Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

Abstract

Background Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP. Methods: Sixty-eight English speaking, adult volunteers (n=17 games) from communities around Hershey, Pennsylvania and Lexington, Kentucky played a conversation card game about end-of-life issues. Readiness to engage in four ACP behaviors were measured by a validated questionnaire (based on the trans-theoretical model) immediately before and 3 months post-game and a semi-structured phone interview. These behaviors were: 1) completing a living will; 2) completing a health-care proxy; 3) discussing end-of-life wishes with loved ones; and 4) discussing quality versus quantity of life with loved ones. Results: Participants’ (n=68) mean age was 51.3 years (SD=0.7, range 22–88); 94% of participants were Caucasian and 67% were female. 78% of participants engaged in ACP behaviors within 3 months of playing the game (e.g. updating documents, discussing end-of-life issues). Furthermore, 73% of participants progressed in Stage of Change (ie. readiness) to perform at least one of the four behaviors. Scores on measures of Decisional Balance and Processes of Change increased significantly by 3 months post-intervention. Conclusions: This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within three months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

Investigation and Analysis of Undergraduate Nursing Students’ Attitudes Toward Advanced Care Planning and Their Willingness to Implement

“…Van et al also believed that the main obstacles to the low participation rate of ACP included lack of ACP conversation opportunities, avoiding death and dying topics, worrying about the impact of ACP topics on family atmosphere, limited time for clinical staff, and so on. 15 Our results showed that the current life and death discussion topics were not promoted and accepted and lacked the popularization and training of ACP. This may be due to the influence of Chinese traditional culture.…”

Community Game Day: Using an End-of-Life Conversation Game to Encourage Advance Care Planning

“…Three months post-event, research assistants administered the ACP Engagement Survey by phone and a quantitative questionnaire (Additional ACP Behavior Survey) which was developed based on previous studies of the game intervention. 31 This survey measures nine ACP behaviors not measured in the ACP Engagement Survey (e.g., seeking out information about hospice, obtaining long-term health care insurance) and also opinions about the game conversation (e.g., ''did the game give you a better understanding about ACP or end-of-life issues?'').…”

“…29,30 Additionally, 70% of participants (with unknown health status) engaged in subsequent ACP behaviors after playing the game. 31 The game has been used successfully in several research settings, including populations of participants with unknown health status in both PA and KY, 29e31 South Asian Indians living in Texas, 32 and chaplainsin-training. 33 Furthermore, the game has been successfully used by in a wide variety of outside organizations (i.e., nonresearch settings) that include religious centers, academic conferences, community festivals, hospice units, and critical care facilities.…”

A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

“…8–12 Barriers for physicians include lack of time and training; barriers for older adults include lack of understanding and wanting to include loved ones who are unavailable or uninterested. 3,13 ACP interventions, such as patient decision aids (eg, websites, videos, card games) 14–16 and care models (eg, trained facilitators), 17 have been tested, 18 but the use of these strategies in routine medical care remains limited. 19,20 …”