---
title: Using an End-of-life Conversation Game to Engage Underserved Communities in Advance Care Planning
nct_id: NCT03456921
overall_status: COMPLETED
phase: NA
sponsor: Milton S. Hershey Medical Center
study_type: INTERVENTIONAL
primary_condition: Advance Care Planning
countries: United States
canonical_url: "https://parkinsonspathways.com/agent/trials/NCT03456921.md"
clinicaltrials_gov: "https://clinicaltrials.gov/study/NCT03456921"
ct_last_update_post_date: 2019-11-04
last_seen_at: "2026-05-12T06:39:45.585Z"
source: ClinicalTrials.gov (mirrored, no enrichment)
---
# Using an End-of-life Conversation Game to Engage Underserved Communities in Advance Care Planning

**NCT ID:** [NCT03456921](https://clinicaltrials.gov/study/NCT03456921)

## Key Facts

- **Status:** COMPLETED
- **Phase:** NA
- **Study Type:** INTERVENTIONAL
- **Target Enrollment:** 1122
- **Lead Sponsor:** Milton S. Hershey Medical Center
- **Collaborators:** John and Wauna Harman Foundation, Hospice Foundation of America
- **Conditions:** Advance Care Planning, Vulnerable Populations, Advance Directives, Terminal Illness
- **Start Date:** 2018-02-28
- **Completion Date:** 2019-09-15
- **CT.gov Last Update:** 2019-11-04

## Brief Summary

This national project will provide an effective, evidence-based intervention for advance care planning (ACP) to 50 underserved US communities, those with poor access to healthcare systems due to economic, cultural or other barriers. The project will also examine 15 of the 50 communities to learn about the unique needs of African American communities in regards to ACP and to assess the intervention with this population. The team includes the Hospice Foundation of America and a university-based research team from Penn State Milton S. Hershey Medical Center.

## Detailed Description

The project goal explores how best to meet the needs of underserved communities to improve engagement in the advance care planning (ACP) process, which is defined as a complex and ongoing process that involves discussions with loved ones and/or clinicians, and/or may involve completion of an advance directive document. This national project involves two components: 1) a community outreach program, Community Game Days; and 2) a research project. The community outreach component seeks to provide an effective, evidence based ACP intervention to 50 underserved communities (defined as those with poor access to healthcare systems due to economic, cultural or linguistic barriers). Of these, 15 African American communities across the United States will be selected for participation in the research aspect of the project which seeks to assess the program's impact on and to learn about the unique needs of African American populations with regard to ACP. A highly integrated, collaborative approach will be used, bringing together a national organization concerned about end-of-life care (the Hospice Foundation of America (HFA) and a university-based academic research team (led by Dr. Lauren Van Scoy at Penn State Milton S. Hershey Medical Center through her research program, Project Talk).

The project teams will organize and support a 14-month long community outreach project that will bring an end-of-life conversation game, "Hello," to 50 communities across the United States. The game has been found to stimulate substantive, enjoyable and meaningful end-of-life discussions among participants. Further, over 70% of participants who played the game went on to perform additional ACP behaviors.2-4 That body of research is limited, however, by a primarily Caucasian or South Asian Indian demographic. It is well established that African Americans have historically low rates of ACP completion when compared to Caucasians and that they often receive overly aggressive and unwanted care at the end-of-life.5,6 Thus, learning how best to engage the African American population in ACP activities is critical. Thus, this research project aims to determine whether and to what extent this priming activity yields similar results in African American communities. The research team will conduct mixed methods research on the impact of the game on the performance of subsequent ACP behavior as well as explore the broad needs of African American communities with regards to ACP.

Fifteen of the 50 qualified locations who can demonstrate through a screening process the ability to attract a majority African American audience will be selected to participate in the research aspect of the project which will involve: 1) pre-game questionnaires to assess population characteristics and readiness to engage in ACP, 2) post- game questionnaires to assess satisfaction, realism about the conversation game and readiness to engage in ACP, 3) post-game focus groups to further explore opinions about the game, the value of priming activities, and the broad needs of the community for encouraging ACP, and 4) 3 month follow-up phone interviews to assess ACP behaviors that have been performed and perceived impact of the priming activity. Participants from the additional 35 sites can opt-in to participate in a 3 months follow-up phone call. As the trial progressed, the time-frame for follow-up phone interviews was extended to 3 - 9 months.

Upon completion of this project, this collaboration is expected to have reached up to 1000 African American individuals and 1,500 other underserved individuals and provided them with an enjoyable and rich experience that facilitates communication about end-of-life issues. The research data is expected to provide a significant contribution to the field by yielding information about the needs of 15 African American communities as well as to yield data related to the impact of the priming activity (the game) on ACP behaviors in this traditionally underserved group.

## Eligibility

- **Minimum age:** 18 Years
- **Sex:** ALL
- **Healthy Volunteers:** Yes

```
Inclusion Criteria:

1. Are over the age of 18
2. Attend a community Game Day event hosted as part of the Hospice Foundation of America community outreach "Hello Project"

Exclusion Criteria:

1. Do not speak English
2. Have significant difficulties with hearing or speaking difficulties by self-report
3. Do not provide informed consent
```

## Arms

- **Game participants** (EXPERIMENTAL) — All participants will engage in playing the end-of-life conversation game called "Hello", which involves answering open-ended questions about medical decision making and end-of-life issues.

## Interventions

- **End-of-life conversation game called "Hello"** (OTHER) — To play 'Hello', players are provided 32 open-ended questions in a prearranged order and an equal number of game chips. A player reads aloud the first question. Players then individually write down their answers, and take turns sharing answers with the group (players can opt to pass). Players control how long they share, what they share, and when they are ready to proceed to the next question. During the conversation, players may choose to acknowledge others for a particularly thoughtful, poignant, or even funny comment by giving them a chip. A simple pre-game coin flip determines whether the player with the most chips 'wins' the game ('heads'), or the player with the least amount of chips wins the game ('tails').

## Primary Outcomes

- **Rate of ACP Behaviors** _(time frame: 9 months post intervention)_ — This phone questionnaire assesses whether participants went on to perform various behaviors related to advance care planning.

## Secondary Outcomes

- **Change in ACP Engagement Survey scores** _(time frame: Baseline (Day 0); immediately post-intervention (Day 0); 3-9 months post intervention)_
- **Conversation satisfaction questionnaire** _(time frame: Immediately post-intervention (Day 0))_
- **ACP Values/Beliefs Questionnaire** _(time frame: immediately post-intervention (Day 0))_
- **Conversation Realism Questionnaire** _(time frame: immediately post-intervention (Day 0))_
- **Net Promoter Score** _(time frame: immediately post-intervention (0))_
- **Hello Game Assessment - Qualitative focus group interview** _(time frame: immediately post-intervention (Day 0))_
- **ACP Needs Assessment - Qualitative focus group interview** _(time frame: immediately post-intervention (Day 0))_

## Locations (1)

- Penn State Hershey College of Medicine, Hershey, Pennsylvania, United States

## Recent Field Changes (last 30 days)

- `status.overallStatus` — added _(2026-05-12)_
- `status.primaryCompletionDate` — added _(2026-05-12)_
- `status.completionDate` — added _(2026-05-12)_
- `status.lastUpdatePostDate` — added _(2026-05-12)_
- `design.phases` — added _(2026-05-12)_
- `design.enrollmentCount` — added _(2026-05-12)_
- `eligibility.criteria` — added _(2026-05-12)_
- `eligibility.minAge` — added _(2026-05-12)_
- `eligibility.sex` — added _(2026-05-12)_
- `outcomes.primary` — added _(2026-05-12)_
- `outcomes.secondary` — added _(2026-05-12)_
- `armsInterventions.arms` — added _(2026-05-12)_
- `armsInterventions.interventions` — added _(2026-05-12)_
- `sponsor.lead` — added _(2026-05-12)_
- `sponsor.collaborators` — added _(2026-05-12)_
- `results.hasResults` — added _(2026-05-12)_
- `locations.penn state hershey college of medicine|hershey|pennsylvania|united states` — added _(2026-05-12)_

---

*Canonical: https://parkinsonspathways.com/agent/trials/NCT03456921.md*  
*Source data (authoritative): https://clinicaltrials.gov/study/NCT03456921*  
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