Cited by 802Medication Adherence and ComplianceEducational Games and GamificationChildhood Cancer Survivors' Quality of Life

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A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

Kato, Pamela M., Cole, Steve W., Bradlyn, Andrew S., Pollock, Brad H.·2008·Pediatrics

DOI 10.1542/peds.2007-3134

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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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BackgroundMethod
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Aventin, Á., Houston, S., & Macdonald, G. M. (2014) · Children and Youth Services Review · doi:10.1016/j.childyouth.2014.10.012 · Cited by 17
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Drigas, A. S., & Papoutsi, C. (2016) · International Journal of Recent Contributions from Engineering Science & IT (iJES) · doi:10.3991/ijes.v4i3.5923 · Cited by 15
““Re-Mission” tries to increase feelings of self-efficacy and iJES ‒ Volume 4, Issue 3, 2016 SHORT PAPER G AMES FOR E MPATHY FOR S ENSITIVE S OCIAL G ROUPS self-esteem to the patients and evoke emotions and empathy for a better communication and interaction with the young patients [28], [29].”
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“, the compliance of an end-user to the medication schedule [92-94] or enhancing daily physical activity [21].”
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Performance test for prototype game for children with adhd
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“A study conducted globally in 34 health centers, comparing children playing Re-Mission with children playing other computer games [19].”
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Background
Measuring psychosocial outcomes: is the consumer or the professional the best judge?
Paul, C. L., Sanson‐Fisher, R., & Carey, M. L. (2013) · European Journal of Cancer Care · doi:10.1111/ecc.12048 · Cited by 14
“Many of the published studies using unmet needs as an outcome measure have not produced a change in these outcomes (Kato et al. 2008; Eriksson et al. 2010).”
Background
Adherence-Related Issues in Adolescents and Young Adults with Hematological Disorders
Leader, A., & Raanani, P. (2014) · Acta Haematologica · doi:10.1159/000360197 · Cited by 15
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Emmerich, K., Bogacheva, N. V., Bockholt, M., & Wendel, V. (2016) · Lecture notes in computer science · doi:10.1007/978-3-319-46152-6_13 · Cited by 14
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BackgroundInfluential
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D’Aprile, G., Ligorio, M. B., & Severino, A. U. (2017) · Technology Knowledge and Learning · doi:10.1007/s10758-017-9344-x · Cited by 14
“2013), cancer therapy management (Kato et al. 2008), and diabetes management (Brown et al.”
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“18,19 27 Accordingly, the ﬁelds of ‘‘serious games’’ and ‘‘games for health’’ are rapidly evolving.”
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Background
Serious video games and psychological support: A depression intervention among young cancer patients
Khan, S., Abbasi, A. Z., Kazmi, S. F., Ting, D. H., Rehman, U., Hlavacs, H., & Arslan, F. S. (2022) · Entertainment Computing · doi:10.1016/j.entcom.2022.100479 · Cited by 13
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Tolks, D., Dadaczynski, K., & Horstmann, D. (2018) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-018-0667-9 · Cited by 13
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Background
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“A serious videogame, ‘‘Re-Mission’’ (HopeLab, Palo Alto, CA), was acceptable to young cancer patients, 40 enhanced their medication compliance, 41 and activated reward-related mesolimbic circuits leading to positive attitudes toward chemotherapy.”
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Apples and Oranges: Serious Chronic Illness in Adults and Children
Schor, E. L., & Cohen, E. (2016) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.08.098 · Cited by 12
Lay Theories and Metaphors of Health and Illness
Hauser, D., Nesse, R. M., & Schwarz, N. (2017) · Springer eBooks · doi:10.1007/978-3-319-57306-9_14 · Cited by 12
Cost-Effectiveness Analysis of an Adherence-Promotion Intervention for Children With Leukemia: A Markov Model-Based Simulation
McGrady, M. E., Eckman, M. H., O'Brien, M. M., & Pai, A. L. H. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsy022 · Cited by 12
“The API was assumed to reflect a hypothetical intervention rather than any single API, as the only published API in pediatric oncology includes a videogame delivered without intervention by a trained professional to adolescents and young adults with a range of cancer diagnoses (Kato et al., 2008).”
Background
Conceptual framework for designing video games for children with type 1 diabetes
Sparapani, V. D. C., Fels, S., Kamal, N. R., & Nascimento, L. C. (2019) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.2764.3090 · Cited by 14
“The use of heroic characters in the history of video games, aiming at promoting health for children, is a strategy that has been used(23,67).”
Background
Hot, horny and healthy—online intervention to incentivize HIV and sexually transmitted infections (STI) testing among young Mexican MSM: a feasibility study
Andrade‐Romo, Z., Chavira-Razo, L., Buzdugan, R., Bertozzi, E., & Bautista-Arredondo, S. A. (2020) · mHealth · doi:10.21037/mhealth.2020.03.01 · Cited by 11
Wind runners
Nikkila, S., Patel, G., Sundaram, H., Kelliher, A., & Sabharwal, A. (2012) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/2212776.2223811 · Cited by 12
“There is significant research focused on educational health games for a wide variety of medical conditions including diabetes [9,13], cancer [8], and mental health issues [5].”
Background
Guest editorial: games for learning and dialogue on humanitarian work
Harteveld, C., & Suárez, P. (2015) · Journal of Humanitarian Logistics and Supply Chain Management · doi:10.1108/jhlscm-01-2015-0005 · Cited by 12
Development and feasibility testing of an interactive avatar education application for education of patients with heart failure
Du, H., Wonggom, P., Burdeniuk, C., Wight, J., Nolan, P. B., Barry, T., Nesbitt, K., & Clark, R. A. (2020) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2020.0007 · Cited by 11
Theoretically driven educational app design: the creation of a mathematics app
Alam, S., & Dubé, A. (2022) · Educational technology research and development · doi:10.1007/s11423-022-10109-9 · Cited by 9
“Arnab et al. (2015) proposed the LM–GM framework as an analytic tool to understand how a game produces learning outcome (see also Kato et al., 2008).”
Background
Reimagining Machine Learning's Role in Assistive Technology by Co-Designing Exergames with Children Using a Participatory Machine Learning Design Probe
Duval, J., Vidal, L. T., Segura, E. M., Li, Y., & Wærn, A. (2023) · International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS) · doi:10.1145/3597638.3608421 · Cited by 14
“Ranging from physical therapy [19], to speech therapy [17], mental health [22, 23, 36], pain management [39, 59], and medication adherence [35], games move us forward.”
Background
Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review
Kim, S., Wilson, P., & Abraham, O. (2024) · JMIR Serious Games · doi:10.2196/58724 · Cited by 11
Necessary but not sufficient? Engaging young people in the development of an avatar‐based online intervention designed to provide psychosocial support to young people affected by their own or a family member's cancer diagnosis
Phelps, C., Minou, M., Baker, A., Hughes, C., French, H., Hawkins, W., Leeuwenberg, A., Crabtree, R., & Hutchings, P. B. (2016) · Health Expectations · doi:10.1111/hex.12473 · Cited by 11
Guidelines for Developing Patient Education Materials
Findeis, A., & Patyk, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-48088-2_14 · Cited by 11
Visuohaptic augmented feedback for enhancing motor skills acquisition
Asadipour, A., Debattista, K., & Chalmers, A. G. (2016) · Warwick Research Archive Portal (University of Warwick) · Cited by 11
A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study
Sparapani, V. D. C., Fels, S., Kamal, N. R., Banca, R. O. L., & Nascimento, L. C. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211017555 · Cited by 14
Challenges and limitations of clinical trials in the adolescent and young adult CNS cancer population: A systematic review
Byrne, E. M., Pascoe, M., Cooper, D., Armstrong, T. S., & Gilbert, M. R. (2023) · Neuro-Oncology Advances · doi:10.1093/noajnl/vdad159 · Cited by 11
Serious Game Scores as Health Condition Indicator for Cancer Patients
Peters, K., Fares, K., Reithofer, A., Rebecca, W., Mateus‐Berr, R., Kuczwara, J., Lehner, Z., Lawitschka, Á., Brunmaier, B., Martínek, D., et al. (2015) · Studies in health technology and informatics · doi:10.3233/978-1-61499-512-8-892 · Cited by 11
Bacon Brains : Video Games for Teaching the Science of Addiction
Epstein, J. B., Noel, J. G., Finnegan, M. K., & Watkins, K. (2016) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2015.1103348 · Cited by 11
“For example, in a large-scale evaluation, young cancer patients who played a video game about cancer treatment were more adherent and demonstrated signi ﬁ cantly more knowledge about their condition than those who did not play the game (Kato, Cole, Bradlyn, & Pollock, 2008).”
Background
Ethical Issues of Gamification in Healthcare
Coelho, L. P., & Reis, S. S. (2020) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-7998-7472-0.ch001 · Cited by 11
Digitale Lehr- und Lernangebote in der medizinischen Ausbildung: Schon am Ziel oder noch am Anfang?
Kühn, S., Frankenhauser, S., & Tolks, D. (2018) · PUB – Publications at Bielefeld University (Bielefeld University) · Cited by 11
A Framework for Evaluating Behavior Change Interventions through Gaming
Rao, V. (2013) · Lecture notes in computer science · doi:10.1007/978-3-319-03161-3_27 · Cited by 11
The Role of the Researcher in Making Serious Games for Health
Kato, P. M. (2015) · IGI Global eBooks · doi:10.4018/978-1-4666-6433-3.ch072 · Cited by 29
Self-citation
Emerging Technologies for Clinical Practice
McKay, D., Przeworski, A., & O'Neill, S. M. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-802075-3.00014-0 · Cited by 11
Games for Health
Smeddinck, J. D. (2016) · Lecture notes in computer science · doi:10.1007/978-3-319-46152-6_10 · Cited by 11
Shall we play again? The effects of repetitive gameplay and self-efficacy on behavioural intentions to take earthquake precautions
Tanes, Z. (2017) · Behaviour and Information Technology · doi:10.1080/0144929x.2017.1334089 · Cited by 11
“…of video games on various health, safety, and social issues, such as asthma, obesity, diabetes, and access to resources (Baranowski et al. 2003; Cullen et al. 2004; Gao et al. 2012; Greitemeyer and Osswald 2010; Kato et al. 2008; McPherson et al. 2006; Peng 2009; Peng, Lee, and Heeter 2010).”
Background
Improving Symptom Management for Survivors of Young Adult Cancer: Development of a Novel Intervention
Dorfman, C. S., Shelby, R. A., Stalls, J. M., Somers, T. J., Keefe, F. J., Vilardaga, J. P., Winger, J. G., Mitchell, K., Ehren, C., & Oeffinger, K. C. (2023) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2022.0100 · Cited by 10
A digital health game to prevent opioid misuse and promote mental health in adolescents in school-based health settings: Protocol for the PlaySmart game randomized controlled trial
Pendergrass, T. M., Hoerner, L. A., Fernandes, C.-S. F., Maslar, A., Aiudi, S., Kyriakides, T. C., & Fiellin, L. E. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291298 · Cited by 9
Breast cancer diagnosis through serious gaming: Clinical reasoning, AI-driven character morphing, and emotional engagement
Barbosa, R. G., & Rodriguês, M. A. F. (2024) · Entertainment Computing · doi:10.1016/j.entcom.2024.100863 · Cited by 10
Application of a Discrete Choice Experiment to Assess Adherence-Related Motivation Among Adolescents and Young Adults With Cancer
McGrady, M. E., Prosser, L. A., Thompson, A. N., & Pai, A. L. H. (2017) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsx104 · Cited by 10
“This hypothesis could explain why the only available intervention for adolescents and young adults with cancer increased knowledge but demonstrated a limited impact on adherence (Kato et al., 2008).”
Background
O jogo como prática de saúde
de Vasconcellos, M. S., de Carvalho, F. G., & de Araújo, I. S. (2018) · Editora FIOCRUZ eBooks · doi:10.7476/9786557080801 · Cited by 11
A smartphone game to prevent HIV among young Kenyans: local perceptions of mechanisms of effect
Winskell, K., Sabben, G., Akelo, V., Ondenge, K., Odero, I. A., & Mudhune, V. (2020) · Health Education Research · doi:10.1093/her/cyaa011 · Cited by 10
“Notable clinical outcomes in RCTs have included a 77% reduction in diabetes-related emergency department visits and urgent care visits [12] and improved treatment adherence in adolescents and young adults undergoing cancer therapy [13].”
Background
Designing a Self-Efficacy Game for Health Literacy in Marginalized Communities
Evans, M. C., Kapuścińska, A., Greenholt, M., Lin, J., Liu, X., Zhang, T., Hammer, J., & Kaufman, G. F. (2021) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3411763.3451609 · Cited by 11
“games and interactive narratives to model efective decision-making [6] and, in the context of health, to improve players’ skill development and rehearsal [5], health knowledge [34], and self-confdence [29], the present work focuses on designing a novel digital game”
Background
Evaluation of Serious Games
Göbel, S. P., Gutjahr, M., & Hardy, S. (2013) · IGI Global eBooks · doi:10.4018/978-1-4666-3673-6.ch007 · Cited by 10
Digital and video games in health promotion: Systematic review of games and health behavior
Haaranen, A., Rissanen, T., Laatikainen, T. K., & Kauhanen, J. (2014) · Finnish Journal of eHealth and eWelfare · Cited by 10
Lost in Translation
Kaufman, G. F., & Flanagan, M. (2013) · International Journal of Gaming and Computer-Mediated Simulations · doi:10.4018/jgcms.2013070101 · Cited by 12
Serious Games in Formal Medical Education: An Experimental Study
Ribeiro, C., Antunes, T., Monteiro, M., & Pereira, J. M. (2013) · International Conference on Games and Virtual Worlds for Serious Applications · doi:10.1109/vs-games.2013.6624240 · Cited by 10

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)
ORCID: Kato, Pamela M.
Cole, Steve W.
Pollock, Brad H.
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
DOI: 10.1542/peds.2007-3134
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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A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

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