'Doctor, I'm Leaving': A Practical Approach to Discharge Against Medical Advice.

Preoperative visits are a core component of perioperative care that facilitate structured information exchange between health care providers and key stakeholders [-]. In China, the rapid development of critical care medicine has resulted in an increasing proportion of surgical patients being transferred to the intensive care unit (ICU) postoperatively. However, patients’ family members typically have extremely limited prior understanding of the ICU, often forming negative stereotypes based on fragmented or distorted information from nonmedical sources. Traditional face-to-face verbal communication between ICU nurses and patients’ family members often fails to effectively convey complex ICU environments, care workflows, and medical equipment, leading to persistent information asymmetry between health care providers and families [,]. This not only causes significant psychological distress for families but also substantially increases communication burdens for already overstretched ICU health care providers [-]. Despite these well-documented challenges, research on preoperative ICU visits remains far less developed than operating room-based preoperative education []. Virtual reality (VR) technology, with its unique immersive, interactive, and standardized features, offers a promising solution to these long-standing communication barriers [,]. Unlike verbal descriptions or static images, VR can provide a realistic ICU environment and complete postoperative care processes, enabling consistent and comprehensive information delivery to all stakeholders. While VR has demonstrated effectiveness in various health care education settings, its application to preoperative ICU visits targeting patients’ family members and health care providers remains largely unexplored [,]. This study represents the first phase of developing a user-centered VR-based preoperative ICU visit system, focusing exclusively on the dual perspectives of patients’ family members and health care providers. Given the complexity of multistakeholder needs and journal length constraints, patient perspectives will be reported separately in a subsequent publication. Specifically, we aim to explore the willingness, perceptions, and information needs of ICU health care providers and patients’ family members regarding VR-based preoperative ICU visits and identify core design requirements and implementation barriers to inform evidence-based system development.