GAMification to Encourage End-Of-Life Discussions Between ICD Patients and Caregivers
Condition: Implantable Defibrillator User; Terminal Illness
MeSH terms: Death
Study type: Interventional

Summary: 
      The purpose of this study is to determine the feasibility and efficacy of the GAMification to
      Encourage End-Of-Life (GAME-EOL) intervention, which uses the Hello Game program to encourage
      and facilitate quality end-of-life (EOL) discussions between implantable cardioverter
      defibrillators (ICD) recipients and family members of ICD recipients.
    

Detailed description: 
      Implantable cardioverter defibrillators (ICD)s are first-line treatment for the primary and
      secondary prevention of sudden cardiac arrest in populations with a history of, or at high
      risk for, lethal arrhythmias. Despite the relatively short survival expectancy following
      device implantation, many ICD recipients do not participate in advance care planning and
      either have no advance directives or advance directives that do not address end-of-life (EOL)
      decisions related to ICDs. The prevalence of ICD recipients with general advance directives
      ranges from 10-30%. Of these advance directives, only 2% have language related to the ICD
      specifically, leaving hundreds of thousands of ICD recipients at risk of unnecessary and
      painful shocks. Approximately 30% of ICD recipients will receive a shock in the active dying
      phase of a terminal illness, from which resuscitation was not intended.

      Communication among family members is integral to EOL decision-making. Appropriate quality
      discussions can create concordance of perceptions and well thought out advance care plans for
      EOL that are congruent with the values and beliefs of the chronically ill and family members.
      The Hello Game (commonpractice.com) was created to encourage conversations among families
      about EOL choices. The gameplay presents a series of questions that include practical and
      philosophical question prompts. These questions range from 1) What kind of music would you
      like to be listening to on your last day alive? to 2) Who should your health care surrogate
      seek advice from if they need to make a decision about your care? Participation in the game
      has been found to improve advance care planning behaviors.

      The purpose of this pilot study is to determine the feasibility and efficacy of the GAME-EOL
      intervention, which uses the Hello Game to encourage and facilitate quality EOL discussions
      between ICD recipients and family members.

      Aim 1: To determine feasibility of the GAME-EOL intervention to facilitate EOL conversations
      between ICD recipients and family members.

      Aim 2: To provide preliminary estimates of the efficacy of the GAME-EOL intervention on:
      (2.1) Completion of advance directives (2.2) Completion of device specific advance directives
      (2.3) Discussion of EOL choices between ICD recipients and family members

      Aim 3: To examine efficacy of GAME-EOL on improving the concordance of EOL perceptions and
      advance care planning between ICD recipients and family members.
    

Intervention name(s): GAME-EOL
Intervention type(s): Behavioral
Intervention description(s): The GAME-EOL involves Hello game booklets as well as meetings with an interventionist. Players (ICD recipient and their family member or friend dyad) take turns asking the questions in their booklet and providing their answers to the question. The gameplay continues until all questions are answered or the dyad wishes to stop. Following the completion of the game play, participants will be offered the opportunity to complete advance directives using the conversation guide and advance directive form included in the conversation guide that accompanies the questionnaire booklet.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: End-of-life; Healthcare Communication; Advance Directives