End-of-Life Conversation Game for Cancer

Overseen By Kylee Kimbel, BS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Milton S. Hershey Medical Center

Disqualifiers: Advance directive, No recent treatment, others

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a conversation game called "Hello" can assist people with cancer and their loved ones in planning for end-of-life care. The study will assess whether the game requires modifications for cancer patients and how playing it influences hospital visits and medical decisions. Participants will either play "Hello for Cancer," which centers on cancer-related discussions, or a general conversation game called Table Topics. Individuals diagnosed with solid tumor cancers and receiving care at Penn State Health, or their chosen caregivers, might be suitable candidates. As an unphased trial, this study offers a unique opportunity to contribute to research that could enhance end-of-life planning for cancer patients and their families.

Do I have to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It seems unlikely, as the study focuses on playing a conversation game rather than medical treatment.

What prior data suggests that the Hello for Cancer game is safe for individuals with cancer?

Research has shown that the Hello game provides a comfortable setting for discussing sensitive end-of-life topics. In studies with over 200 participants, the game proved easy to handle, with no reports of negative effects. It mainly helps people discuss their wishes and decisions for end-of-life care. As it is not a medical treatment, it does not carry the same risks as a drug or procedure. Participants found it engaging and useful for planning their care, indicating it is safe to play. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Hello for Cancer game because it offers a unique approach to facilitating end-of-life conversations for individuals with cancer and their loved ones. Unlike traditional methods that might involve direct counseling or medical consultations, this game creates an interactive and engaging environment to explore complex topics around cancer experiences and medical decision-making. By encouraging open dialogue through thought-provoking questions, the game can help participants express their feelings and preferences in a less formal setting. This innovative method could lead to more meaningful discussions and better-informed decisions about end-of-life care.

What evidence suggests that the Hello for Cancer game is effective for advance care planning in cancer patients?

Research has shown that the Hello game aids people in planning future medical care. In previous studies, participants found it useful for discussing end-of-life care. This trial will test a modified version, the Hello for Cancer game, specifically with cancer patients. The game includes questions that encourage individuals to consider and share their health care preferences. Early results suggest it can make these challenging conversations easier and more approachable. Meanwhile, another arm of this trial will use the Table Topics game, which poses a variety of conversation-starting questions not specifically related to medical decision-making. ^{1 3 5 6 7}

Who Is on the Research Team?

Lauren Van Scoy, MD

Principal Investigator

Penn State College of Medicine

Are You a Good Fit for This Trial?

This trial is for individuals with various solid cancers such as breast, lung, and colorectal cancer. Participants will be from Penn State Health clinics who are interested in advance care planning. They should be willing to answer questionnaires, play a game designed to facilitate end-of-life conversations, join a focus group discussion, and do a follow-up interview.

Inclusion Criteria

Patient with Cancer: Receives care at Penn State Health or is the chosen caregiver for a participant treated at Penn State Health

My caregiver can speak and read English or Spanish.

I can speak and read English or Spanish.

Exclusion Criteria

Patient with Cancer: Has not received treatment for their cancer at a Penn State Health facility in the past year

Patient with Cancer: Unable to consent to participate in study

Caregiver/Loved one: Unable to consent to participate in study

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants play either the Hello for Cancer game or the Table Topics game, complete pre- and post-game questionnaires, and participate in focus groups.

1 day

1 visit (in-person)

Follow-up

Participants complete a telephone follow-up interview to assess ACP behaviors and satisfaction with the intervention.

1-4 months

Long-term Follow-up

The patient's medical chart is reviewed for up to two years to capture healthcare utilization and documentation of ACP discussions.

Up to 2 years

What Are the Treatments Tested in This Trial?

Interventions

• Hello for Cancer game

Trial Overview The study tests the 'Hello for Cancer' game against the 'Table Topics' game to see if they help in advance care planning. It checks how these games affect healthcare usage like hospital stays or emergency visits and explores necessary changes for using Hello in cancer populations.

How Is the Trial Designed?

Group I: Hello for Cancer game Experimental Treatment 1 Intervention

For this arm, individuals will play the modified Hello game (Hello for Cancer). This game was modified to be better suited for individuals with cancer and their loved ones, and those modifications are now being tested. This game will include questions related to a variety of topics around an individual's cancer experience and medical decision making related to their cancer diagnosis. After playing the game, individuals will be asked to reflect on the game questions and provide feedback to inform further modifications.

Group II: Table Topics game Placebo Group 1 Intervention

For this arm, individuals will play commercially available Table Topics game during the research event. This game asks a variety of conversation starting questions, not particularly related to medical decision making.

Who Is Running the Clinical Trial?

Milton S. Hershey Medical Center

Lead Sponsor

Trials

515

Recruited

2,873,000+

Published Research Related to This Trial

The iManageCancer project developed two serious games aimed at helping adult and young cancer patients manage psychological challenges like anxiety and depression, promoting positive engagement and social participation.

Initial testing highlighted the importance of game design clarity and technical functionality, which significantly influenced player outcomes; ongoing pilots and evaluations will further assess the effectiveness of these games.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of serious games in the iManageCancer project. Hoffmann, S., Wilson, S.[2020]

Effective communication about goals of care between clinicians, patients, and families is crucial for improving patient outcomes and reducing healthcare costs, as shown in a review of 23 randomized controlled trials involving 6,376 participants.

Interventions such as patient decision aids and enhanced patient-clinician communication significantly improved understanding and dialogue, with nurse-facilitated interventions showing particular promise in enhancing the quality of end-of-life care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Communication Interventions to Improve Goal-Concordant Care of Seriously Ill Patients: An Integrative Review. Bennett, F., O'Conner-Von, S.[2021]

The development of the 'Pallium game' involved multiple phases, including exploratory, Delphi, and case studies, demonstrating a structured approach to creating a tool for palliative care communication.

The game was found to be effective in facilitating discussions about sensitive topics, helping patients and families express their feelings and needs, thus enhancing the therapeutic relationship and overall care experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: "Pallium Game". Fernandes, CS., Vale, MB., Magalhães, B., et al.[2023]

The Go Wish card game is a feasible tool for helping seriously ill patients in hospitals articulate their end-of-life care preferences, with 25% of approached patients successfully completing the game.

The most important value identified by patients was 'to be free from pain,' highlighting key concerns such as spirituality and symptom management, and the process took an average of 21.8 minutes, making it a time-efficient method for goal-setting discussions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of discussing end-of-life care goals with inpatients using a structured, conversational approach: the go wish card game. Lankarani-Fard, A., Knapp, H., Lorenz, KA., et al.[2010]

The use of card games in palliative care has been shown to facilitate sensitive conversations about end-of-life topics, allowing patients to engage more comfortably in discussions about their care.

Patients reported high satisfaction with this approach, which not only encourages participation but also motivates them to engage in advanced care planning behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient card games in palliative care: integrative review. Fernandes, CS., Lourenço, M., Vale, B.[2022]

The newly developed board game was well-accepted by Chinese older adults, showing a low attrition rate and positive feedback during a one-hour game session with 30 participants.

After playing the game, participants reported a significant increase in their confidence (self-efficacy) to discuss end-of-life care preferences, suggesting the game effectively encourages conversations about advance care planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A serious game for engaging older adults in end-of-life care discussion: A mixed method study. Liu, L., Chan, HY., Ho, TC., et al.[2023]

The therapeutic board game Shop Talk, translated into Italian, was well-received by 30 pediatric cancer patients aged 7-18, showing high acceptability and feasibility in various play settings.

After playing, participants experienced a significant reduction in negative emotions and an increase in positive emotions, indicating that Shop Talk effectively supports emotional well-being in young cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability and feasibility of a therapeutic board game for children and adolescents with cancer: the Italian version of Shop Talk. Bettini, A., Amore, E., Vagnoli, L., et al.[2019]

The Strong Together intervention, a self-advocacy serious game, was well-received by 40 women with advanced cancer, who found it realistic and reflective of their experiences, indicating its potential effectiveness in enhancing self-advocacy skills.

Participants expressed a desire for more content and diverse characters, suggesting that while the intervention was beneficial, there is room for improvement to better meet the needs of users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"I was never one of those people who just jumped right in for me": patient perspectives on self-advocacy training for women with advanced cancer. Thomas, TH., Murray, PJ., Rosenzweig, M., et al.[2023]

Interactive health electronic games can significantly enhance patient engagement and promote positive health behavior changes in cancer patients, potentially improving their quality of life.

These digital tools not only empower patients but also provide suitable palliative care and support self-management, making them a valuable addition to traditional cancer treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic game: A key effective technology to promote behavioral change in cancer patients. Safdari, R., Ghazisaeidi, M., Goodini, A., et al.[2017]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12173959/

Facilitating Advance Care Planning Conversations Among ... The Hello game has been shown to be effective in promoting ACP in several populations but has not been tested in patients with cancer or their CP.

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06028152

Using an End-of-life Conversation Game to Engage ... The goal of this clinical trial is to explore feasibility, acceptability, and effectiveness of end-of-life conversation game "Hello" as a tool to help ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0885392417302981

Community Game Day: Using an End-of-Life Conversation ... This convergent, mixed-methods study assessed whether an end-of-life conversation card game is an acceptable and effective means for performing ACP for patients ...

4. jpsmjournal.com jpsmjournal.com/article/S0885-3924(25)00335-5/pdf

Facilitating Advance Care Planning for Patients With ... 1. Participants will determine effective ways to utilize a conversation game when discussing end-of-life care with cancer patients and their care partners.

5. pennstatehealthnews.org pennstatehealthnews.org/2020/07/a-conversation-game-may-reduce-disparity-in-end-of-life-care-for-african-americans/

A conversation game may reduce disparity in end-of-life ... Study participants played the game Hello, which involves a series of discussion questions designed to spark conversation about end of life care.

6. jpsmjournal.com jpsmjournal.com/article/S0885-3924(25)00335-5/fulltext

Facilitating Advance Care Planning for Patients With ... This qualitative study engaged 7 dyads consisting of patients with cancer and their care partner in an advance care planning conversation game called "Hello".

7. hospicefoundation.org hospicefoundation.org/projects/hello-project/

"Hello" Project A 16-month research grant project on the importance of talking about end-of-life wishes and documenting those wishes using the conversation game, Hello.