Engagement in advance care planning: effect of playing the card game Anticip’action in a community setting

The card game Anticip’action was developed to foster Advance Care Planning (ACP) culture in medical and community settings. Available in a mobile (smartphone app) and paper formats, this conversation tool helps users to clarify and express their fears, hopes and life priorities, and to carry out actions in line with them. The goals of this study were to evaluate in a community setting, the effect of presenting Anticip’action on attitude towards ACP, self-perceived preparedness in case of a health crisis, and action readiness, as well as to collect users’ evaluation of the game, and their preference to use the game in mobile or paper formats. Participants attended a 90-minute public event on the topic of advance directives, received information about ACP, filled questionnaire 1 (Q1), were introduced to the game, filled Q2, took the game home, and returned Q3 6–8 weeks later. Data collection included retention rates; pre-post responses on self-perceived preparedness in case of a health crisis, attitude towards ACP, and readiness to take related actions (analyzed using paired t-test on mean 1–5 Likert scores); proportions of anticipatory actions (planned or done) reported in Q3; average endorsement and perceived impact of the game (uMars, 1–5 Likert scores); proportions of reported intention and actual use of the game. Of the 124 attendees, 118 (mean age 75) completed Q1 & Q2, and 32 returned Q3. Mean baseline levels of attitude, self-perceived preparedness and readiness were uncommonly high (from 2.87 to 4.56). Discovering the game did not significantly impact these values. However, in Q3 (N = 32), 72% of respondents reported intending to take one or several specific anticipatory actions, and 22% had accomplished at least one since discovering the game. Anticip’action obtained high mean endorsement scores (Q2 = 3.67, Q3 = 3.9) and was evaluated as highly impactful for fostering anticipation (Q2 = 4.19, Q3 = 4.17). At home, participants generally preferred using the paper version. Anticip’action, especially in its paper format, is highly endorsed by a senior population with an existing interest in ACP and appears to effectively support the implementation of anticipatory actions. These findings need to be confirmed in larger and more diverse populations. The study was preregistered on the OSF platform (https://doi.org/10.17605/OSF.IO/PN8HS) on 01.12.2023.