Neurocrine Biosciences had an exciting opportunity in the third quarter of 2023 to launch a new indication for INGREZZA® (valbenazine) capsules for the treatment of chorea associated with Huntington’s disease (HD) in adults. INGREZZA was initially launched as a first-in-class medication for tardive dyskinesia in 2017.
In anticipation of the FDA approval of INGREZZA for HD chorea, the field sales training team developed a comprehensive launch curriculum to prepare the field team.
However, they still felt that something powerful was missing — the field teams’ full comprehension of the marked and insidious effects of the uncontrollable movements associated with HD chorea on patients and their care partners. It was imperative to the field sales training team that the neurology account specialists understood the deep and extensive emotional, clinical and functional impact of chorea on people living with HD and on their care partners.
Seeking the most effective, concrete and resonant approach for portraying a patient and care partner’s daily experience, Tania Randolph, neurology field sales training manager for Neurocrine, recommended the creation of an immersive virtual reality (VR) learning environment as the best path forward. This technology would allow the neurology account specialists to truly empathize with and understand the patient and caregiver experiences in living with the progressive symptoms of HD chorea.
Recently promoted from a field role, Randolph had previous experience with immersive learning and knew the meaningful effects VR would have on her teams’ understanding of the impact of HD chorea. She passionately advocated for implementing VR training for this use.
Ultimately, Randolph’s confidence and conviction in the benefits of an immersive learning approach convinced internal decision-makers of the potential value and impact of the technology as a training tool for the field teams.
Using virtual headsets and controllers, three VR experiences were designed to put learners in the shoes of a person with HD chorea. These experiences demonstrated the progressive nature and impact of HD chorea over time, including how uncontrollable movements interfere with typical daily tasks, such as getting dressed, eating and drinking.
What some people may consider small tasks, such as hanging a jacket on a hook or pouring a cup of coffee, were experienced via VR through the eyes and body of a person with HD chorea to evoke personal responses to both the physical and emotional challenges in the learners. To further immerse learners in the VR experience, the narration reflected the affected speech patterns of people with progressing HD.
In the first experience, learners were introduced to a patient who has been living with HD and now has early-stage HD chorea. Through the VR platform, learners experienced what he experienced in real time as they attempted to perform routine daily tasks, only to be met with difficulties including hand weakness and a lack of coordination.
Learners were also introduced to the patient’s wife (care partner) and son. Throughout the simulation, learners could see what the patient saw in his home setting and hear his thoughts on how this disease, even in its early stages, had already affected his life.
In the second simulation, his HD chorea had progressed, but he still lacked awareness that the difficulties in movement that he was experiencing were related to chorea.
Learners experienced a progression of coordination loss and encountered balance problems while simply walking from one room to another — common developments of advancing HD chorea. Learners then attempted to pour a cup of coffee; using hand controllers to perform this task, they could feel uncontrollable and unsteady hand movements and poor coordination.
Eventually, the coffee spilled, and the mug shattered on the floor, evoking frustration, sadness and confusion. Learners’ experience in this simulation reflected the executive function, cognitive and behavioral impacts of HD chorea.
Engaging in the final simulation, learners developed a deeper understanding of why eating could be very challenging for a patient with more advanced HD chorea.
Learners were tasked with attempting to eat a bowl of oatmeal. Extreme frustration ensued when chorea symptoms interfered with the performance of simple actions, including grasping the spoon and getting it from the bowl to the mouth. The lack of coordination, loss of control and decreased dexterity experienced in the simulation reflected the challenges often accompanying more advanced stages of the disease.
In addition to the physical challenges presented in this simulation, the emotional and behavioral changes associated with advanced HD chorea were also highlighted. For example, the patient’s confusion and anger were met with frustration, worry and uncertainty from his wife, who was desperately seeking additional help for her beloved husband.
The content of each simulation builds on the last in terms of worsening symptoms, and also in terms of the mounting difficulties of a life spent with HD. Thus, each successive experience was more impactful than the last, generating empathy in learners for patients with HD chorea and their care partners.
The HD chorea VR learning experiences undeniably and positively impacted learners and training managers. By investing in disease education as an immersive, hands-on experience, Neurocrine created an immediate behavioral change in learners, as they saw firsthand the impacts, both physical and emotional. Their new understanding led to improved communication and a more patient-centric approach to healthcare provider conversations.
Each learner was completely immersed in this experience for 15 minutes without distraction. Some learners had deep emotions as they participated, including crying, as they heard and experienced the emotional toll on patients and care partners.
The deep and lasting impact that the training experience had on the team continues to inspire, motivate and drive the field team to have meaningful and productive conversations with healthcare providers about patient experiences and when to consider INGREZZA as a potential treatment option.
Particularly, the implementation of the HD chorea VR experience was met with high praise that matched its high impact, as seen in one learner’s feedback:
“Truly connected with the HD patient and how challenging their daily life is. So excited to help these patients.”
As word spread about the success of the immersive experience, other teams within Neurocrine began reaching out to learn more. Randolph’s VR initiative was so impactful she was awarded the Neurocrine Innovation Value of the Quarter Award, a prestigious accolade for which she was nominated by both her peers and directors.
Neurocrine remains dedicated to providing innovative training experiences to their teams to elevate each individual’s understanding of their patient communities. This ultimately helps them better serve providers and patients.
Miki White is director of member services for LTEN. Email her at mwhite@L-TEN.org or connect through linkedin.com/in/mikiwhite.
