Effect of a gamified simulation on nursing students' communication skills in end-of-life care: A randomized controlled trial

<h2>Abstract</h2><h3>Background</h3> Communication is essential in palliative care, yet nursing students often struggle in end-of-life (EoL) settings. We evaluated SG-EoL, a gamified simulation to enhance verbal and non-verbal communication. <h3>Methods</h3> In a randomized controlled trial (<i>N</i> = 41), SG-EoL was compared with a quiz. Students completed pre/post simulations with a standardized patient; empathetic verbal responses and non-verbal behaviors (nodding, eye gaze, forward leaning) were timed. <h3>Results</h3> Forward leaning increased in the intervention group (<i>p</i> =. 02); no significant changes were found for verbal communication, nodding, or eye gaze. <h3>Conclusions</h3> SG-EoL improved one non-verbal behavior but not overall communication. Adding feedback, visual cues, and debriefing could enhance learning.