title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Van Scoy
authors.affiliation: 1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
authors.affiliation: 2 Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Reading
authors.affiliation: 3 Department of Communication, University of Kentucky, Lexington, KY, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Scott
authors.affiliation: 4 Department of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
authors.affiliation: 5 Department of Pediatrics and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Levi
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D000068957:Games, Recreational; D006801:Humans; D016224:Living Wills / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010865:Pilot Projects; D019727:Proxy / Q000523:psychology; D011582:Psychological Theory; D011788:Quality of Life / Q000523:psychology; D013727:Terminal Care / Q000523:psychology
keywords: advance care planning; advance directives; communication; end-of-life care; health behavior; palliative care