title: Exploring the Topics Discussed During a Conversation Card Game About Death and Dying: A Content Analysis.
abstract: Substantive discussions between loved ones are necessary for effective advance care planning. Although multiple tools are currently in use for promoting conversations, the content and clinical relevance of the conversations they stimulate is unknown.
  
  
  
  To describe the content and clinical relevance of conversations that occur during a nonfacilitated end-of-life conversation game.
  
  
  
  Using convenience sampling, we scheduled adult volunteers to participate in an end-of-life conversation game (2-6 individuals per game; n = 68). Participants discussed 20 questions about death, dying, or end-of-life issues. Games lasted up to two hours and were audio-recorded, transcribed, and analyzed using a conventional qualitative content analysis approach to identify emerging themes.
  
  
  
  Participants (n = 68) were primarily Caucasian (94%), females (68%), with mean age of 51.3 years (SD 0.7). Seventeen games were analyzed. Four primary themes emerged during game conversations: 1) the importance of people, relationships, and the roles played during end-of-life decision making, 2) values, beliefs, and preferences related to end-of-life care and the dying period, 3) considerations about preparing for the aftermath of one's death, and 4) the relevance of stories or experiences for informing one's own end-of-life preferences.
  
  
  
  Topics discussed during a nonfacilitated end-of-life conversation game are substantive and address important issues for advance care planning.
authors.affiliation: Medicine and Humanities, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA. Electronic address: lvanscoy@hmc.psu.edu.
authors.forename: Lauren Jodi
authors.initials: LJ
authors.lastname: Van Scoy
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Reading
authors.affiliation: Communication, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Scott
authors.affiliation: Medicine and Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chuang
authors.affiliation: Humanities and Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Levi
authors.affiliation: Medicine and Humanities, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
mesh_terms: D032722:Advance Care Planning; D001293:Attitude to Death; D003142:Communication; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D005717:Games, Experimental; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life; D012067:Religion; D012944:Social Support; D013727:Terminal Care / Q000523:psychology
keywords: Advance directives; communication; end-of-life care; medical decision making; palliative care; terminal care