VoicingHan: Avatar life-review for paliative care

Semi Ryu, Dr. Egidio del Fabbro, Dr. Danielle Noreika, Dr. Sarah Price

(Read the article-The winner of Hamilton International Arts in Health award-Arts for Innovation)

VoicingHan is an avatar mediated life-review project designed for cancer patients, in a palliative care setting. The VoicingHan study enrolled 12-patients receiving outpatient palliative care at VCU Massey cancer center, from June to Aug 2019. Each participant had a session lasting about 30-40 minutes of spontaneously engaged avatar life-review, starting from childhood and ending at elder hood. The storytelling performances were recorded via avatar video format and distributed to the participants for their review, sharing and legacy document. 

A Korean concept, “Han” reflects a paradoxical state of consciousness combining an extreme state of grief with a great hope for overcoming a seemingly impossible situation. We situate Han in a special and holistic cognition found among patients and staff members in the palliative care program who confront the critical issue of mortality, and the human dilemma in connecting our physical and spiritual domains.

VoicingHan explores how digital art can support quality of life for cancer patients in palliative care settings through the creative process of life review, facilitated by avatar virtual bodies. Traditionally, life-review relies on interview and audio-recording as primary means of engaging the therapeutic process. VoicingHan avatar life-review is mediated by a virtual body which contributes to the playful and therapeutic possibility of constructing a new perception of one’s own life stories. 

In traditional life review therapy, the narrative construction would occur dialogically between therapist and patient. By engaging the patient in a guided history of the past through the developmental challenges of each stage of development, the therapist would effectively deconstruct areas that had been psychologically unresolved and allow for the client to “reauthor” their lived experience through recognizing a larger pattern of events which have occurred across her or his lifespan. The meaning and significance of those events may be reinterpreted in a therapeutically beneficial way. Building up a trusted relationship between the patient and therapist is vital to this process, but is often challenging in the clinical setting due to the time, costs and competing demands of medical treatment and psychological counseling.

Unlike traditional life-review, VoicingHan life stories do not follow prescriptive pathways or oral histories of events, but instead are spontaneously triggered by the participant’s choice of avatar and virtual environment. Each avatar has a mirrored body movement and lip-synchronization of live speech. The participants perform a virtual body self at any stage in life and customize elements such as gender, ethnicity, and environment, performing events as if happening right now in the present tense.  Acting out their chosen life events, the participants are immersed into their life stories quickly and playfully. Each participant constructs a life review which reveals meaning making, rather than focusing on personal history or fixed identity, linked with therapeutic aspects.

The initial study of VoicingHan was designed for assessing Feasibility of Delivering an Avatar Facilitated Life-review Intervention for Patients with Cancer. Post-survey found all patients agreed or strongly agreed (Likert Scale 1-5) they would participate again, recommend it to others, and found the experience beneficial. After one month ESAS scores were either unchanged or improved in 80% of patients. An Avatar-facilitated Life-review was feasible with high rate of adherence, completion, and acceptability by patients.

VoicingHan study has been published in prestigious publication venues such as International Journal of Performance Art and Digital Media (June 2020, Taylor & Francis) and Journal of Paliative Medicine ( Sep 2020). Qualitative research article was recently accepted for publication at Journal Arts & Health: An International Journal for Research, Policy and Practice (Taylor & Francis).