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

32 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

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 individuals with various solid cancer types (including: breast, gastro-intestinal, lung, melanoma, head and neck, and/or genito-urinary cancers) treated at Penn State Health clinics and their loved ones perform advance care planning (ACP). The main questions it aims to answer are: What modifications and/or adaptations are necessary to Hello for use in cancer populations? What impact does participation in Hello event have on health care usage (e.g., number of hospitalizations, ICU admissions, emergency department visits, etc.)? How feasible is it to randomize participants to play either Hello for Cancer or Table Topics? Participants will: * Complete pre-game questionnaires * Play either Hello or Table Topics game * Complete post-game questionnaires * Participate in a focus group * Complete a telephone follow up interview 1-4 months after their event This study is a continuation of NCT06028152.

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.

How does the End-of-Life Conversation Game for Cancer differ from other treatments for cancer?

The End-of-Life Conversation Game for Cancer is unique because it uses a card game format to facilitate sensitive discussions about end-of-life care, which is different from traditional medical treatments that focus on physical symptoms. This approach helps patients and families express their feelings and experiences, addressing emotional and psychosocial needs in a supportive setting. ^{1 2 3 4 5}

What data supports the effectiveness of the Hello for Cancer game treatment?

Research shows that using games to discuss end-of-life care can help patients think about their values and goals in a comfortable way, making it easier to talk with healthcare providers. Games like the Go Wish card game have been found to be feasible and effective in helping patients communicate their end-of-life care preferences. ^{2 6 7 8 9}

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

I can speak and read English or Spanish.

My caregiver 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 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 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 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]

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 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 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 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 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]

Citations

1. United States 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. [2010]

2. Ireland pubmed.ncbi.nlm.nih.gov

A serious game for engaging older adults in end-of-life care discussion: A mixed method study. [2023]

3. Germany 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. [2023]

4. India pubmed.ncbi.nlm.nih.gov

Electronic game: A key effective technology to promote behavioral change in cancer patients. [2017]

5. United States pubmed.ncbi.nlm.nih.gov

Communication Interventions to Improve Goal-Concordant Care of Seriously Ill Patients: An Integrative Review. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Patient card games in palliative care: integrative review. [2022]

7. Germany 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. [2019]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: "Pallium Game". [2023]

9. England pubmed.ncbi.nlm.nih.gov

The role of serious games in the iManageCancer project. [2020]