Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis

Abstract

Background: Gamification has been adopted in the health care field for broaching sensitive topics and increasing motivation for behavior changes. Games developed to stimulate discussion surrounding end-of-life issues, and thereby promoting advance care planning also emerged. Aim: The aim is to integrate the quantitative evidence and qualitative evidence to understand the effectiveness of and experience with games for advance care planning. Design: A mixed-methods systematic review and meta-analysis (PROSPERO ID: CRD42020163312) was undertaken. Joanna Briggs Institute Critical Appraisal tools were used for quality appraisal. Data were synthesized and pooled for meta-analysis or meta-aggregation when appropriate. Data sources: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, WanFang, China Knowledge Resource Integrated Database, and Chinese Biomedical Literature Database from the inception of the databases for qualitative, quantitative, and mixed-method studies. Results: Eleven articles of ten studies were included, six of which were feasibility studies. The quality of the quantitative component of most included studies (7/8) was rated as low, and the qualitative component of most included studies (7/8) was rated as moderate. The meta-analysis showed that games for advance care planning are effective to increase self-efficacy, readiness, knowledge, and process of advance care planning behaviors. The meta-aggregation showed that games for advance care planning are highly acceptable and the participants perceived the game experience as fun and enjoyable. Conclusions: Advance care planning games seem to be a promising intervention for increasing the uptake of advance care planning behaviors. Well-designed randomized controlled trials evaluating the effectiveness of games for advance care planning are needed in the future.

End-of-Life Preference Lists as an Advance Care Planning Tool for Japanese People

“…This is because there could be differences in the regional and medical environments within Japan. Second, further reliability and validity testing is needed to make this list useful for scale development because this list was developed as a support tool to stimulate ACP communication as in other countries (Delgado-Guay et al, 2016; Li et al, 2021; Liu et al, 2021; Menkin, 2007). The third is the inability to capture changes in preferences because of the cross-sectional nature of the study.…”

How can advance care planning tools help young people's voices be heard?

“…44 The Hello game is an inexpensive and easily disseminated intervention, recommended for those aged 13 years or older, that promotes ACP through gamification. 17,45,46 It does this by integrating ACP with an enjoyable game to overcome reluctance to discussing death and dying and introducing open-ended questions to prompt in-depth discussions of values and preferences about EOLC. 47 It can also increase the confidence of healthprofessionals to have these conversations.…”

Using Zoom and Card Game to Conduct Advance Care Planning Classes: An Innovative Practice

“…The gamified element was designed to facilitate the discussion on sensitive topics (van Gaalen et al, 2020). This approach proved to be successful in creating behavioural changes in sensitive topics within non-game environments (Liu et al, 2021).…”

“…Previous research has shown that ACP could improve patient outcomes, increase family communication and satisfaction with care, and reduce unnecessary hospitalization (Borgstrom, 2020;Kernick et al, 2018;van Wijmen, Pasman, Twisk, Widdershoven, & Onwuteaka-Philipsen, 2018). Still, despite several benefits, initiating the ACP and discussing its process is still challenging due to sociocultural and policy barriers that vary between countries (Phenwan et al, 2020), especially since many cultures view death and dying as taboo (Liu et al, 2021).…”

“…One training program to increase ACP awareness utilizes a card game, Life Unlocking Card Game, to talk about death and dying. Gamification in ACP is an emerging method that has been increasingly popular, as it creates a safe environment to discuss sensitive topics via gaming elements (Liu et al, 2021). This concept was implemented in this card game to allow participants to address sensitive topics, such as ACP, death, and dying.…”