Factors Affecting Acceptability to Young Cancer Patients of a Psychoeducational Video Game About Cancer

An analysis of clinical outcomes and essential parameters for designing effective games for upper limb rehabilitation: A scoping review

Background and Aims

Upper limb disabilities are one of the most common disabilities among different groups of people who always need rehabilitation. One of the important methods in helping to carry out efficient rehabilitation processes and exercises is the use of games. The aim of this study is to identify the parameters necessary to design a successful rehabilitation game and the outcomes of using these games in upper limb disabilities rehabilitation.

Methods

This scoping review was conducted by searching the Web of Science, PubMed, and Scopus. The eligibility criteria were: any form of game-based upper limb rehabilitation, published in a peer-reviewed journal, published in English, and not include articles that did not focus upper limb disabilities rehabilitation games, review, meta-analysis, or conference papers. Analysis of collected data was done using descriptive statistics (frequency and percentage).

Results

The search strategy retrieved 537 relevant articles. Finally, after removing irrelevant and repetitive articles, 21 articles were included in this study. Among the six categories of diseases or complications of upper limb disabilities, games were mostly designed for stroke patients. Smart wearables, robots and telerehabilitation were three technologies that were used for rehabilitation along with games. Sports and shooters were the most used games for upper limb disability rehabilitation. Among 99 necessary parameters for designing and implementing a successful rehabilitation game in ten categories. "Increasing the patient's motivation to perform rehabilitation exercises", "Game difficulty levels", "Enjoying and the attractiveness of the game for patients", and "Providing positive or negative audiovisual feedback" were the most important parameters. "Improvement in musculoskeletal performance" and "Increasing users' enjoyment/joy of therapeutic exercises and their motivation to perform these exercises" were the most important positive outcomes, and "Mild discomfort such as nausea and dizziness when using games" was the only negative outcome.

Conclusions

The successful design of a game according to the parameters identified in the present study can lead to an increase in the positive outcomes of using games in the rehabilitation of disabilities. The study results indicate that upper limb therapeutic exercise augmented with virtual reality games may be highly effective in enhancing motor rehabilitation outcomes.

Communication Tools Used in Cancer Communication with Children: A Scoping Review

Simple Summary

Despite the potential benefits of effective communication, telling children about unpredictable and life-threatening conditions such as cancer is challenging. This scoping review aimed to map the potential communication tools for children with cancer, their families, and healthcare professionals. We found 25 studies and 21 communication tools. Communication tools might support children to improve their knowledge and psychological outcomes. However, we found a lack of communication tools that were (1) accessible and validated, (2) designed for healthcare professionals, (3) targeted children, families, and healthcare professionals, and (4) were designed to meet the needs of children and families. This review identified areas for further research.

Abstract

Background: Although communication tools might guide healthcare professionals in communicating with children about cancer, it is unclear what kind of tools are used. This scoping review aimed to map the communication tools used in cancer communication among children with cancer, families, and healthcare professionals. Methods: A comprehensive search using PubMed (including MEDLINE), Embase, CENTRAL, PsycINFO, and CINAHL was conducted on 1 August 2021. We mapped communication tools and their impacts. Results: We included 25 studies (9 experimental studies and 16 feasibility studies) of 29 reports and found 21 communication tools. There was a lack of communication tools that were (1) accessible and validated, (2) designed for healthcare professionals, (3) targeted children, families, and healthcare professionals, and (4) were designed to meet the needs of children and families. Experimental studies showed that the communication tools improved children’s knowledge and psychological outcomes (e.g., health locus of control, quality of life, self-efficacy). Conclusion: We mapped communication tools and identified areas that needed further research, including a lack of tools to guide healthcare professionals and share information with children and families. Further research is needed to develop and evaluate these communication tools. Moreover, it is necessary to investigate how communication tools support children, families, and healthcare professionals.

A pilot study of game-based learning programs for childhood cancer survivors

Background

Childhood cancer survivors lacking awareness on their potential risks of late effects often fail to seek adequate follow-up care. Patient education matching their preference is of great importance to improve their adherence to survivorship care. In this study, we developed two age-dependent game-based learning programs, which enable continuous approaches for childhood cancer survivors along their intellectual maturation. Then, we assessed the effectiveness of the programs.

Methods

Childhood cancer survivors over 10 years of age who regularly visited a long-term follow-up clinic were enrolled in this study. They were requested to play either of two different types of game tools, one for school children and another for adolescents and young adults, for one month at home. To evaluate the educational effects of the programs, they were examined for health management awareness, self-esteem, and knowledge on cancer-related late effects before and after the intervention with age-based questionnaires and knowledge tests.

Results

Among 83 participants, 49 (59.0%) completed the assessments over the period of 12 months. The health management awareness and knowledge levels increased significantly at 1-month after the intervention as compared to the baseline in both school children and adolescents/young adults (for health management awareness, p = 0.011 in elementary school children; p = 0.007 in junior high school children; p < 0.001 in adolescents/young adults; for knowledge levels, p < 0.001 in school children; p < 0.001 in adolescents/young adults). The effect was maintained for 12 months in school children while it decreased in adolescents and young adults with time. Self-esteem significantly increased at 1-month (p = 0.002 in school children; p = 0.020 in adolescents/young adults) and was maintained for 12 months in both age groups.

Conclusion

The game-based learning programs enhanced health locus of control and self-esteem in childhood cancer survivors. The game-based learning programs could be applied effectively to survivorship care as a new modality of patient education.

Trial registration

This study was retrospectively registered in UMIN-CTR (UMIN000043603) on March 12, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09359-w.

Playful interventions to promote the subjective wellbeing of pediatric cancer inpatients during laboratory and imaging exams: A qualitative study

PURPOSE

We investigate the experience of pediatric oncology patients with objects and equipment involved in laboratory and image examinations during hospitalization for cancer treatment while generating guidelines for playful interventions to improve their subjective wellbeing.

METHOD

The study was carried out at a public tertiary referral teaching hospital in Southern Brazil. Data collection was based on participatory observations with six children aged 4-8 years. Their experiences with exams were observed through pretend play and recorded in field diaries, audio, and video. Data were analyzed using Thematic Analysis and discussed according to the PERMA-V model, a theoretical framework from positive psychology.

RESULTS

Several objects and equipment that seem to affect the wellbeing of children during exams were identified. Four playful interventions were proposed as supportive care initiatives: use of technology to allow immersive experiences in learning about treatment and medical condition; design for personalization; gamifying experiences to allow positive reinforcement; and design for focus redirection.

CONCLUSIONS

Guidelines for playful interventions to foster the subjective wellbeing of hospitalized children during image and laboratory exams were proposed. The PERMA-V model provided a solid base for the analysis of the interventions, which will be implemented and tested in future studies in clinical settings.

Playful strategies to foster the well-being of pediatric cancer patients in the Brazilian Unified Health System: a design thinking approach

Background

Cancer care can negatively impact children’s subjective well-being. In this research, well-being refers to patients’ self-perception and encompasses their hospital and care delivery assessment. Playful strategies can stimulate treatment compliance and have been used to provide psychosocial support and health education; they can involve gamification, virtual reality, robotics, and healthcare environments. This study aims to identify how playfulness, whenever applicable, can be used as a strategy to improve the subjective well-being of pediatric cancer patients in the Brazilian Unified Health System.

Methods

Sixteen volunteers with experience in pediatric oncology participated in the study. They were physicians, psychologists, child life specialists, and design thinking professionals. They engaged in design thinking workshops to propose playful strategies to improve the well-being of pediatric cancer patients in the Brazilian Unified Health System. Data collection consisted of participatory observations. All activities were video recorded and analyzed through Thematic Analysis. The content generated by the volunteers was classified into two categories: impact of cancer care on children’s self-perception and children’s perceptions of the hospital and the care delivery.

Results

Volunteers developed strategies to help children deal with time at the hospital, hospital structure, and care delivery. Such strategies are not limited to using playfulness as a way of “having fun”; they privilege ludic interfaces, such as toys, to support psychosocial care and health education. They aim to address cancer and develop communication across families and staff in a humanized manner, educate families about the disease, and design children-friendly environments. Volunteers also generated strategies to help children cope with perceptions of death, pain, and their bodies. Such strategies aim to support understanding the meaning of life and death, comprehend pain beyond physicality, help re-signify cancer and children’s changing bodies, and give patients active voices during the treatment.

Conclusions

The paper proposes strategies that can improve the well-being of pediatric cancer patients in the Brazilian Unified Health System. Such strategies connect children’s experiences as inpatients and outpatients and may inform the implementation of similar projects in other developing countries.

An educational video game for nutrition of young people: Theory and design

BACKGROUND

Playing Escape from DIAB (DIAB) and Nanoswarm (NANO), epic video game adventures, increased fruit and vegetable consumption among a multi-ethnic sample of 10-12 year old children during pilot testing. Key elements of both games were educational mini-games embedded in the overall game that promoted knowledge acquisition regarding diet, physical activity and energy balance. 95-100% of participants demonstrated mastery of these mini-games suggesting knowledge acquisition.

AIM

This article describes the process of designing and developing the educational mini-games. A secondary purpose was to explore the experience of children while playing the games.

METHOD

The educational games were based on Social Cognitive and Mastery Learning Theories. A multidisciplinary team of behavioral nutrition, PA, and video game experts designed, developed, and tested the mini-games.

RESULTS

Alpha testing revealed children generally liked the mini-games and found them to be reasonably challenging. Process evaluation data from pilot testing revealed almost all participants completed nearly all educational mini-games in a reasonable amount of time suggesting feasibility of this approach.

CONCLUSIONS

Future research should continue to explore the use of video games in educating children to achieve healthy behavior changes.

Usability testing of an online self-management program for adolescents with cancer

The objective of this study was to explore the usability of a bilingual (English and French) Internet-based self-management program for adolescents with cancer and their parents and refine the Internet program. A qualitative study design with semistructured, audio-taped interviews and observation was undertaken with 4 iterative cycles. A purposive sample of English-speaking and French-speaking adolescents with cancer and one of their parents/caregivers was recruited. Adolescents and parents provided similar feedback on how to improve the usability of the Internet program. Most changes to the website were completed after the initial cycles of English and French testing. Both groups also found information presented on the website to be appropriate, credible, and relevant to their experiences of going through cancer. Participants reported the program would have been extremely helpful when they were first diagnosed with cancer. Usability testing uncovered some issues that affected the usability of the website that led to refinements in the online program.

Promoting dental hygiene to children: comparing traditional and interactive media following threat appeals

Until now, social marketing campaigns mainly targeted children using traditional media. However, little is known about the effectiveness of computer games to communicate health-related information to children. This study compares the impact of an interactive game as a medium to provide health information and improve children's dietary habits to the impact of more traditional media. Using a 2 × 3 between-subject factorial design with 190 children (7-9 years old), this study investigates the effect of threat messages (weak vs. strong) concerning dental hygiene on behavioral outcome (snack choice), and how this effect is moderated by the type of medium used to communicate subsequent health information after the threat appeal (computer game, information brochure, narrative story). Results show a positive significant effect of perceived threat on children's adaptive behavior. However, this effect only remains significant when afterwards children are exposed to a narrative health-related story. When children play a game or read a brochure, they need to devote more attention to process this content, distracting them from the original threat message. In sum, when a threat message is followed by additional health information, the medium through which this information is presented influences the effectiveness of the preceding threat message.

Jogo educativo sobre drogas para cegos: construção e avaliação

Estudo realizado com o objetivo de construir e avaliar um jogo educativo sobre drogas psicoativas acessível a pessoas cegas, desenvolvido em três etapas: construção do jogo educativo, avaliação por três especialistas em educação especial e doze cegos. Foi construído um jogo de tabuleiro denominado Drogas: jogando limpo . Na Versão Alfa os especialistas fizeram sugestões em relação às e instruções e ao tabuleiro: textura das casas, peças do jogo e escrita em Braille. Na Versão Beta, procedeu-se à avaliação pelos cegos, os quais sugeriram alterações na textura das casas e colocação de velcro para fixação do pino no tabuleiro. Passou-se, então, à Versão Gama, jogada pelas últimas três duplas de cegos e considerada adequada. Na avaliação dos juízes, o jogo revelou-se adequado, pois permite o acesso à informação sobre drogas psicoativas de maneira lúdica.

Adapting a Videogame to the Needs of Pediatric Cancer Patients and Survivors

OBJECTIVE

This study assessed whether two serious videogames, "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) (both from Archimage, Inc., Houston, TX) shown to effect change in healthy children's diet and possibly physical activity are acceptable for obesity prevention among pediatric cancer patients and survivors at high risk of obesity.

PATIENTS AND METHODS

Pediatric (9-12-year-old) cancer patients and survivors (n=28) were randomly assigned to one of three groups: Group A, watched film adaptations of both game stories and played the first two episodes of each game; Group B, played all of Diab; or Group C, played all of Nano. Qualitative interviews about what the children liked and didn't like and what should be changed were conducted midway and at the end of each group's participation. Data were analyzed using thematic analysis.

RESULTS

Pediatric cancer patients and survivors enjoyed playing both games. Two themes emerged to guide future modifications of the game: Three patients reported difficulty with the energy balance and meal selection portion of Nano, and four patients stated endings showing a character dying made them sad.

CONCLUSIONS

Two serious videogames designed to promote healthier diet and increased physical activity among healthy children were also found to be acceptable by pediatric cancer patients and survivors. Easier options needed to be programmed into energy balance games in Nano. To avoid possible emotional reactions, such as sadness, Nano's ending will be revised so that a character does not die from his affliction. Minor changes will be made in other gameplay mechanics and storylines to meet target audience needs and preferences.

The Use of Computer Games in Education

Games-based learning has captured the interest of educationalists as it is perceived as a potentially highly motivating approach for learning in a diverse number of areas. Despite this, there is a dearth of empirical evidence in the GBL literature, and confusion as to where games-based learning fits in relation to games, simulations, and serious games. This chapter will present a review of the current state of the GBL empirical literature, but will particularly focus on the fields of software engineering, Information Systems, and computer science. This chapter will also take into account the advantages and disadvantages that have to be considered when selecting a GBL approach.

Video Games in Health Care: Closing the Gap

Although a great deal of media attention has been given to the negative effects of playing video games, relatively less attention has been paid to the positive effects of engaging in this activity. Video games in health care provide ample examples of innovative ways to use existing commercial games for health improvement or surgical training. Tailor-made games help patients be more adherent to treatment regimens and train doctors how to manage patients in different clinical situations. In this review, examples in the scientific literature of commercially available and tailor-made games used for education and training with patients and medical students and doctors are summarized. There is a history of using video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus on making tailor-made games for different disease groups, which have been evaluated in scientific trials more recently. Commercial video games have been of interest regarding their impact on surgical skill. More recently, some basic computer games have been developed and evaluated that train doctors in clinical skills. The studies presented in this article represent a body of work outlining positive effects of playing video games in the area of health care.

Immersive virtual environment technology: a promising tool for future social and behavioral genomics research and practice

Social and behavioral research needs to get started now if scientists are to direct genomic discoveries to address pressing public health problems. Advancing social and behavioral science will require innovative and rigorous communication methodologies that move researchers beyond reliance on traditional tools and their inherent limitations. One such emerging research tool is immersive virtual environment technology (virtual reality), a methodology that gives researchers the ability to maintain high experimental control and mundane realism of scenarios; portray and manipulate complex, abstract objects and concepts; and implement innovative implicit behavioral measurement. This report suggests the role that immersive virtual environment technology can play in furthering future research in genomics-related education, decision making, test intentions, behavior change, and health-care provider behaviors. Practical implementation and challenges are also discussed.

Design and evaluation of a computer game to promote a healthy diet for young adults

This article reports the development and evaluation of a computer game (RightWay Café) as a special medium to promote a healthy diet for young adults. Structural features of computer games, such as interactive tailoring, role playing, the element of fun, and narrative, were operationalized in the RightWay Café game to afford behavior rehearsal in a safe and entertaining way. Theories such as the health belief model, social cognitive theory, and theory of reasoned action guided the content design of the game to influence mediators of behavior change, including self-efficacy, perceived benefits, perceived barriers, and behavior change intention. A randomized controlled evaluation study with pretest, posttest, and follow-up design demonstrated that this game was effective in teaching nutrition and weight management knowledge and increasing people's self-efficacy and perceived benefits of healthy eating, as well as their intention to be on a healthy diet. Limited long-term effects were also found: participants in the game-playing group had greater self-efficacy than participants in the control group after 1 month. This study validates the computer game-based approach to health promotion for young adults. Limitations and implications are also discussed.

A video game improves behavioral outcomes in adolescents and young adults with cancer: a randomized trial

OBJECTIVE

Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma.

METHODS

A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group. The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54).

RESULTS

Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life.

CONCLUSIONS

The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.

Playing for real: video games and stories for health-related behavior change

BACKGROUND

Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format.

METHOD

Twenty-seven articles were identified on 25 video games that promoted health-related behavior change through December 2006.

RESULTS

Most of the articles demonstrated positive health-related changes from playing the video games. Variability in what was reported about the games and measures employed precluded systematically relating characteristics of the games to outcomes. Many of these games merged the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behavior-change technology (e.g., tailored messages, goal setting). Stories in video games allow for modeling, vicarious identifying experiences, and learning a story's "moral," among other change possibilities.

CONCLUSIONS

Research is needed on the optimal use of game-based stories, fantasy, interactivity, and behavior change technology in promoting health-related behavior change.