Advance Care Planning in Dialysis Patients With a Conversation Game

To support advance care planning (ACP), a conversation game, Anticip'action, and a connected 3-step ACP intervention using the game were developed. This study assessed the acceptability, feasibility, and effect of the intervention with patients undergoing dialysis at a tertiary hospital.

Dialysis nurses received a 10-hour training in ACP and use of the card game Anticip'Action. All patients on dialysis in the nephrology division were eligible. Acceptability and feasibility were assessed using questionnaires and note taking. Effect was assessed using pre-post number of advance directives (ADs), number of patients designating a surrogate, quality of written ACP documentation, patients' responses to the 9-items ACP Engagement Survey, and patients' assessment of their ACP documentation.

Twelve nurses conducted ACP interventions. Thirty-three patients (87% of eligible patients) accepted to be included, 25 (75%) started the ACP intervention, 23 completed it, and 18 answered all questionnaires. 5 withdrawals were due to premature death. Nurses and patients rated the training, the intervention and the card game as good and highly acceptable: mean scores ranged from 2.87 to 4.17 on a 5-point Likert scale questions. Organizational difficulties were reported by nurses. Significant increases were observed on uploaded ADs (+ 30%), designated health care surrogates (+ 80%), patients reporting end-of-life planning actions (12/19), patients' engagement in ACP (+ 1.04 on 1-5 scale, P ≤ 0.001), quality of ACP documentation (+ 2.68 on a 1-5 scale, P ≤ 0.001), and patients' evaluation of their ACP documentation (3.44 ± 1.04 on 1-5 scale).

The 3-step ACP intervention using Anticip'action showed good implementation potential in clinical context.