Efficacy of a self-advocacy serious game intervention for women with advanced cancer

项目摘要 癌症患者必须克服与其癌症相关的多重持续挑战(“自我倡导”)。 接受以病人为中心的护理的经验。患有转移性乳腺癌或晚期妇科癌症的女性 经常面临巨大的挑战，管理他们的生活质量担忧以及与癌症和治疗相关的问题 症状。如果他们不自我倡导管理这些问题，他们就有可能生活质量差、高 症状负担，以及不以患者为中心的护理。严肃的游戏(有教育意义的电子游戏)是有效的 允许用户替代地参与反映其个人经历的情况的健康干预， 接收有意义的信息，并学习与个人相关的技能，这些技能可以在现实生活中应用。长的- 这项工作的学期目标是通过教学使癌症患者做好以患者为中心的护理准备 他们使用身临其境的、可访问的技术进行自我宣传。目前这项研究的目标是测试 一种使用严肃的游戏平台向患有癌症的妇女传授自我辩护技能的新干预措施的有效性 转移性乳腺癌或晚期妇科癌症。强大的共同干预由多个 会议，互动严肃的游戏应用程序与量身定做的自我倡导目标设定和培训。严肃的 游戏基于自我倡导的概念框架，并应用行为改变理论和严肃 促进技能发展和实施的游戏机制。这款游戏的工作原理是让用户沉浸在 患有晚期癌症的女性角色的经历；要求用户做出关于 人物如何自我主张；展示自我主张或自我主张的积极和消极后果 以及提供多种个性化的反馈机制和游戏功能以强制执行 自我倡导技能的获得和转移到现实生活中。这项研究评估了强者的疗效 在336名成年(18岁)女性中进行随机临床试验的联合干预 三个月的转移性乳癌或三期或四期妇科癌症诊断。参与者将是 随机分配接受为期3个月的强联合干预或纸质自我倡导指南。这个 主要结果是患者的自我主张。次要结果包括生活质量、症状负担和 以病人为中心的关怀。中心假设是，试验组会有更高的自我主张， 生活质量，以及以患者为中心的护理和较低的症状负担相比，论文自我倡导 导游小组。作为一种探索性结果，我们将确定干预是否会减少次优医疗保健 利用率。这项研究还将评估影响药物疗效的行为和博弈机制 强有力的共同干预。这项研究提供了第一个基于理论的自我倡导干预 并阐明了严肃的游戏传授技能和帮助 将这些技能转移到现实生活中。自我倡导干预有可能推动以患者为中心 通过向患者提供切实的技能，使他们做好准备，有意义地参与癌症护理。

Project Summary Individuals with cancer must overcome multiple, ongoing challenges (“self-advocate”) related to their cancer experience to receive patient-centered care. Women with metastatic breast or advanced gynecologic cancer often face significant challenges managing their quality of life concerns and cancer- and treatment-related symptoms. If they do not self-advocate to manage these concerns, they risk having poor quality of life, high symptom burden, and care that is not patient-centered. Serious games (video games that teach) are effective health interventions that allow users to vicariously engage in situations reflecting their personal experiences, receive meaningful information, and learn personally relevant skills that they can apply in real life. The long- term objective of this work is to prepare patients with cancer to engage in patient-centered care by teaching them self-advocacy skills using immersive, accessible technologies. The goal of the current study is to test the efficacy of a novel intervention using a serious game platform to teach self-advocacy skills to women with metastatic breast or advanced gynecologic cancer. The Strong Together intervention consists of a multi- session, interactive serious game application with tailored self-advocacy goal-setting and training. The serious game is based on a self-advocacy conceptual framework and applies behavior change theories and serious game mechanisms to promote skill development and implementation. The game works by immersing users in the experiences of characters who are women with advanced cancer; requiring users to make decisions about how the characters self-advocate; demonstrating the positive and negative consequences of self-advocating or not, respectively; and providing multiple, individualized feedback mechanisms and game features to enforce self-advocacy skill acquisition and transference to real life. This study evaluates the efficacy of the Strong Together intervention by conducting a randomized clinical trial in 336 adult (ages >18 years) women within three months of a metastatic breast or Stage III or IV gynecologic cancer diagnosis. Participants will be randomly assigned to receive the 3-month Strong Together intervention or a paper self-advocacy guide. The primary outcome is patient self-advocacy. Secondary outcomes include quality of life, symptom burden, and patient-centered care. The central hypothesis is that the experimental group will have higher self-advocacy, quality of life, and patient-centered care and lower symptom burden compared to the paper self-advocacy guide group. As an exploratory outcome, we will determine if the intervention reduces suboptimal healthcare utilization. The study will also evaluate the behavioral and game mechanisms that influence the efficacy of the Strong Together intervention. This study provides the first theoretically based self-advocacy intervention for adult women with cancer and clarifies the mechanisms by which serious games teach skills and assist in transferring those skills to real life. Self-advocacy interventions have the potential to advance patient-centered care by providing patients with tangible skills that prepare them to meaningful engage in their cancer care.