Facilitating Advance Care Planning Conversations Among Patients With Cancer and Their Care Partners Utilizing a Conversation Game: A Pilot Study

Sep 23, 2026

Facilitating advance care planning (ACP) conversations among patients with cancer and their care partners using the Hello conversation game was evaluated through a convergent mixed-methods pilot study. Seven dyads (n=14) played Hello in small groups, then completed satisfaction and acceptability questionnaires and participated in focus groups. Thematic analysis identified group dynamics and peer connection, Hello as a helpful conversation starter, and needed cancer-context modifications, especially adding questions on quality of life and mental health, with differences noted for localized versus advanced cancer.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

ABSTRACT

Background

Aims

Methods and Results

Conclusion

Introduction

Decision-making challenges in cancer care

Rationale for ACP and barriers

The Hello conversation game as an intervention

Cancer Reports ORIGINAL ARTICLE OPEN ACCESS Facilitating Advance Care Planning Conversations Among Patients With Cancer and Their Care Partners Utilizing a Conversation Game: A Pilot Study Kylee Kimbel1 | Michael Hayes1,2 | Morgan Bucher1 | William A. Calo1,2 | Tullika Garg3 | Monika Joshi1,2 | Hannah Kuntz1 | Terrence E. Murphy1 | Erika VanDyke1 | Emily Wasserman1 | Lauren J. Van Scoy1,2 1Penn State College of Medicine, Hershey, Pennsylvania, USA | 2Penn State Cancer Institute, Hershey, Pennsylvania, USA | 3Geisinger Medical Center, Danville, Pennsylvania, USA Correspondence: Lauren J. Van Scoy ([lvanscoy@pennstatehealth.psu.edu](lvanscoy@pennstatehealth.psu.edu)) Received: 20 December 2024 | Revised: 13 May 2025 | Accepted: 2 June 2025 Funding: This work was supported by Kristen Olewine Milke CARE at Center Penn State Hershey Cancer Institute. and this study was reviewed and approved by the Penn State University Institutional Review Board (STUDY00023029) . Keywords: advance care planning | advance directives | cancer | health games | medical decision-making | qualitative research ABSTRACT Background: Patients with cancer should engage in decision-making throughout the course of their illness and treatment. Current guidelines recommend early, frequent advance care planning (ACP) conversations among clinicians, patients, and care partners (CPs) and advance directive (AD) completion. However, only 55% of patients with cancer have completed such directives, suggesting the need for interventions to increase rates ofACP. The Hello game has been shown to be effective in promoting ACP in several populations but has not been tested in patients with cancer or their CP. Aims: To assess the acceptability of Hello and determine the modifications necessary for use in cancer populations. Methods and Results: This convergent mixed methods study involved seven dyads (7 patients with cancer and their 7 CPs to total n = 14); dyads played Hello in groups of 2–4. Post-game, dyads completed satisfaction and acceptability questionnaires and focus groups. Qualitative thematic analysis was performed; quantitative data was summarized. Patients' mean age was 56.4 years—43% were female, 57% had genitourinary cancer, and 43% had breast cancer. Three themes emerged from both patient and CP focus groups (n = 14 individuals): (1) Participants enjoyed the group dynamics and relating to peers when playing Hello; (2) Hello serves as a helpful conversation starter; (3) modifications could help tailor Hello for use in cancer context—particularly adding more questions about quality of life and mental health. The patient focus groups had an additional theme: (4) Patients with localized cancer may have a different experience with Hello when compared to those with advanced cancer. Conclusion: Hello was well-received by dyads, and their feedback was used to tailor Hello for patients with cancer and their CPs. Next steps for this project include assessing the acceptability of the modified game. Trial Registration: [clinicaltrials.gov](clinicaltrials.gov: NCT06028152)[: NCT06028152](clinicaltrials.gov: NCT06028152) 1 | Introduction Patients with cancer often face difficult medical decisions over the course of treatment. These decisions include whether to pursue aggressive treatments that may involve side effects that could affect quality of life or whether a comfortfocused, palliative approach is preferred [1] . It is critical that patients with cancer and their care partners consider and This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC. Cancer Reports, 2025; 8:e70250 1 of 12 [https://doi.org/10.1002/cnr2.70250](https://doi.org/10.1002/cnr2.70250) address preferences for cancer-focused treatment alo

FAQs

What problem does the study address regarding cancer care planning?

Patients with cancer often need ongoing decisions about treatment goals and preferences, but many have not completed advance directives or participated in ACP conversations. The study targets this gap by testing an intervention to increase engagement.

How was the Hello conversation game evaluated in the pilot study?

Seven dyads of patients with cancer and their care partners played Hello in groups of 2–4. After the game, dyads completed satisfaction and acceptability questionnaires and took part in focus groups.

What modifications did participants suggest for using Hello in cancer populations?

Feedback indicated that Hello works as a conversation starter and supports group dynamics, but tailoring is needed. In particular, adding more questions about quality of life and mental health was highlighted.

Sep 23, 2026

Uploaded by Taylor Morgan