Research On The Effect Of Game Intervention On Advance Care Planning In Advanced Cancer Patients

Objective:To investigate the effects of the game intervention on cognitive,self-efficacy,readiness,and positive and negative affect in advance care planning（ACP）for patients with advanced cancer.Method:This study was a two-arm parallel randomized controlled trial.A total of 84 patients with advanced cancer who were hospitalized in a tertiary cancer hospital in Hunan Province from September 2021 to December2021 were selected and divided into the control group（n=42）and the intervention group（n=42）using the random number table.The control group received conventional health education with the concepts related to ACP;the intervention group received ACP game intervention in groups of3 to 5 patients,which was gamified with the concepts related to ACP based on the control group.A baseline survey（T₀）was conducted at the time of inclusion,and follow-up surveys were conducted at post-intervention（T₁）and 1 month post-intervention（T₂）.The survey included patients’demographic and sociological data,ACP cognitive,self-efficacy and readiness,and positive and negative affect.Two-independent sample t-tests,t’test,Wilcoxon signed anecdotal test,Chi-square test or Fisher exact test,and repeated measures ANOVA were performed withα=0.05 as the test level and P values were taken as two-sided probabilities,using Intention-to-treat analysis（ITT analysis）and Per-protocol analysis（PP analysis）.Results:1.Baseline:both ITT and PP analyses showed no statistical differences（p>0.05）in demographic and sociological data,ACP cognitive,self-efficacy and readiness,and positive and negative affect,between the two groups before the intervention（T₀）.2.Post-intervention results:（1）ACP cognition:both ITT and PP analyses showed that the main effect of intervention,the main effect of time,and the interaction effect were statistically significant in two groups（P<0.05）.The ACP cognitive in the intervention group showed an increasing trend after the intervention,while the control group showed an increasing and then decreasing trend.At T₁ and T₂,the level of ACP cognitive in the intervention group was higher than that in the control group（P<0.05）.（2）ACP self-efficacy and readiness:both ITT analysis and PP analysis showed that the main effect of intervention,the main effect of time,and the interaction effect in two groups were statistically significant（P<0.05）.ACP self-efficacy and readiness in both groups showed an increasing trend after the intervention.AT T₁ and T₂,the levels of ACP self-efficacy and readiness levels in the intervention group were higher than those in the control group（P<0.05）（3）Positive and negative affect:the results of ITT analysis for the comparison of positive affect before and after the intervention showed that positive affect was significantly higher in the control group and the intervention group after the intervention（P<0.05）;while the results of PP analysis showed that positive affect was higher in the intervention group after the intervention（P<0.05）,and there was no significant difference（P>0.05）in the change of positive affect after the intervention in the control group.The results of ITT analysis and PP analysis for the comparison of negative affect before and after the intervention showed that negative affect was higher in the control group after the intervention（P<0.05）,and decreased in the intervention group（P<0.05）.Conclusion:（1）Game intervention can effectively improve ACP cognition,self-efficacy and readiness levels,enhance positive affect,and relieve negative affect in advanced cancer patients;（2）game intervention is more effective than health education in improving ACP cognition,self-efficacy and readiness levels,enhancing positive affect and relieving negative affect in advanced cancer patients.