The Impact of an Advance Care Planning Game on Life-Sustaining Treatment Preferences, Depression, and Hope in Older Adults With Stroke

February 2, 2026 updated by: Yu-Chun Chien, Lotung Poh-Ai Hospital
Stroke is the world's third leading cause of death and a major source of disability, with high rates of recurrence and mortality that often limit patients' ability to express their values and treatment preferences. This highlights the importance of Advance Care Planning (ACP) after stroke. This randomized controlled trial examined the effects of an ACP block-based game on life-sustaining treatment preferences, depression, and hope among adults aged 65-100 with subacute stroke in a regional teaching hospital. The Life Support Preferences Questionnaire (LSPQ) served as the primary outcome to assess preference changes immediately after the intervention and at four weeks, while the Hospital Anxiety and Depression Scale (HADS) and the Herth Hope Index (HHI) were secondary measures. The intervention used the "LOHAS Journey" ACP game, which applies travel-themed scenarios, blocks to express medical choices, hope-enhancing elements, and companion cards emphasizing personal resources and potential surrogate decision-makers, while also encouraging warm emotional expression. Generalized Estimating Equations (GEE) were used to analyze repeated measures and time-by-group effects. If effective, this ACP game may support broader clinical adoption of structured discussions on life-sustaining treatment preferences for older stroke patients.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Background:

Stroke is the third leading cause of death worldwide and one of the most common causes of disability, accounting for approximately 10% of all deaths. One in four people experiences a stroke in their lifetime, and about 10% of stroke survivors face the risk of recurrent stroke within five years, often with more severe symptoms than the first episode. The one-year and five-year mortality rates after stroke are as high as 41% and 60%, respectively. Due to its high incidence, high recurrence rate, and high mortality, many stroke patients are unable to express their values and treatment preferences during the course of illness. This underscores the necessity of engaging in Advance Care Planning (ACP) discussions after stroke.

Purpose:

This study aims to explore the effects of an ACP game intervention on life-sustaining treatment preferences, depression, and hope among older adults with stroke.

Design:

A randomized controlled trial design was adopted.

Participants:

Using purposive sampling, we recruited subacute stroke patients aged 65-100 years from the neurology, neurosurgery, and rehabilitation wards of a regional teaching hospital in eastern Taiwan.

Measurement Tools:

The Life Support Preferences Questionnaire (LSPQ) was used as the primary outcome measure to assess differences in life-sustaining treatment preferences immediately after the intervention and at week 4 post-intervention. Secondary outcome measures included the Hospital Anxiety and Depression Scale (HADS) and the Herth Hope Index (HHI).

Intervention:

The intervention utilized the "LOHAS Journey" ACP block-based game developed for this study. The game incorporates travel-themed scenario guidance, allowing participants to express their medical preferences through the arrangement of blocks. "Hope blocks" were added to transform various stroke- and cancer-related scenarios, enhancing the participants' sense of hope. The game also includes companion option cards, emphasizing personal resources and potential future surrogate decision-makers. Beyond discussing life-sustaining treatment preferences, the game further encourages warm emotional expressions such as gratitude and affection.

Statistical Analysis:

Generalized Estimating Equations (GEE) were used to examine differences in life-sustaining treatment preferences, depression, and hope across repeated measurements, as well as to analyze time and group interaction effects.

If the effectiveness of the ACP block-based game on life-sustaining treatment preferences, depression, and hope among older adults with stroke is confirmed, it will support the promotion of ACP-related discussions in clinical stroke care.

Study Type

Interventional

Enrollment (Estimated)

72

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Taiwan
      • Yilan, Taiwan
        • Lotong PohAi Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Older adults aged 65-100 years.
  • Diagnosed with ischemic or hemorrhagic stroke confirmed by computer tomography (CT) or magnetic resonance imaging (MRI), and in the subacute stage 1-6 months after stroke onset.
  • A National Institute of Health Stroke Scale (NIHSS) score ≤ 15, indicating mild to moderate stroke severity.
  • Clear consciousness and able to communicate in Mandarin or Taiwanese.

Exclusion Criteria:

  • Individuals diagnosed with chronic psychiatric disorders such as major depression, mania, or bipolar disorder.
  • Older adults diagnosed with moderate to severe dementia.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: ACP Block Game Intervention
Other: ACP Block Game Intervention
The "LOHAS Journey" Advance Care Planning (ACP) block game serves as an intervention. This non-invasive intervention, themed around a game-like journey, guides participants through various scenarios, allowing them to express their healthcare preferences through the blocks. The inclusion of "Hope Blocks" transforms several scenarios related to stroke and cancer, helping participants strengthen their hope for healthcare. The game also provides support tabs highlighting personal resources and potential future healthcare decision-makers. Beyond discussing life-sustaining treatment preferences, the game encourages expressing warm emotions such as gratitude and love.
No Intervention: Usual Care
Routine stroke care

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
life support preferences questionnaire; LSPQ
Time Frame: From enrollment to the end of treatment at 5 weeks
The questionnaire is designed to assess participants' preferences for various life-sustaining treatments across six medical scenarios and five treatment options. The maximum possible score is 150 and the minimum is 25. Higher scores indicate a greater willingness to receive life-sustaining medical treatments.
From enrollment to the end of treatment at 5 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
hospital anxiety and depression scale; HADS
Time Frame: From enrollment to the end of treatment at 5 weeks
This scale is used to screen for the prevalence of anxiety and depression among patients in medical settings who do not have psychiatric disorders. It contains 14 items, with a total score ranging from 0 to 21. Scores of 0-7 are considered within the normal range; scores of 8-10 indicate borderline or potential anxiety or depressive symptoms; and scores of ≥11 suggest the possible presence of emotional disorders or underlying conditions. Higher scores indicate more severe anxiety or depressive symptoms.
From enrollment to the end of treatment at 5 weeks
herth hope index; HHI
Time Frame: From enrollment to the end of treatment at 5 weeks
This scale is used to assess the level of hope among patients with acute, chronic, or terminal illnesses. It consists of 12 items, with a total score ranging from 12 to 48. Higher scores indicate a higher level of hope.
From enrollment to the end of treatment at 5 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Lotung Poh-Ai Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 29, 2026

Primary Completion (Estimated)

May 31, 2026

Study Completion (Estimated)

July 31, 2026

Study Registration Dates

First Submitted

November 14, 2025

First Submitted That Met QC Criteria

November 17, 2025

First Posted (Actual)

November 19, 2025

Study Record Updates

Last Update Posted (Actual)

February 4, 2026

Last Update Submitted That Met QC Criteria

February 2, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB114-220-B

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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