a School of Nursing , University of Texas - Austin , Austin , TX , USA.
b Medicine and Humanities , The Pennsylvania State University College of Medicine , Hershey , PA , USA.
Ethn Health. 2019 Aug;24(6):705-723. doi: 10.1080/13557858.2017.1357068. Epub 2017 Jul 27.
Advance care planning (ACP) allows individuals to express their preferences for medical treatment in the event that they become incapable of making their own decisions. This study assessed the efficacy of a conversation game intervention for increasing South Asian Indian Americans' (SAIAs') engagement in ACP behaviors as well as the game's acceptability and cultural appropriateness among SAIAs. Eligible community-dwelling SAIAs were recruited at SAIA cultural events held in central Texas during the summer of 2016. Pregame questionnaires included demographics and the 55-item ACP Engagement Survey. Played in groups of 3-5, the game consists of 17 open-ended questions that prompt discussions of end-of-life issues. After each game session, focus groups and questionnaires were used to examine the game's cultural appropriateness and self-rated conversation quality. Postintervention responses on the ACP Engagement Survey and rates of participation in ACP behaviors were collected after 3 months through phone interviews or online surveys. Data were analyzed using descriptive statistics, frequencies, and paired -tests comparing pre/post averages at a .05 significance level. Of the 47 participants, 64% were female, 62% had graduate degrees, 92% had lived in the U.S. for >10 years, 87% were first-generation immigrants, and 74% had no advance directive prior to the game. At the 3-month follow-up, 58% of participants had completed at least one ACP behavior, 42% had discussed end-of-life issues with loved ones, 15% did so with their healthcare providers, and 18% had created an advanced directive. ACP Engagement Survey scores increased significantly on all four of the process subscales by 3 months postgame. SAIA individuals who played a conversation game had a relatively high rate of performing ACP behaviors 3 months after the intervention. These findings suggest that conversation games may be useful tools for motivating people from minority communities to engage in ACP behaviors.
预先医疗指示计划（ACP）使个人能够在丧失决策能力的情况下表达对医疗的偏好。本研究评估了对话游戏干预对提高南亚裔美国人（SAIA）参与 ACP 行为的效果，以及该游戏在 SAIA 中的可接受性和文化适宜性。符合条件的社区居住的 SAIA 是在 2016 年夏天在德克萨斯州中部的 SAIA 文化活动中招募的。预游戏问卷包括人口统计学和 55 项 ACP 参与调查。游戏以 3-5 人为一组进行，共包含 17 个开放式问题，旨在引发对临终问题的讨论。每场游戏结束后，使用焦点小组和问卷来检查游戏的文化适宜性和自我评估的对话质量。干预后 3 个月，通过电话访谈或在线调查收集 ACP 参与调查的反应和参与 ACP 行为的比率。使用描述性统计、频率和配对 t 检验分析数据，在.05 显著性水平上比较预/后平均值。在 47 名参与者中，64%是女性，62%拥有研究生学位，92%在美国生活了>10 年，87%是第一代移民，74%在游戏前没有预先医疗指示。在 3 个月的随访中，58%的参与者完成了至少一项 ACP 行为，42%与亲人讨论了临终问题，15%与医疗保健提供者讨论了这个问题，18%制定了预先医疗指示。ACP 参与调查的得分在游戏后 3 个月的所有四个过程子量表上都显著增加。玩对话游戏的 SAIA 个体在干预后 3 个月内进行 ACP 行为的比率相对较高。这些发现表明，对话游戏可能是激励少数族裔社区的人们参与 ACP 行为的有用工具。
