Serious Games in Cancer Care
Serious games are an effective approach to improve illness self-management and are increasingly being recognized for their use and benefits for patients’ health and wellness (Krebs et al., 2019). Compared to conventional interventions, serious games provide interactive and enjoyable experiences for patients to learn more effectively (Wouters et al., 2013) and achieve favorable health outcomes (Sardi et al., 2017), including improved emotional health, better self-management skills, and positive behavioral changes (Charlier et al., 2016; Kim et al., 2018a). Among cancer patients, serious games are also proven to improve their symptoms, adherence, self-management, and mood (Hodgkinson et al., 2007; Kato et al., 2008; Kim et al., 2018b; Loerzel et al., 2020; Wang et al., 2019). Although startup costs for serious games can be substantial, once developed and distributed, they are less costly than interventions requiring trained staff and clinicians (Baranowski et al., 2017).
One aspect of self-management, self-advocacy, helps patients address challenges related to their health and ensure their care reflects their values and priorities (Thomas et al., 2020a). Self-advocacy skills include being able to (1) make personally meaningful decisions about their cancer care, (2) communicate effectively with healthcare providers, and (3) build strength through connection to others (Hagan et al., 2018). Among women with advanced cancer, self-advocacy is of critical importance for them to cope with the physical, emotional, and decisional challenges of having a serious illness (Keogh, 2014; Wessels et al., 2010). To address a dearth of self-advocacy interventions in cancer, our research team partnered with Simcoach Games in Pittsburgh, PA to develop a serious game intervention, Strong Together, to help women with advanced cancer learn about self-advocacy skills. In the game, the characters - who are women with advanced cancer - must respond to challenges in their care, and their decisions will decide whether their quality of life improves. The scenarios take place in patients' familiar places, homes, cancer clinics, or coffee shops, with their significant others, friends, doctors, nurses, or families (Thomas et al., 2019). Figure 1 provides a screenshot of the Strong Together intervention.
Figure 1. A screenshot of Strong Together. The character was meeting with her treating oncologist to discuss her anti-cancer treatment in the clinic. The user is presented with three options on how to respond to the oncologist’s treatment recommendation. Based on this decision, the story progresses with changes based on whether the user’s selection option demonstrates self-advocacy of wanting to know more about the recommended treatment.