Trial reportJournal of general internal medicine2023
Using a Video Game Intervention to Increase Hospitalists' Advance Care Planning Conversations with Older Adults: a Stepped Wedge Randomized Clinical Trial.
Trial report in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04557930 (Hopewell Hospitalist), which is not on this map. Cited by 6 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning Conversations by Hospitalists With Older Adults
Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 7 citations in OpenAlex.
- Goals of care discussions in hospitalised patients: systematic review of randomised trials.BMJ supportive & palliative care · 2026Pooled it
- Role of recruitment bias in stepped-wedge cluster randomised controlled trials: a systematic review.BMJ open · 2025Pooled it
- Causal Inference for Intervention Spillover in a Stepped Wedge Cluster-randomized Trial: Lessons from a Physician Network.Social networks · 2026Article
- Gaming the System: Evaluating Spillover in a Video Game Intervention for Advance Care Planning using Physician Social Networks.Health services & outcomes research methodology · 2026Article
- Utility of advance care planning billing codes: a cross-sectional analysis of U.S. hospitalists' documentation.BMC research notes · 2025Article
- Constructing within and between hospital physician social networks for modeling physician research participation.BMC medical research methodology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundGuidelines recommend Advance Care Planning (ACP) for seriously ill older adults to increase the patient-centeredness of end-of-life care. Few interventions target the inpatient setting.
objectiveTo test the effect of a novel physician-directed intervention on ACP conversations in the inpatient setting.
designStepped wedge cluster-randomized design with five 1-month steps (October 2020-February 2021), and 3-month extensions at each end.
settingA total of 35/125 hospitals staffed by a nationwide physician practice with an existing quality improvement initiative to increase ACP (enhanced usual care).
participantsPhysicians employed for ≥ 6 months at these hospitals; patients aged ≥ 65 years they treated between July 2020-May 2021.
interventionGreater than or equal to 2 h of exposure to a theory-based video game designed to increase autonomous motivation for ACP; enhanced usual care. MAIN MEASURE: ACP billing (data abstractors blinded to intervention status).
resultsA total of 163/319 (52%) invited, eligible hospitalists consented to participate, 161 (98%) responded, and 132 (81%) completed all tasks. Physicians' mean age was 40 (SD 7); most were male (76%), Asian (52%), and reported playing the game for ≥ 2 h (81%). These physicians treated 44,235 eligible patients over the entire study period. Most patients (57%) were ≥ 75; 15% had COVID. ACP billing decreased between the pre- and post-intervention periods (26% v. 21%). After adjustment, the homogeneous effect of the game on ACP billing was non-significant (OR 0.96; 95% CI 0.88-1.06; p = 0.42). There was effect modification by step (p < 0.001), with the game associated with increased billing in steps 1-3 (OR 1.03 [step 1]; OR 1.15 [step 2]; OR 1.13 [step 3]) and decreased billing in steps 4-5 (OR 0.66 [step 4]; OR 0.95 [step 5]).
conclusionsWhen added to enhanced usual care, a novel video game intervention had no clear effect on ACP billing, but variation across steps of the trial raised concerns about confounding from secular trends (i.e., COVID).
trial registrationClinicaltrials.gov; NCT04557930, 9/21/2020.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.