Facilitating Advance Care Planning Conversations Among Patients With Cancer and Their Care Partners Utilizing a Conversation Game: A Pilot Study

Abstract

Background: Patients with cancer should engage in decision-making throughout the course of their illness and treatment. Current guidelines recommend early, frequent advance care planning (ACP) conversations among clinicians, patients, and care partners (CPs) and advance directive (AD) completion. However, only 55% of patients with cancer have completed such directives, suggesting the need for interventions to increase rates of ACP. The Hello game has been shown to be effective in promoting ACP in several populations but has not been tested in patients with cancer or their CP.

Aims: To assess the acceptability of Hello and determine the modifications necessary for use in cancer populations.

Methods and results: This convergent mixed methods study involved seven dyads (7 patients with cancer and their 7 CPs to total n = 14); dyads played Hello in groups of 2-4. Post-game, dyads completed satisfaction and acceptability questionnaires and focus groups. Qualitative thematic analysis was performed; quantitative data was summarized. Patients' mean age was 56.4 years-43% were female, 57% had genitourinary cancer, and 43% had breast cancer. Three themes emerged from both patient and CP focus groups (n = 14 individuals): (1) Participants enjoyed the group dynamics and relating to peers when playing Hello; (2) Hello serves as a helpful conversation starter; (3) modifications could help tailor Hello for use in cancer context-particularly adding more questions about quality of life and mental health. The patient focus groups had an additional theme: (4) Patients with localized cancer may have a different experience with Hello when compared to those with advanced cancer.

Conclusion: Hello was well-received by dyads, and their feedback was used to tailor Hello for patients with cancer and their CPs. Next steps for this project include assessing the acceptability of the modified game.

Trial registration: clinicaltrials.gov: NCT06028152.

Keywords: advance care planning; advance directives; cancer; health games; medical decision‐making; qualitative research.