JMIR Publications

ABSTRACT

Background:

In the context of an aging population, it is crucial to promote early discussions to help patients express their view on what is essential in their life, on their preferences over future medical treatments and on end-of-life issues. An inter-professional research team at Geneva University and HUG hospital, has developed a digital version of Anticip’action, a game designed to initiate and conduct end-of-life planning discussions, that can be used on a smartphone or tablet.

Objective:

This study aimed at assessing the ergonomic quality of the digital version of the game.

Methods:

10 representative users completed a usability test conducted online with a filmed video-conference system. The test began with a rapid desirability test to capture initial impressions on the main screen of the game without knowing what it is about. It was followed by a think-aloud procedure, including 26 tasks to perform all steps of the game. Finally, post-test questionnaires were conducted to collect participants’ feedback on the usability (SUS), attractiveness (AttrakDiff), relevance and subjective endorsement of the game (Mobile App Rating Scale), as well as open questions to further explore usability issues. Usability problems were categorized and evaluated with the use of standard evaluation grids. Content readability was evaluated with Scolarius, a French equivalent of the Flesch Reading Ease test.

Results:

The rapid desirability test revealed an overall good or average impression. The aesthetic of the game left participants mostly indifferent, and some misinterpretations could be noticed. In 83.2% of the cases (208/250), participants successfully completed the think aloud tasks without assistance. Some tasks revealed usability issues requiring assistance. The analysis of failures and difficulties encountered (23 in total) revealed that some issues were due to a suboptimal wording of task instructions, and that there are 9 major usability problems. All could be addressed with minor modifications. The Scolarius test indicates that the card titles are understandable for elementary school level users while the rectos containing more explanations require high school level. At the end of the test, Anticip’action was evaluated between good and excellent on its usability (79/100 on the SUS questionnaire) and obtained an overall positive assessment on its attractiveness (global score of 1,6 on AttrakDiff questionnaire) and relevance (4.1/5 on the Mobile App Rating Scale, section F). Participants provided overall positive qualitative feedback and endorsed the game (3.3/5 on the “I would recommend” question).

Conclusions:

The usability of Anticip’action was evaluated as good by users and minor area of improvement were identified. Anticip’action, which is freely available, can be recommended as a valuable resource for patients, families, and caregivers to prompt reflection, raise awareness, and support advance care planning conversations. Clinical Trial: The study was preregistered on the OSF platform: https://osf.io/8gzsf.