Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

Abstract

Background: Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP.

Methods: Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones.

Results: Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention.

Conclusion: This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

Keywords: advance care planning; advance directives; communication; end-of-life care; health behavior; palliative care.

Conflict of interest statement

Conflict of Interest:

The conversation game “My Gift of Grace” was designed and is sold by an independent company, Common Practice. XXX is an unpaid research advisor to Common Practice, which waived the licensing fee required for use of Intellectual Property for the purposes of this research. However, the authors have no financial relationships with Common Practice to disclose, and Common Practice was not involved in the development, implementation, analysis, or publication of this research. The funders of this research have no relationships with Common Practice or others related to this research to disclose.

Figures

Figure 1.

The trans-theoretfcal model.

Figure 2.

Stages of Change Pre- and 3 months Post-intervention