Game Encourages Advanced Care Planning

Few people relish the idea of planning end-of-life care, but researchers have found that playing a game designed to start a conversation about advanced planning has proven successful.

In a new study, people with chronic illness and caregivers played a game in which they took turns answering questions about end-of-life issues. The researchers found that three months after playing the game, 75 percent of participants had gone on to complete some form of advance care planning.

“Our findings suggest that not only is the game a positive experience, but it also helps motivate players to engage in advance care planning behaviors,” said Dr. Lauren J. Van Scoy, an assistant professor of medicine and humanities in the Penn State College of Medicine.

“Whether it was completing an advance directive or looking up hospice information, they were engaged in some of the necessary psychological work needed to take the next step and be prepared for decision making.”

Published in the Journal of Pain and Symptom Management, the new study is the most recent of several that have examined whether playing the game “Hello” can encourage people to begin advance care planning, a process that Van Scoy said is ongoing and can and should take months to complete.

While some people may think that advance care planning is as simple as creating an advance directive — a document that outlines a person’s wishes about medical treatment in case that person can’t communicate them to a doctor — Van Scoy said the process is more complicated than drafting a legal document.

“Before you create an advance directive, you need to think about your values and beliefs, think about your trade offs, and talk with your family and doctors,” Van Scoy said. “And eventually, once you come to grips with what you want, then you can create the actual document.”

Previous studies have examined whether people enjoy playing the game and if it encourages meaningful conversations, but Van Scoy also wanted to explore if it resulted in people changing their behavior and engaging in advance care planning.

For the new study, the researchers recruited 93 people — 49 patients and 44 caregivers — and split them into groups.

During each game, participants took turns drawing cards and reading them aloud. Each card had a question based on an end-of-life issue, for example, “What do you fear most: Experiencing the worst pain of your life or not getting the chance to say goodbye to your family?” Each participant then wrote down their answer before sharing with the group.

Three months later, the researchers called each participant to follow up. They asked each about their opinions of the game and if they had since engaged in advance care planning, which could include researching hospice care, obtaining life insurance, or creating an advance directive, among others.

The researchers found that in the three months after playing the game, 75 percent of participants had done some form of advance care planning and 44 percent had completed advance directives.

Van Scoy noted the results are meaningful because on average, only about one-third of adults engage in advance care planning, even though previous research has found it increases people’s satisfaction with their end-of-life care and lowers end-of-life health care costs.

“I’m pleased that consistently, across three separate studies, we’ve seen that people go on to engage in advance care planning after playing the game,” Van Scoy said. “Moving forward, I’m hoping to test the game in a randomized control trial to see if we can replicate the results.”

Source: Penn State