Strong Together: Piloting a Serious Game to Improve Self-Advocacy among Female Patients with Advanced Cancer
When faced with the challenges of advanced cancer, women must advocate (or
stand up) for their needs and priorities. However, there are no interventions
to promote self-advocacy in advanced cancer patients. Serious games offer a
novel mechanism by which to deliver interactive, engaging health education. The
fully-automated Strong Together self-advocacy serious game may allow women with
advanced cancer to learn self-advocacy skills and therefore improve their
The purpose of this pilot randomized controlled trial (RCT) is to evaluate the
feasibility, acceptably, and preliminary efficacy of the Strong Together
serious game. The aims of this study are to: (1) evaluate the feasibility and
acceptability of the 3-month Strong Together intervention and (2) explore the
differences in self-advocacy and symptom burden between groups over time.
This pilot RCT will recruit (N=81) women. Eligibility criteria include:
female; age ≥ 18 years; diagnosis of Stage III or IV gynecological or Stage IV
breast cancer within the past 3 months; 6-month prognosis; scoring below the
mean of the FSACS Scale; Eastern Cooperative Oncology Group performance status
score of 0-1; and ability to read and write in English. Measures will be
collected at baseline, 3-months, and 6-months. Randomization (2:1) will occur
to the 3-month Strong Together intervention group or the enhanced care as usual
group. Feasibility will be assessed by calculating percentages of the
intervention’s dosage, engagement, recruitment, retention, and data completion.
Acceptability will be assessed through exit interviews and an acceptability
scale. Preliminary efficacy will be measured by exploring differences in
self-advocacy and symptom burden scores and calculating point- and
interval-estimates between the groups at 3 and 6 months.
This study represents a unique opportunity to address the lack of self-advocacy
interventions in advanced cancers, reduce the risks of women with low
self-advocacy, and guide an adequately-powered RCT.
Teresa Hagan Thomas, PhD, RN is an Assistant Professor
in the Department of Health Promotion & Development at the University of
Pittsburgh School of Nursing in Pittsburgh, PA. Her research focuses on patient
self-advocacy among patients with advanced cancer, especially those from
vulnerable populations. Dr. Thomas is a 2018 NPCRC and American Cancer Society
Career Development Award grantee.