The Impact of an Advance Care Planning Game on Life-Sustaining Treatment Preferences, Depression, and Hope in Older Adults With Stroke

NCT07235839 | Active Not Recruiting

• 1 other identifier: IRB114-220-B
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Stroke; Advance Care Planning

Keywords

stroke; Advance Care Planning; game; depression; hope

Outcome Measures

Primary Outcomes (1)

• life support preferences questionnaire; LSPQ

  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.

  From enrollment to the end of treatment at 5 weeks

Secondary Outcomes (2)

• 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

Study Arms (2)

ACP Block Game Intervention

EXPERIMENTAL

Other: ACP Block Game Intervention

Usual Care

NO INTERVENTION

Routine stroke care

Interventions

ACP Block Game Intervention OTHER

The "LOHAS Journey" Advance Care Planning (ACP) block game serves as an intervention. This non-invasive intervention, themed around a game-like journey, guides participants through various scenarios, allowing them to express their healthcare preferences through the blocks. The inclusion of "Hope Blocks" transforms several scenarios related to stroke and cancer, helping participants strengthen their hope for healthcare. The game also provides support tabs highlighting personal resources and potential future healthcare decision-makers. Beyond discussing life-sustaining treatment preferences, the game encourages expressing warm emotions such as gratitude and love.

ACP Block Game Intervention

Eligibility Criteria

• Age: 65 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• Individuals diagnosed with chronic psychiatric disorders such as major depression, mania, or bipolar disorder.
• Older adults diagnosed with moderate to severe dementia.

Sponsors & Collaborators

• Lotung Poh-Ai Hospital: lead

Study Sites (1)

Lotong PohAi Hospital

Yilan, Taiwan

Location

MeSH Terms

Conditions

Stroke; Depression

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Behavioral Symptoms; Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: November 14, 2025
• First Posted: November 19, 2025
• Study Start: January 29, 2026
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): July 31, 2026
• Last Updated: February 4, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)