A Digital Serious Game (Anticip'action) to Support Advance Care Planning Discussions in the General Population:...

In the context of an aging population and increasingly medicalized end-of-life practices, it is crucial to promote early discussions to help patients express their view on what is essential in their life as well as articulate their preferences regarding future medical treatments and end-of-life issues. An interprofessional research team at Geneva University and the Geneva University Hospitals has developed Anticip'action, a card game designed to help initiate and conduct advance care planning and end-of-life discussions. It is available for free in paper format in diverse languages and in a digital version in French.

This study aims to assess the ergonomic quality of the digital version of the game with primary users.

Overall, 10 users (women: n=5, 50%; men: n=5, 50%; mean age 41, SD 13.4 years; range 25-65 years; education: upper level; comfortable with smartphones) completed an online usability test. The test began with a rapid desirability test to capture initial impressions of the game's main screen without knowing what it is about. This was followed by a think-aloud procedure, including 26 tasks to perform all steps of the game. Posttest questionnaires were administered to collect participants' subjective perceptions of the usability (System Usability Scale), attractiveness (AttrakDiff), and relevance as well as overall endorsement of the game (Mobile Application Rating Scale). Open-ended questions were used to further explore usability issues. Usability problems were categorized and evaluated using standard evaluation grids. Content readability was assessed with Scolarius.

The rapid desirability test revealed an overall good or average impression. In 83.2% (208/250) of the cases, participants successfully completed the think-aloud tasks without assistance. Some of the tasks (4/25, 16%) revealed multiple usability issues requiring assistance. Analysis of the 23 failures and difficulties encountered revealed that 3 (13%) issues were due to suboptimal wording of the task instructions and that there were 9 (39%) major usability problems. All could be addressed through minor modifications. The Scolarius test indicated that the card titles were understandable at an elementary school level, while the explanations on the back of the cards required a high school reading level. Participants rated Anticip'action as good or excellent in usability (79 out of 100 on the System Usability Scale), attractiveness (1.57 on the -3 to +3 AttrakDiff scale), and relevance (4.1 out of 5 on section F of the Mobile Application Rating Scale). Participants provided overall positive qualitative feedback.

The usability testing of the digital French version of Anticip'action produced positive results, with some areas for improvement identified. It can be recommended as a valuable resource for patients, families, and caregivers to prompt reflection, raise awareness, and support advance care planning conversations. Further tests should be conducted on wider population groups, including older patients and individuals less comfortable with digital solutions.