Game helps older adults be 'proactive' to prevent chemotherapy-associated nausea, vomiting
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Researchers at University of Central Florda developed an educational game to help older adults with cancer manage chemotherapy-related nausea and vomiting.
The investigators received a $2.5 million grant from NIH’s National Institute of Nursing Research to conduct a large-scale randomized clinical trial.
Victoria Loerzel, PhD, RN, FAAN, the Beat M. and Jill L. Kahli endowed professor in oncology nursing at University of Central Florida, and colleagues developed a serious game designed to simulate life at home for older adults after chemotherapy treatment.
The game — which takes about 15 minutes to complete — asks patients to make decisions for an older avatar to prevent nausea and vomiting. The player also must decide what to do when these symptoms arise.
The game also reinforces actions that can be taken to minimize side effects of nausea and vomiting, such as taking medication, avoiding certain foods and drinking plenty of fluids.
“Nausea and vomiting are among the top side effects seen among patients treated for cancer. Up to 80% of adults undergoing chemotherapy will have nausea and vomiting,” Loerzel told Healio.
“Older adults are more likely to experience serious consequences from nausea and vomiting than younger adults,” Loerzel added. “We wanted to create an experience that mirrored the real-life experience of managing nausea and vomiting at home.”
Healio spoke with Loerzel about how the intervention works, the value it provides beyond standard educational materials and the next steps in research.
Healio: Why are nausea and vomiting more problematic for older adults with cancer?
Loerzel: For older adults, nausea and vomiting can lead to metabolic or nutritional issues, including loss of appetite, weight loss or malnutrition. These conditions can lead to a decrease in functioning, declines in physical or mental health, as well as reduced quality of life. This is important and concerning, because older patients may not have the reserves that younger adults may have. Vomiting also can lead to dehydration and renal impairment, which are compounded by the presence of multiple comorbidities. Additionally, our research showed older adults traditionally do very little to manage side effects at home. They often adopt a watch-and-wait strategy. By the time they decide to go to the ED, the side effects are often quite bad.
Healio: How did you develop this educational game?
Loerzel: We developed the intervention using a community advisory board made up of patients who had experienced nausea or vomiting while under treatment, as well as oncology nurses and caregivers. We did a series of focus groups and interviews, and we asked people to describe their symptoms and how they managed them. We asked them about what worked and what didn’t. We also spoke with caregivers — who bring their own unique perspectives — as well as oncology nurses, who were able to tell us about the education they provided to these older patients. We used this information to create the simulation used in this game. We developed the visuals of the game in the laboratory, and we showed the game to the community advisory board to confirm that it was reflecting their experience. We made changes as needed, and then we brought the final game to our community advisory board and had them play it.
Healio: How does the game differ from other educational apps on this subject?
Loerzel: Many apps bring up standard information about nausea and vomiting that describes what it is and how it can be managed. Most patients already have that information, so we wanted to go a step further. We wanted to reinforce what had already been taught, and allow patients to practice making decisions in a safe environment so they could see the outcomes of these decisions.
In the game, patients make decisions for an avatar that is just like them. They play through a scenario in which they make decisions about medications, food and beverage choices, and other comfort measures. If they make great decisions, the avatar feels good. If they don’t make good decisions, the avatar will not feel well and will experience nausea and vomiting. Our goal is to have them be proactive and engage in preventing and managing these symptoms so they can stay out of the hospital and the ED.
Healio: How has this performed in your research so far?
Loerzel: Our preliminary study showed very promising results related to the number of self-management behaviors each group did. Our intervention group engaged in twice as many preventive behaviors for nausea vs. the control groups. The game taught them to be proactive in preventing nausea. The control group, which didn’t receive the intervention, didn’t engage in many preventive behaviors, but they did twice as many behaviors to manage nausea and vomiting once they got it. So, in our opinion, the game did exactly what it should have: It made those who experienced the intervention more proactive in preventing symptoms.
Healio: What are the next steps in research?
Loerzel: Right now, we are doing a randomized clinical trial at two sites to examine the game’s effectiveness for improving some of the outcomes. We’re looking at quality of life, the symptom experience in general, and differences in levels and severity of symptoms between those who use the game and controls.
Reference:
- Game mimics reality to improve life for older adults with cancer (press release). Available at: https://www.ucf.edu/news/game-mimics-reality-to-improve-life-for-older-adults-with-cancer/. Published Dec. 6, 2023. Accessed Feb. 13, 2024.
For more information:
Victoria Loerzel, PhD, RN, FAAN, can be reached at University of Central Florida College of Nursing, 12201 Research Parkway, Suite 300, Orlando, FL 32826; email: victorial.loerzel@ucf.edu.
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