The Impact of an Advance Care Planning Game on Life-Sustaining Treatment Preferences, Depression, and Hope in Older Adults With Stroke
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 72
- 试验地点
- 1
- 主要终点
- life support preferences questionnaire; LSPQ
研究概览
简要总结
Stroke is the world's third leading cause of death and a major source of disability, with high rates of recurrence and mortality that often limit patients' ability to express their values and treatment preferences. This highlights the importance of Advance Care Planning (ACP) after stroke. This randomized controlled trial examined the effects of an ACP block-based game on life-sustaining treatment preferences, depression, and hope among adults aged 65-100 with subacute stroke in a regional teaching hospital. The Life Support Preferences Questionnaire (LSPQ) served as the primary outcome to assess preference changes immediately after the intervention and at four weeks, while the Hospital Anxiety and Depression Scale (HADS) and the Herth Hope Index (HHI) were secondary measures. The intervention used the "LOHAS Journey" ACP game, which applies travel-themed scenarios, blocks to express medical choices, hope-enhancing elements, and companion cards emphasizing personal resources and potential surrogate decision-makers, while also encouraging warm emotional expression. Generalized Estimating Equations (GEE) were used to analyze repeated measures and time-by-group effects. If effective, this ACP game may support broader clinical adoption of structured discussions on life-sustaining treatment preferences for older stroke patients.
详细描述
Background:
Stroke is the third leading cause of death worldwide and one of the most common causes of disability, accounting for approximately 10% of all deaths. One in four people experiences a stroke in their lifetime, and about 10% of stroke survivors face the risk of recurrent stroke within five years, often with more severe symptoms than the first episode. The one-year and five-year mortality rates after stroke are as high as 41% and 60%, respectively. Due to its high incidence, high recurrence rate, and high mortality, many stroke patients are unable to express their values and treatment preferences during the course of illness. This underscores the necessity of engaging in Advance Care Planning (ACP) discussions after stroke.
Purpose:
This study aims to explore the effects of an ACP game intervention on life-sustaining treatment preferences, depression, and hope among older adults with stroke.
Design:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 100 Years（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Older adults aged 65-100 years.
- •Diagnosed with ischemic or hemorrhagic stroke confirmed by computer tomography (CT) or magnetic resonance imaging (MRI), and in the subacute stage 1-6 months after stroke onset.
- •A National Institute of Health Stroke Scale (NIHSS) score ≤ 15, indicating mild to moderate stroke severity.
- •Clear consciousness and able to communicate in Mandarin or Taiwanese.
排除标准
- •Individuals diagnosed with chronic psychiatric disorders such as major depression, mania, or bipolar disorder.
- •Older adults diagnosed with moderate to severe dementia.
研究组 & 干预措施
ACP Block Game Intervention
干预措施: ACP Block Game Intervention (Other)
Usual Care
Routine stroke care
结局指标
主要结局
life support preferences questionnaire; LSPQ
时间窗: From enrollment to the end of treatment at 5 weeks
The questionnaire is designed to assess participants' preferences for various life-sustaining treatments across six medical scenarios and five treatment options. The maximum possible score is 150 and the minimum is 25. Higher scores indicate a greater willingness to receive life-sustaining medical treatments.
次要结局
- hospital anxiety and depression scale; HADS(From enrollment to the end of treatment at 5 weeks)
- herth hope index; HHI(From enrollment to the end of treatment at 5 weeks)
研究者
Yu-Chun Chien
Principal Investigator
Lotung Poh-Ai Hospital