Objectives This study examined the effects of virtual reality (VR) among palliative care patients at an acute ward. Objectives included evaluating VR therapy benefits across three sessions, assessing its differential impact on emotional versus physical symptoms and determining the proportion of patients experiencing clinically meaningful improvements after each session.

Methods A mixed-methods design was employed. Sixteen palliative inpatients completed three personalised 20 min VR sessions. Symptom burden was assessed using the Edmonton Symptom Assessment Scale-Revised and quality of life with the Functional Assessment of Chronic Illness Therapy (FACIT-Pal-14). Standardised criteria assessed clinically meaningful changes. Quantitative data were analysed using linear mixed models.

Results Quality of life improved significantly pre-VR to post-VR with a large effect size (Cohen’s d: 0.98). Total symptom burden decreased after 20 min VR sessions (Cohen’s d: 0.75), with similar effect sizes for emotional (Cohen’s d: 0.67) and physical symptoms (Cohen’s d: 0.63). Over 50% of patients experienced clinically meaningful improvements per session, though substantial individual variability occurred.

Conclusions This study reveals the nuanced efficacy of personalised VR therapy in palliative care, with over half of the patients experiencing meaningful benefits in emotional and physical symptoms. The marked variability in responses underscores the need for realistic expectations when implementing VR therapy.