A pilot study of game-based learning programs for childhood cancer survivors

Abstract

Background: Childhood cancer survivors lacking awareness on their potential risks of late effects often fail to seek adequate follow-up care. Patient education matching their preference is of great importance to improve their adherence to survivorship care. In this study, we developed two age-dependent game-based learning programs, which enable continuous approaches for childhood cancer survivors along their intellectual maturation. Then, we assessed the effectiveness of the programs.

Methods: Childhood cancer survivors over 10 years of age who regularly visited a long-term follow-up clinic were enrolled in this study. They were requested to play either of two different types of game tools, one for school children and another for adolescents and young adults, for one month at home. To evaluate the educational effects of the programs, they were examined for health management awareness, self-esteem, and knowledge on cancer-related late effects before and after the intervention with age-based questionnaires and knowledge tests.

Results: Among 83 participants, 49 (59.0%) completed the assessments over the period of 12 months. The health management awareness and knowledge levels increased significantly at 1-month after the intervention as compared to the baseline in both school children and adolescents/young adults (for health management awareness, p = 0.011 in elementary school children; p = 0.007 in junior high school children; p < 0.001 in adolescents/young adults; for knowledge levels, p < 0.001 in school children; p < 0.001 in adolescents/young adults). The effect was maintained for 12 months in school children while it decreased in adolescents and young adults with time. Self-esteem significantly increased at 1-month (p = 0.002 in school children; p = 0.020 in adolescents/young adults) and was maintained for 12 months in both age groups.

Conclusion: The game-based learning programs enhanced health locus of control and self-esteem in childhood cancer survivors. The game-based learning programs could be applied effectively to survivorship care as a new modality of patient education.

Trial registration: This study was retrospectively registered in UMIN-CTR ( UMIN000043603 ) on March 12, 2021.

Keywords: Childhood cancer survivors; Computer game; Health locus of control; Patient education.

Fig. 1

The outline of the study. Subjects were assessed for their health-management awareness, self-esteem, and knowledge level on cancer-related late effects before starting with a game-based learning program. Then they were asked to play an age-matched game once a week for one month at home. Efficacy of the intervention was surveyed with questionnaires at 1-, 6- and 12-month from the baseline assessment. CCSs, childhood cancer survivors; AYA, adolescents and young adults

Fig. 2

Persistence of learning effects in subject completing all assessments. a, health management awareness; b, self-esteem; c, knowledge level. Distributions of the total scores of surveys for health management awareness and self-esteem in each age category are shown as box plots. For knowledge level, mean scores ± SE of Knowledge tests at two age categories are shown. First, we analyzed an increase in the score at 1-month from the baseline with the Wilcoxon signed-rank test or the paired student t-test. Then we evaluated the dataset at 3 post-intervention assessment points with the Friedman test or the One-way repeated measures ANOVA