ICU-VR Prior to ICU Admission

The primary endpoint will be the difference in the patients' perceived quality of information provision during preparation of the future planned ICU admission between the intervention and control group, measured after ICU admission. This will be assessed using a subset of the Consumer Quality Index-Relatives ICU (CQI-Relatives ICU), carefully tailored to the needs of this study by members of the RATE-XR steering group and currently being used in another randomized controlled trial investigating the effect of ICU-VR on information provision in relatives of ICU patients. The CQI-Relatives ICU was designed according to a robust method developed by the Healthcare Institute of the Netherlands.

Patients' perspectives and satisfaction towards the ICU-VR intervention (only in the intervention group) and perspectives and satisfaction towards the preparation for ICU admission, the delivered ICU care, and the ICU aftercare. This will be measured two weeks after the VR session and two weeks after an ICU discharge using a questionnaire, which was based on the Patient Satisfaction Questionnaire and Family Satisfaction with ICU Care tools. This questionnaire is carefully tailored to the needs of the study, in which we also added some items to evaluate patients' perspectives on the ICU-VR intervention. This questionnaire was previously used in another RCT to evaluate the effect of ICU-VR in post-ICU patients and is currently being used in our HORIZON-IC study (as mentioned in the introduction and rationale)

The severity of PTSD-related symptoms will be expressed as the sum score of the Impact of Event Scale - Revised (IES-R) and the prevalence of probable PTSD will be expressed as the proportion of patients having an IES-R sum score above 23. The IES-R is a 22-item self-report measure that assesses subjective distress caused by traumatic events. It is a revised version of the older version, the 15-item IES. The IES-R contains seven additional items related to the hyperarousal symptoms of PTSD, which are not included in the original IES. Items are rated on a 5-point scale ranging from 0 ('not at al') to 4 ('extremely'). The IES-R yields a total score (ranging from 0 to 88; higher scores indicate more severe symptoms), and subscale scores can also be calculated for the Intrusion, Avoidance and Hyperarousal subscales. The severity and prevalence of PTSD will be assessed two weeks after an ICU discharge.