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J Palliat Med. 2016 Jun;19(6):661-7. doi: 10.1089/jpm.2015.0390. Epub 2016 Mar 29.

Conversation Game Effectively Engages Groups of Individuals in Discussions about Death and Dying.

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1 Division of Pulmonary, Allergy, and Critical Care, Pennsylvania State University , Hershey, Pennsylvania.
2 Department of Communications, University of Kentucky , Lexington, Kentucky.
3 Department of Humanities and Medicine, Pennsylvania State University , Hershey, Pennsylvania.
4 Department of Pediatrics and Humanities, College of Medicine, Pennsylvania State University , Hershey, Pennsylvania.



Discussions about end-of-life (EOL) values, wishes, and beliefs are critical for effective advance care planning (ACP). New strategies are needed to engage individuals in EOL conversations.


The study objective was to test the feasibility of using a conversation game to engage individuals in EOL discussions.


This study used a mixed-methods approach. Participants played a conversation game that prompts players to answer and discuss 20 questions about death, dying, and EOL care. Participants completed pre- and postgame questionnaires and participated in postgame focus groups. Subjects were 70 healthy volunteers (18 groups of families, friends, or strangers). Demographics, emotional state, and perceived relational closeness were measured using preintervention questionnaires. Postintervention questionnaires measured conversation satisfaction, realism, self-rated quality, and emotional state. Postgame focus groups evaluated players' experiences playing the game.


Using a seven-point Likert scale (1 = low score, 7 = high score), players rated game conversations as satisfying (mean [M] = 6.1, SD = 0.9), realistic (M = 5.6, SD = 0.8), and of high quality (M = 5.7, SD = 0.9). There were no negative effects on emotional state immediately postgame (M = 1.3, SD = 0.5). A thematic analysis of participants' experiences (n = 55) revealed that (1) playing the game was an enjoyable, positive experience; (2) a game is a good framing for EOL discussions; and (3) there were mixed opinions about ideal game group composition.


This study established that healthy volunteers enjoyed engaging in a two-hour discussion about EOL issues when framed as a game. The game experience was a positive, satisfying, and enjoyable activity for participants. Further studies are needed to determine if health games can promote effective ACP.

[Indexed for MEDLINE]

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