JMIR Publications

ABSTRACT

Background:

Advance care planning (ACP) is conceptualized as an ongoing dialogue; however, initiating ACP discussions remains difficult in practice. In addition to knowledge deficits, insufficient formation of psychological readiness to begin reflecting on ACP may represent a structural barrier to initiation.

Objective:

To describe the distribution of cognitive, attitudinal, and psychological responses following a fully web-based digital educational intervention integrating an explanatory video and a narrative-based interactive visual novel game focused on ACP.

Methods:

This exploratory cross-sectional online study was conducted between July and December 2025. Participants (individuals with and without medical or caregiving experience) completed the intervention and post-intervention questionnaire. Responses to 12 key items (Q7–Q18) were assessed using a 5-point Likert scale. Descriptive statistics were calculated and between-group comparisons were performed using Welch’s t-test. Free-text responses were analyzed descriptively as supplementary qualitative data.

Results:

The data of 158 participants (46 with medical or caregiving experience and 112 without such experience) were analyzed. Mean scores for items related to understanding of ACP, clarity of content, and intention to consider ACP were above the neutral midpoint of the scale. However, responses showed variability across items rather than uniform convergence toward strong endorsement. Between-group comparisons identified statistically significant differences for selected items, whereas most responses did not differ substantially by professional background. For items related to perceived psychological barriers, response distributions did not indicate dominant negative tendencies.

Conclusions:

The observed response patterns are consistent with the perspective that difficulty in initiating ACP may be related to limited psychological readiness in addition to knowledge-related factors. Narrative-based digital education delivered in a fully online format may function as an entry-level experiential opportunity that supports individuals in beginning to reflect on ACP, rather than prompting immediate decision-making.