":"Salameh","sequence":"additional","affiliation":[{"name":"Arab American University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2164-8183","authenticated-orcid":false,"given":"Ahmad","family":"Ayed","sequence":"additional","affiliation":[{"name":"Arab American University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6339-9176","authenticated-orcid":false,"given":"Ibrahim","family":"Aqtam","sequence":"additional","affiliation":[{"name":"Nablus University for Vocational and Technical Education"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-2715-8"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06611-0"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43045-020-00036-x"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12991-017-0155-1"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-psych-030122-124119"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1397566"},{"issue":"10","key":"e_1_3_3_8_1","article-title":"Music interventions for improving psychological and physical outcomes in people with cancer","volume":"10","author":"Bradt J.","year":"2021","unstructured":"Bradt J., Dileo C., Myers-Coffman K., Biondo J. 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