Advance care planning (ACP) is the process of thinking through and articulating in advance one's preferences for future medical care, and has long been promoted as a way for people to receive medical treatment consistent with their values, goals, and preferences. Many experts consider the decision ?Who will make medical decisions for you if you couldn't speak for yourself?? to be the single most important component of ACP. Even so, research has shown that surrogates often inaccurately represent patients' wishes ?which raises the question whether an intervention can help patients do a better job identifying spokespersons with the qualities needed to accurately represent patients' wishes. Surprisingly, no interventions (to our knowledge) have been explicitly designed to help people consider the actual qualities of their chosen spokesperson, much less engage these spokespersons to confirm that they can accurately represent the patient's wishes. We developed a ?serious game? intervention called ?Who Would You Choose: Serious Fun? (WWYC) to help people consider the key qualities healthcare spokespersons should have. The intervention uses a spinner, cards, and dice, along with a smart-phone App to prompt players (using scenarios and metaphors) to choose a spokesperson whose qualities are best suited to the role. Friendly competition is encouraged by having players receive points for correct answers, and additional points for good explanations of their choices. At the end of the game, players identify a real-life spokesperson based on the qualities considered during game-play. Then, using an associated smart-phone App, the intervention will help spark communication between the player and their chosen spokesperson. The project has three specific aims:
Aim 1. To explore how playing the novel game Who Would You Choose affects people's choice of a spokesperson. Using qualitative methods including focus groups and one-on-one interviews, we will explore how WWYC affects individual players' thought process for choosing a spokesperson, and whether their choice changes as a result of game-play.
Aim 2. To establish that WWYC is a feasible way to help individuals choose and engage a spokesperson. We will judge it feasible if: 1) We can efficiently recruit 100 individuals to play the game; 2) >75% of game players report that playing the game is helpful for choosing a spokesperson; 3) >75% of game players endorse the game; 4) >75% of spokespersons engage with WWYC (using its online interface) following player request.
Aim 3. To integrate qualitative and quantitative data to explain how the experience of playing the game relates to their spokesperson's willingness to engage. We hypothesize that a positive player experience with WWYC will be associated with successful engagement with their spokesperson.
Because the number of older Americans is growing, and it is widely known that surrogate decision-makers often do not accurately represent the wishes and goals of their loved ones, effective interventions are needed to help individuals choose the right people to serve as their medical spokesperson. The R21 application, Choosing an Effective Healthcare Spokesperson: Establishing the Feasibility of a Serious Game, is intended to deepen our understanding of how people choose a spokesperson for health care decisions, and to move us closer towards a readily scalable intervention for helping people optimize that choice. This project will use qualitative and quantitative methods to 1) examine how playing the novel serious game, Who Would You Choose: Serious Fun, affects people's choice of a spokesperson, and 2) assess its feasibility as an intervention that can be compared with standard practices.
