Effects of a Game on Advance Care Planning Engagement in Older Adults: A Randomized Controlled Trial

Discussing death is taboo in many cultures, hindering advance care planning (ACP). Gamification has shown as a strategy to overcome the barrier of broaching sensitive topics.

To determine the effects of a culturally-sensitive, theory-driven board game on ACP engagement among older adults.

This study utilized a sequential explanatory mixed-methods design, including a multisite two-arm parallel randomized controlled trial followed by qualitative interviews, conducted between August and November 2020. Participants aged 60 and above recruited from nine community centers in Changsha, China, were randomly assigned on a 1:1 ratio to either the intervention group to play a board game about end-of-life care or the control group to play a board game about healthy lifestyles for approximately an hour in a group-based format. Study outcomes including self-efficacy and readiness for ACP and knowledge about end-of-life care are measured at baseline, immediate and one-month postintervention.

Of the 144 participants (mean age 69.9), those in the intervention group showed significant improvements in self-efficacy and readiness for ACP, and knowledge immediate postintervention compared to the control group, but the changes were not maintained at one-month follow-up. Three themes about the gaming experiences emerged from the qualitative data were: enjoyable experience, positive impacts and mixed views for ACP.

The board game effectively increased immediate self-efficacy and readiness for ACP among older adults, suggesting that it is a useful tool for promoting ACP engagement. However, ongoing support through repeated interactions and family participation is needed to sustain the changes.