Marina U. Bers 1, Joseph Gonzalez-Heydrich 2

David DeMaso 2, Evelyn Corsini 3 , William Harmon 3

To evaluate the feasibility and safety of a pilot therapeutic virtual environment, called Zora, for use by adolescents facing hemodialysis.

Zora is a 3D multi-user computer environment designed at the MIT Media Laboratory. It was designed to help young people explore issues of identity, while engaging in a virtual community. Users build "virtual rooms" and populate them with objects and characters, program them with storytelling behaviors, and converse with other young people in real-time through a virtual character representing themselves.

Children and adolescents facing hemodialysis form a community because they shar a common medical condition and treatment. Yet, at the same time they are confined to bedspace which allow little social interaction. The use of a virtual environment may facilitate mutual patient support and interaction.

Eleven patients ranging from 13 to 19 years old were recruited from the dialysis unit at Boston Children's Hospital. The patients (3 at time) have access to a networked computer at their bedside during dialysis. Zora was only accessible in the dialysis unit and through remote communication with MIT Media Laboratory.

After one month, semi-structured interviews were used to obtain feedback. Logs of the on-line interactions and videotapes of interactions were examined and compared to those obtained from Zora's use by healthy adolescents at the MIT Media Laboratory.

Results revealed that Zora was safe and useful for the patients on hemodialysis. They were able to create their virtual city. Four themes emerged. First, patients uniformly noted that the application provided a "good way" to communicate with each other in a "private" way, while undergoing the "public"e vent of dialysis. Second, patients reported that they "enjoyed being able to move around" in Zora where they could visit other people's rooms as this was different from being "tied down" during dialysis. Third, Zora provided a space to voice opinions more freely than is generally allowed or tolerated in an acute medical environment. Finally, some patients requested a broader community to talk more anonymously with people in similar situations given "embarrassment" to talk with known peers about their illness.

Compared with physically healthy children who have used Zora, hemodialysis patients made more use of fantasy in creating their rooms. For example, the patients almost always chose cartoon characters and fictional names to represent themselves. This contrasted with the other children who more often imported their own pictures and used their own names. Many of the patients reported that they did this as a way of distancing themselves from the harshness of dialysis.

The findings suggest that computer-based interventions have the potential to open up a world of possibilities with regard to increasing communication and mutual understanding between patients facing difficult medical illnesses.