Educating the community: Exploring Phage Therapy Through Virtual Reality

With increasing referral for phage therapy, patient engagement is crucial. We are excited to introduce an innovative educational initiative that utilises virtual reality (VR) and 360-degree camera technology to help ease the anxiety of patients—both adults and children—entering the hospital for phage therapy. In this immersive experience we explore what phage therapy is and how it works. Our resident scientists and clinicians guide patients and/or their carer through the entire journey, from phage testing in the laboratory to phage production and, ultimately, to the bedside. Along the way, they explain key concepts such as antimicrobial resistance and the role of phage therapy in combating infections. In addition, this enables the patients and their carers to explore a virtual hospital environment, providing a detailed overview of what to expect during their treatment journey.

We recently showcased this VR experience at a scientific meeting (Virus of Microbes 2024, Cairns, Australia, Abstract #266), receiving overwhelmingly positive feedback from research students and scientists alike. Many attendees appreciated the opportunity to explore our lab setup virtually, expressing interest in the specific equipment we use—right down to the types of pipettes and incubators, as well as the spaces where our research occurs.

Through engaging visuals and informative narratives, the VR experience demystifies phage therapy, highlighting its benefits and procedures in a friendly, reassuring manner. By familiarising patients with the process, we aim to reduce fear and uncertainty, fostering a sense of comfort and empowerment.

To assess the effectiveness of our VR educational initiative, we are exploring a few options including, implementing a combination of quantitative and qualitative methods. For example, through surveys, we can engage pre-experience survey to gauge initial knowledge and anxiety levels about phage therapy (as shown in surveys conducted by us with Cystic Fibrosis Australia and Australian Prescribers, see references). In comparison, in post-experience survey, we can collect feedback on participants’ understanding, anxiety level and overall experience. Open-ended questions can reveal qualitative insights for our clinical educators.

We plan to have a patient advocacy group focused on phage therapy who can provide valuable insights into their experiences of phage therapy journey. This would yield rich qualitative data regarding perceptions, suggestions on improvements for the next iteration of the VR experience, and emotional responses.

Engagement metrics, such as time spent in the VR experience and levels of interaction, can serve as benchmarking indicators alongside the increased understanding of phage therapy and AMR.

While the use of Oculus and VR may be perceived as a gimmick, we are dedicated to educating the public about phage therapy and AMR. We plan to implement follow-up surveys or interview weeks after the VR experience and phage therapy treatment to assess retention and any shifts in attitudes toward phage therapy. We recognise that patients may already have a bias favouring phage therapy as an alternative treatment.

Our goal is to incorporate this approach into our STAMP clinical trial, enabling us to analyse the collected data to identify trends, strengths and areas for improvement in our educational efforts.

Join us in making hospital visits a more positive experience through the transformative power of virtual reality.

To view in 2D, Youtube Links:

Adult 2d - https://youtu.be/d7fm1ge_8f4

Paed 2d - https://youtu.be/COeFJrKQWoY

For 360, best results are through an Oculus:

Adults 360 - https://www.youtube.com/watch?v=fm2n4Cy5GKw

Paed 360 - https://www.youtube.com/watch?v=Usy_LgUErco

Methodology:

Storyboards for adult and paediatric patients were designed and approved by HREC from Western Sydney Local Health District, Westmead Institute for Medical Research, and Sydney Children’s Hospital Network respectively. Briefly, members of the Phage Australia team at Westmead took the patient on a journey from entering the Hospital precinct, to talking to an Infectious Diseases (ID) consultant, to behind-the-scenes activities in the laboratory from phage matching to phage production. The ID consultants spoke directly to the camera in the office and in the ward to emulate an in-person experience.

Filming across multiple sites across Westmead Health Precinct took place in February 2024 using an Insta360 pro by Frameless Interactive. The final products are available via both the YouTube360 video player and on the Meta Quest 2 Virtual Reality Headset (see link above).

Animation was done by a Year 12 high school student (Angelina Zhang) as part of Phage Australia’s Phage Therapy education program in 2024.

The music is composed and arranged by Ann Palumbo and Paul Laszlo. Paul received phage therapy at the Westmead Health Precinct in October 2022 and was featured in a documentary “Last Chance to Save a Life” on SBS (Australia). To date he is infection free. To read about Ann and Paul’s journey visit this link, https://www.medicalresearch.nsw.gov.au/how-phage-therapy-saved-this-musician-from-a-life-threatening-infection/?goback=true

Acknowledgement:

Patients and their families.

Clinical and research teams across Westmead Health Precinct. Specifically, the Phage Australia Westmead team: Dr Stephanie Lynch, Dr Ameneh Khatami, Dr Holly Sinclair, Dr Rabeya Rahmatullah, Ms Carina Lauter, Dr Clinton Colaco and Ms Shirley Wong.

MRFF Frontiers Stage 1. Australian Government. JI and Phage Australia network. 2021-2 AUD$1M.

Office of Health and Medical Research, NSW State Government, Australia: Education package for phage therapy. RL and Phage Australia Westmead. 2022. AUD$65k.

Office of Health and Medical Research, NSW State Government, Australia: Securing sovereign manufacturing of phages in NSW. JI, RL, AK and Phage Australia network. 2023-5, AUD$3.59M.

Hooper Shaw Foundation. Addressing AMR: bioprospecting and co-evolution. JI and Phage Australia Westmead. 2023-6. AUD$4M

References:

Khatami A, Foley DA, Warner MS for the Phage Australia Clinical Network, et al. Standardised treatment and monitoring protocol to assess safety and tolerability of bacteriophage therapy for adult and paediatric patients (STAMP study): protocol for an open-label, single-arm trial. BMJ Open 2022;12:e065401. doi: 10.1136/bmjopen-2022-065401

Moore, N, et al. (2022). Designing virtual reality–based conversational agents to train clinicians in verbal de-escalation skills: Exploratory usability study.  JMIR Serious Games,10(3), e38669.

Lynch S, Sinclair H, Khatami A, Mileham N, Sacher JC, Zheng J, Lin RCY, Iredell JR. Policy in practice: Cystic Fibrosis Australia and Phage Australia surveys: understanding clinical needs and attitudes towards phage therapy in the cystic fibrosis community, Sustainable Microbiology, Volume 2, Issue 1, 2025, qvae036, https://doi.org/10.1093/sumbio/qvae036

Plymoth M, Lynch SA, Sinclair H, Khatami A, Paterson D, Sacher JC, Zheng J, Lin RCY, Iredell JR. Attitudes to Phage Therapy among Australian Infectious Diseases Physicians. medRXiv https://doi.org/10.1101/2023.07.03.23292153