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A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial
Abstract
OBJECTIVE. Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma. METHODS. A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group. The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54). RESULTS. Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life. CONCLUSIONS. The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.
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“Serious gaming (ie, [digital] games used for purposes other than purely entertainment) is a novel and promising approach to support the treatment of clinical symptoms and improvement of adaptive functioning among diverse patient groups [31-35].”
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Designing Serious Game Interventions for Individuals with Autism
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BackgroundInfluentialSocial and Emotional Learning Programs for Adolescents
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Blazing Angels or Resident Evil? Can Violent Video Games be a Force for Good?
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Serious games in prevention and rehabilitation—a new panacea for elderly people?
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“Solid scientific evaluation studies by Baranowski [1] and Kato [ 5 ] have proven positive effects of game-based approaches in the direction on health-related behavior changes, e.g.”
BackgroundA neurofeedback video game (MindLight) to prevent anxiety in children: A randomized controlled trial
Schoneveld, E. A., Malmberg, M., Lichtwarck-Aschoff, A., Verheijen, G. P., Engels, R. C. M. E., & Granic, I. (2016) · Computers in Human Behavior · doi:10.1016/j.chb.2016.05.005 · Cited by 174
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“International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham, UK within educational contexts to assist teaching and learning (e.g., de Freitas and Griffiths 2008), within medical and other therapeutic settings to aid patient recovery (e.g., Kato et al. 2008 ) and in various work con…”
BackgroundSerious Games: A New Paradigm for Education?
de Freitas, S., & Liarokapis, F. (2011) · Springer eBooks · doi:10.1007/978-1-4471-2161-9_2 · Cited by 178
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“…to appear (for example, see research reviews and studies by Bartlett, Anderson, & Swing, 2009; Blanchard, Stock, & Marshall, 1999; Griffiths, 2002; Kato, Cole, Bradlyn, & Pollock, 2008; Lieberman, 2001; Mellecker & McManus, 2008), and this also should be somewhat applicable and useful to…”
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“Moreover, there was no evidence for significant change in health locus of control in either of these two investigations.(55,60) The results for self-efficacy were mixed; one investigation targeting adherence and other behavioral outcomes via video gaming for AYA cancer survivors between the ages of 13 and 29 years sho…”
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“Serious gaming (ie, [digital] games used for purposes other than purely entertainment) is a novel and promising approach to support the treatment of clinical symptoms and improvement of adaptive functioning among diverse patient groups [31-35].”
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“Since the release of the “Re-Mission” titles, which showed good adherence to treatments and easy access to knowledge, from HopeLab in California, the use of computer games in health education and physical education has been considered to have positive effects [19].”
The Role of Cognitive and Affective Challenge in Entertainment Experience
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“Some researchers [52] designed the video game Re-Mission for adolescents with cancer to increase their self-efficacy and decrease disease-related stigma.”
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“Additional exploratory analyses also assessed the possibility that (3) the magnitude of gameplay-induced neural activation is associated with post-play differences in attitudes toward cancer chemotherapy – a key psychological target of ReMission as a serious IDG [7,8].”
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“These behavioral objectives were translated into a suitable game based on relevant psychological theories, such as (1) the Self-Regulation Model, 26 (2) Social Cognitive Theory, 27 and (3) Learning Theory.”
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“…as attested by the more than 200,000 copies delivered, and its learning effectiveness, demonstrated in a randomized controlled trial involving 375 patients which revealed that playing this game was associated with better knowledge, self-efficacy, and adherence to oral chemotherapies [10].”
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“9 However, it remains a task for future research to explore the factors that determine whether and how efficacy experiences produced by video games are transferred into real-life experiences and behavior.”
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Improving Informed Consent of Surgical Patients Using a Multimedia-Based Program?
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“In their study of AYAs with cancer, the use of a video game that addressed various behavioral issues important to participation in treatment was shown to result in improved adherence to oral medications.(39)”
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“Other studies have focused on the potential of active videogames in reducing obesity(14) and adherence to cancer medications.(15) In a 2010 article Kato(16) reported that the use of games in psychology were primarily for education and training with patients.”
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“Recent approaches to integrating the Internet into patient care range frompatient forums to information sites and even therapeutic games.(9,10) Internet programs based on cognitive behavioral techniques with patient guidance via regular online contact with a health care professional (ie, therapist-guided programsor gu…”
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Thompson, D. I. (2012) · Journal of Diabetes Science and Technology · doi:10.1177/193229681200600411 · Cited by 103
Technology-mediated interventions for enhancing medication adherence
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McCann, L., McMillan, K. A., & Pugh, G. (2019) · JMIR Cancer · doi:10.2196/12071 · Cited by 98
“Reported theories used to inform the intervention features included the theory of reasoned action [65], the Adolescent Resilience Model [49], the Hope Process Framework [39], the self-regulation model of health and illness [53], social cognitive theory [53], cognitive behavioral therapy [57,58], and”
BackgroundMethodInfluentialVernadakıs, N., Gioftsidou, A. F., Antonıou, P., Ioannidis, D., & Gıannousı, M. (2012) · Computers & Education · doi:10.1016/j.compedu.2012.01.003 · Cited by 96
“Video games, due to the enormous popularity they are enjoying, could possibly be such a strategy because exergames give an access to sport or to a more active lifestyle.”
BackgroundSansom-Daly, U. M., Wakefield, C. E., Bryant, R. A., Butow, P., Sawyer, S., Patterson, P., Anazodo, A., Thompson, K., & Cohn, R. J. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-339 · Cited by 94
“It is anticipated that approximately 220 patients will need to be approached to achieve a final sample of 90 participants (assuming a response rate of 50% and attrition rate of 20%, based on previous interventions with AYA) [19,46,47].”
BackgroundA Review of Interventions to Enhance HIV Medication Adherence
Whiteley, L., Olsen, E. M., Haubrick, K. K., Odoom, E., Tarantino, N., & Brown, L. K. (2021) · Current HIV/AIDS Reports · doi:10.1007/s11904-021-00568-9 · Cited by 95
Artificial Intelligence and Healthcare Simulation: The Shifting Landscape of Medical Education
Hamilton, A. J. (2024) · Cureus · doi:10.7759/cureus.59747 · Cited by 117
Fuchslocher, A., Niesenhaus, J., & Krämer, N. C. (2010) · Entertainment Computing · doi:10.1016/j.entcom.2010.12.001 · Cited by 91
“A clinical study [8] showed that the game intervention significantly improved treatment adherence and cancer-related self-efficacy of teenage and adolescent patients who were undergoing cancer therapy.”
BackgroundA State-of-the-Art Systematic Content Analysis of Games for Health
Lu, A. S., & Kharrazi, H. H. K. (2018) · Games for Health Journal · doi:10.1089/g4h.2017.0095 · Cited by 88
Malnutrition and obesity in pediatric oncology patients: Causes, consequences, and interventions
Co‐Reyes, E., Li, R., Huh, W. W., & Chandra, J. (2012) · Pediatric Blood & Cancer · doi:10.1002/pbc.24272 · Cited by 89
“A video game intervention has successfully increased medication adherence in children with cancer [88], and in another instance, an ongoing clinical trial is investigating the ways in which weight-related tailored text messages as part of a weight management program affect BMI among obese adolescents (CTID: NCT0144855…”
Interventions for promoting participation in shared decision-making for children with cancer
Coyne, I., O’Mathúna, D. P., Gibson, F., Shields, L. E., Leclercq, E., & Sheaf, G. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008970.pub3 · Cited by 89
Towards a Comprehensive Methodology for the Research and Evaluation of Serious Games
Mayer, I. S. (2012) · Procedia Computer Science · doi:10.1016/j.procs.2012.10.075 · Cited by 91
Cibrian, F. L., Lakes, K. D., Schuck, S. E. B., & Hayes, G. R. (2021) · International Journal of Child-Computer Interaction · doi:10.1016/j.ijcci.2021.100421 · Cited by 96
Spielerische Ansätze in Prävention und Gesundheitsförderung: Serious Games und Gamification
Tolks, D., Lampert, C., Dadaczynski, K., Maslon, E., Paulus, P., & Sailer, M. (2020) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-020-03156-1 · Cited by 93
Tarrega, S., Castro-Carreras, L., Fernández-Aranda, F., Granero, R., Giner-Bartolomé, C., Aymamí, N., Gómez-Peña, M., Santamaría, J., Forcano, L., Steward, T., et al. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01721 · Cited by 80
“Cronbach’s alpha reliability for these three scales in the sample was 0.99, 0.95, and 0.88, respectively.”
BackgroundInfluentialLee, K., Kim, S., Kim, S. H., Yoo, S., Sung, J. H., Oh, E. G., Kim, N. W., & Lee, J. (2023) · Journal of Medical Internet Research · doi:10.2196/38333 · Cited by 79
“…events that were unrelated to the digital intervention [72] occurred in 2 participants in the usual-care group who were concerned about cancer recurrence [33] and in the control group participants who played the control game [251] or were similar for both the intervention and control groups [173].”
The Role of AI in Serious Games and Gamification for Health: Scoping Review
Tolks, D., Schmidt, J., & Kühn, S. (2023) · JMIR Serious Games · doi:10.2196/48258 · Cited by 87
“The game Re-Mission was developed for children with cancer and showed good results regarding compliance and the understanding of disease-related issues in the target group [13].”
BackgroundMultimedia educational interventions for consumers about prescribed and over-the-counter medications
Ciciriello, S., Johnston, R. V., Osborne, R. H., Wicks, I. P., deKroo, T., Clerehan, R., O'Neill, C., & Buchbinder, R. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008416.pub2 · Cited by 80
Fiellin, L. E., Hieftje, K. D., Pendergrass, T. M., Kyriakides, T. C., Duncan, L. R., Dziura, J. D., Sawyer, B. G., Mayes, L. C., Crusto, C. A., Forsyth, B. W. C., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8148 · Cited by 84
“They have efficacy [14] in areas ranging from depression to asthma to cancer [15,16-19].”
Balancing Play, Meaning and Reality: The Design Philosophy of LEVEE PATROLLER
Harteveld, C., Guimarães, R., Mayer, I. S., & Rafael Bidarra, E. (2009) · Simulation & Gaming · doi:10.1177/1046878108331237 · Cited by 78
“Although some success stories do exist (Blunt, 2006; Kato, Cole, Bradlyn, & Pollock, 2008; Sidor, 2007), the incoherency in, and even the simple absence of, theory prevents practitioners from learning from each other and subsequently from developing more successful digital serious games.”
BackgroundCorrelation between videogame mechanics and executive functions through EEG analysis
Mondéjar, T., Hervás, R., Johnson, E., Gutierrez, C., & Latorre, J. M. (2016) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2016.08.006 · Cited by 84
A systematic review of serious games in asthma education
Drummond, D., Monnier, D., Tesnière, A., & Hadchouel, A. (2016) · Pediatric Allergy and Immunology · doi:10.1111/pai.12690 · Cited by 77
“Clinical outcomes are rarely evaluated in studies evaluating the effectiveness of SGs in the field of preventive medicine (43, 44, 46, 54, 55).”
BackgroundResultSerious Games: What Are They? What Do They Do? Why Should We Play Them?
Blumberg, F. C., Almonte, D. E., Anthony, J. S., & Hashimoto, N. (2013) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195398809.013.0019 · Cited by 76
LeGrand, S., Muessig, K. E., McNulty, T., Soni, K., Knudtson, K., Lemann, A., Nwoko, N., & Hightow‐Weidman, L. (2016) · JMIR Serious Games · doi:10.2196/games.5687 · Cited by 76
Interventions to Enhance Adherence to Oral Antineoplastic Agents: A Scoping Review
Rosenberg, S. M., Petrie, K. J., Stanton, A. L., Ngo, L. D., Finnerty, E. K., & Partridge, A. H. (2019) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djz244 · Cited by 82
“on a pre-specified adherence outcome [48, 56, 69] and a fourth study reported a”
BackgroundInfluentialTransforming Health Care: Empowering Therapeutic Communities through Technology-Enhanced Narratives
Tian, K. T., Sautter, P., Fisher, D., Fischbach, S., Luna‐Nevarez, C., Boberg, K. B., Kroger, J., & Vann, R. J. (2014) · Journal of Consumer Research · doi:10.1086/676311 · Cited by 80
Computer games supporting cognitive behaviour therapy in children
Brezinka, V. (2014) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104512468288 · Cited by 73
Videogames and Health Improvement: A Literature Review of Randomized Controlled Trials
Rahmani, E., & Boren, S. A. (2012) · Games for Health Journal · doi:10.1089/g4h.2012.0031 · Cited by 73
Digital Gaming Interventions in Psychiatry: Evidence, Applications and Challenges
Vajawat, B., Varshney, P., & Banerjee, D. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113585 · Cited by 73
Metadata
- Authors
- Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. H.
- Affiliations
- Stanford Health Care (US)
- HopeLab (US)
- West Virginia University (US)
- The University of Texas at San Antonio Health Science Center (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2008-08-01
- Volume
- 122
- Issue
- 2
- Pages
- e305-e317
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2163083471
- Cited by
- 802
- References
- 71
- Citations by year
- 2026: 14 · 2025: 26 · 2024: 26 · 2023: 39 · 2022: 41 · 2021: 44 · 2020: 51 · 2019: 44 · 2018: 61 · 2017: 46 · 2016: 75 · 2015: 95 · 2014: 62 · 2013: 55 · 2012: 48
- FWCI
- 17.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hopelab Foundation
- National Cancer Institute (CA-054174, P30CA054174, CA95861, CA 098543, U10CA098543, U10CA095861)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- video game intervention, medication adherence, adolescent and young adult cancer, self-efficacy, health knowledge, trimethoprim-sulfamethoxazole, 6-mercaptopurine, antibiotic prophylaxis, acute leukemia, lymphoma, soft tissue sarcoma, stress, quality of life, health education
- MeSH terms
- Adaptation, Physiological, Adaptation, Psychological, Adolescent, Adult, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Neoplasms, Patient Compliance, Patient Education as Topic, Probability, Quality of Life, Reference Values, Health Behavior, Poisson Distribution, Video Games, Self Efficacy
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