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 Table of Contents  
REVIEW ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 2  |  Page : 474-480

Electronic game: A key effective technology to promote behavioral change in cancer patients


1 Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
2 Health Information Technology Department, School of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol, Iran

Date of Web Publication25-Jul-2016

Correspondence Address:
Azadeh Goodini
Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.154939

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 > Abstract 


Cancer diagnosis is a very unpleasant and unbelievable experience. Appropriate management and treatment of these diseases require a high degree of patient engagement. Interactive health electronic games are engaging, fun, challenging, and experiential and have the potential to change the attitude and behavior, which can improve the player's health. The use of these digital tools, as one of the most attractive and entertaining modern technologies, canem power patients, provide suitable palliative care, promote health behavior change strategies, increase patient engagement, enhance healthy lifestyle habits, improve self.management, and finally improve the quality of life of the patients. Finally, the aim of this article was to describe electronic games and their effects on the promotion of behavior change in cancer patients. In addition, this article describes categories, characteristic features, and benefits of this digital media in the lifestyle modification of cancer patients.

Keywords: Behavior change, cancer patient, electronic game, technology


How to cite this article:
Safdari R, Ghazisaeidi M, Goodini A, Mirzaee M, Farzi J. Electronic game: A key effective technology to promote behavioral change in cancer patients. J Can Res Ther 2016;12:474-80

How to cite this URL:
Safdari R, Ghazisaeidi M, Goodini A, Mirzaee M, Farzi J. Electronic game: A key effective technology to promote behavioral change in cancer patients. J Can Res Ther [serial online] 2016 [cited 2019 Dec 10];12:474-80. Available from: http://www.cancerjournal.net/text.asp?2016/12/2/474/154939



The aim of this article was to describe electronic games and their effects on the promotion of behavior change in cancer patients. In addition, this article describes categories, characteristic features, and benefits of this digital media in the lifestyle modification of cancer patients.


 > Introduction and Overview Top


Nowadays, people wish to improve their lives; therefore, government is increasingly trying to enhance the quality of their people's lives throughout the world; decrease suffering from illnesses and death; and provide physical, mental, and social welfare.[1] Cancer diagnosis is a very unpleasant and unbelievable experience in the life of a person.[2]

This disease is characterized by the transformation of abnormal cells and the loss of cell distinction and causes physical, mental, and social problems which may cause disorders in the quality of life during this disease. Despite effective drugs, advanced medical technologies, and trained, experienced hospital staff and educated healthcare professionals, patients do not always show the behaviors which are expected of the medical staff. Most patients hardly adapt themselves with treatment methods that save their lives.[3],[4] Finding the solution to these rather complicated challenges, considering the behavioral and psychological factors in addition to physical factors, can play a prominent role in maintaining healthcare education.

Serious games are a bunch of computer games which are designed to achieve goals that are hidden behind their entertainment aspect. These games are different depending on the purpose for which they are designed. This digital instrument is an interactive software program which is mainly aimed at entertainment, but its advantage is not just limited to entertainment. Health games are among the most common type of serious games that are designed to transfer information and health teachings.[5] Interactive health games are engaging, enjoyable, challenging, and experiential; and have the potential to change the attitudes and behaviors, which can improve the players' health. Health electronic games, despite being a new term, have actually existed on the market for more than 34 years since the early 1980s. There has been reports in the literature of commercially available digital games used for therapeutic purposes in different patient populations.[6] Most of them were directed towards children because the average game player was quite young and electronic games were largely targeted toward this market. As these gamers grew older, electronic games became more sophisticated and the market broadened for an older audience. This is reflected in the broader age range of the target audience of recent health games, as well. Over time, digital media could attract the cooperation of all people without considering the personal borders such as age, sex, and education level. In the health area, digital games are considered an attractive tool to disseminate changes in the health and related behaviors.[7]

Prensky (2007) also believes that involving players is a positive effect of these games. As a response to a question about why electronic games involve people, he mentioned that “Games are a form of entertainment and give us as ense of pleasure. Games have rules and give us structure. Games have goals and motivate us. Games are interactive and give us motions and sense of doing something. Games have outcomes and feed back to teach us. Games have conflicts, contests, and challenges and give us the adrenaline. Games cause problem solving and give us social community. Games have stories and giveus feelings”.[8]

According to Becker (2008), today's electronic games give us many ways to communicate, teach, and influence the attitudes and behavior. The use of computer games in learning has benefits for people; it increases motivation to learn and makes it easy to understand complex issues, leads to thought full earning, and strengthens self-regulation through feedback.[9]

This technology, through using fundamental methods, the appearance of game consoles (such as Xbox and PlayStation), and the computer and internet, could change the life of many people to potentially improve their situation.[10] Games have become very popular for drawing the attention of people to the promotion of their lifestyle and help them to learn about a variety of health conditions and treatments.

Today, health- oriented games provide ways to communicate and influence the attitudes and behaviors of individuals. Also, these games provide the possibility of practicing theory learning, practical skills, and active learning in individual and group situations.[11]

Finally, the aim of this article was to describe electronic games and their effects on promoting behavioral change in cancer patients. In addition, this article describes categories, characteristic attributes, and benefits of the digital media in the lifestyle modification of cancer patients.


 > Materials and Methods Top


The present research was a review study, which was carried out by searching through the authentic scientific sources, including PubMed, Google Scholar, Scope, and other information sources. The focus was on electronic games, categories, and characteristic attributes as well as articles describing this technology for the cancer care purpose regardless of the publication year.

”Video games”, “electronic games”, “games”, and “digital games” are used interchangeably in this article as general terms to refer to any electronic, computer, console, or arcade game that meet the following parameters. Electronic games are an interactive, often automated, complex system in which players store and manipulate information and engage in an artificial conflict defined by rules of the system, resulting in a quantifiable outcome.

Necessity of the use of electronic games to meet cancer patient challenges

With the development of medical knowledge and advances in technology, healthcare systems need the latest developments to attain better results and increase productivity.[12] Based on the patient's difficult situation, a need for health-oriented games, as an entertainment and education tool dealing with their own medical condition, has already been expressed.[13]

Considering that cancer is a life-threatening disease, it can influence people's lives from different aspects. In fact, it causes many problems due to the progress of the disease.

While the diagnosis is strongly influenced by the individual family circumstances, treatment is often painful and requires frequent periods of hospitalization, and regular checkup by the therapist.[14] Anxiety, fear, uncertainty, anger, and sadness are common challenges that patients and families sometimes have when coping with cancer. They are normal responses to the stress of cancer, especially when the cancer is first diagnosed.[15]

In fact, game and technology-related game is specifically designed for use by patients to improve disease management and alter their lifestyle in fundamental ways. Because of their fun and excitement, they may also provide an innovative way of learning.[16]

Over time, they may also help to eliminate disease side effects due to distraction and being deeply involved in the game. Gamers that suffer from mental health issues are able to vent their frustration and aggression by playing video games and experience a noted improvement. Researchers believe that the ability of the games to act on neuronal mechanisms which activate positive emotions and the reward system help to improve the kids' demeanor as they face the daily challenges of their illness. It should be noted that electronic games do not only provide relief from emotional pain, but they can also help those who are suffering from physical pain.[17] Diet program is an important challenge of physical therapy for patients with cancer. Nutritional recommendations for patients with cancer are different because they are designed to recover the patients' stability against the side effects of cancer treatment. One of the side effects of medications that can affect the nutrition of the patient is lack of appetite.

Healthy eating video games such as the Squire's Quest game are designed for teaching, identifying, and classifying suitable foods in the food groups and identifying the health benefit of each food group in an attractive format for individuals. The Squire's Quest is a computer game designed to increase the children's consumption of fruit, juice, and vegetable (FJV), and thus prevent cancer and other illnesses in the long-term.[18],[19] Moreover, some games in this category have guidelines for good nutrition and wellness, including interactive educational activities and games for patients.[20]

Fatigue is the most common side effect of cancer treatment. This side effect is when a person has little energy to do the things that they normally do or wish to do. This type of fatigue can affect many aspects of a person's life, including the disability to do their usual activities. Exercise programs in the form of exercise games such as rehabilitation programs during treatment can assist them to reduce fatigue.[21]

Cancer rehabilitation exercise helps a person with cancer to obtain the best physical, social, psychological, and health promotion during and after cancer treatment. The goal of rehabilitation is to help a person regain control over many aspects of their lives and remain as independent and productive as possible.[22]

A popular example of clinically available health games, which directly focuses on cancer and improves the patient's adherence to medication plans and perceived self-efficiency, is the action game Re-Mission. The digital game aims to convey basic information about common cancer symptoms and treatment strategies through game mechanics, for example, enemy and weapon design.[23] Ben's Game is another video game about fighting cancer. The objective of the game is to destroy all mutated cells and to collect the seven shields which provide protection against common side effects of chemotherapy. In the game, children with cancer can express their emotion, which in turn relieves little pain. The game is designed in cooperation with Ben who brought his own experience with his disease to the game.[24] The games that are mentioned are summarized in [Table 1].
Table 1: Electronic health games

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Categories of electronic games in health environment

Generally, this technology includes lots of different categories for health-related purposes. Games related to health are being developed in five categories as shown in [Table 2].[6],[28]
Table 2: Categories of electronic games in health environment

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A. Exercise games such as fitness and health promotion which incorporate exercise into playing. They include games that motivate exercise through game play and virtual coaching, such as Nintendo's Wii and Wii Fit for home use. Playing an exercise video game has been found to promote the psychological benefits of exercise.[29]

B. Brain fitness games such as cognitive fitness, brain training, and learning games which educate children on various health conditions. The educational content of these games has been designed to increase illness-related knowledge and change the attitudes and behaviors related to treatment adherence, based on the hope that these changes will lead to better health outcomes.[30]

C. Condition management games such as diabetes, asthma, cancer, and pain management can be used to relieve anxiety and distract from pain. These games provide educational information about the condition and treatment methods to improve adherence to a physician recommended treatment plan.[31]

Packy and Marlon is a platform video game that was designed to improve self-care behaviors in children with juvenile diabetes. Packy and Marlon, two diabetic elephants, are tasked with retrieving the stolen goods and clearing out the malicious rodents, while also remembering to take their insulin and check their blood glucose. At the end of the game, they face the evil bosses Veets and Yebur of the Lunch Room Crew.[28]

D. Healthy eating games such as weight management have been designed to improve the knowledge and behaviors regarding nutrition and weight management.[32]

E. Professional training games such as simulations for training surgeons form an innovative approach to the education of medical professionals, and surgical specialists are eager to apply them for a range of training purposes. Breast Cancer Detective is a web-based learning tool about breast cancer screening for senior medical students.[33] SimCity, another simulation game which has been used to help nursing students, critically considers community issues and practices community planning.[34]

Characteristic features of electronic games

Electronic games have been used strategically to affect a number of issues in health among patients. Well-designed games with the following effective important attributes are user friendly. Some of the most important factors which have been identified in designing this technology are presented in [Table 3].[38],[39]
Table 3: Characteristic features of electronic games

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 > Discussion Top


Electronic games, as digital media, can improve the quality of life people with certain types of health problems.[40] Complex conditions such as chronic diseases like cancer impose irreparable damage to the society in the near future.

The use of health-oriented games, as new digital tools, in empowering patients with cancer can reduce healthcare costs, and facilitate and accelerate the improvement of health services for individuals in addition to entertaining them.

A diagnosis of cancer and its subsequent treatment can have a devastating impact on the quality of life of the patient, as well as on the lives of the family members. Cancer patients may require supportive and palliative care at different stages of the disease and from a range of service providers in the community, hospitals, hospices, care homes, and community hospitals. Patients with cancer require services to ensure their physical, psychological, social, and spiritual needs are met effectively and to enable them to live in the place of their choice, if at all possible.[41] Unfortunately, in this disease, the situation does not get any better. Psychoemotional problems are severe and limit the patients' natural activity. Psychological distress is common among people affected by cancer and is an understandable response to a traumatic and threatening experience.[42] The use of this technology not only improves the cancer patients' health through learning, but also provides an opportunity for lifestyle modification. The therapeutic effects of games are attributed to the distraction which they provide to divert the attention away from these side effects of cancer.[43]

Cancer and its treatment can have a major impact on the patient's ability to carry on with their usual daily routines. Activities that most people take for granted; such as moving, speaking, eating, and drinking; can be severely impaired. Current characteristic attributes of this technology can improve the course of care for patient and increase the motivation. Play and entertainment are effective foundations which probably have a key role in helping patients to manage different aspects of their illness through playing with this tool.[44] This digital device represents an effective method of self-management in a vulnerable population during a critical time of care. Also, games can have indirect clinical implications because they can promote the quality of care through improving the physician's skills involved in patient care. This medium can improve the patients' participation in treatment, increases their knowledge about their disease, and improves self-management training.[45]

The efficacy of games to enhance the quality of life, optimize health behaviors, and improve knowledge suggests that the strengths of these tools should be seriously considered during designing interventions in healthcare. Digital games offer a rare opportunity to leverage the children's already established enthusiasm in order to reform education and promote health development.[46]

Finally, the benefits derived from the use of this new technology for the various groups areas follows:

  • For physicians: Improving the management of patient care without time and place constraints
  • For medical institutions: Reducing treatment costs, reducing visits to centers, and increasing patient and healthcare provider satisfaction
  • For the Ministry of Health: Promoting health culture through educating healthy behaviors in the community, and thereby, improving the quality of life
  • For the society: Increasing the level of participation in social activities through learning social skills and productivity improvement
  • For patients: Continuity of care without the constraints of time and place, reduction of healthcare costs, provision of motivation and vitality, empowerment of the mind, reduction of the adverse physical and psychological consequences of the disease, and lifestyle modification.


This new technology not only has positive impacts on individual but also inappropriate use of the game technology can have negative effects on patient and relatives. In addition to the dimensions of joy, happiness, excitation releasing, teaching, and knowledge improvement; games also have some negative dimensions because of the misuse and incorrect design which may lead to cognitive, mental, and physical damage. On the other hand, if such games are not selected according to the age, culture, and content; it is possible to have consequences such as social isolation, decreased academic performance, increased aggressive behaviors, and disturbed attention, focus problems, etc. These problems can be overcome by appropriate planning, observing the correct design, and enhancing the culture of their use.

Due to mentioned importance, it is essential that we consider planning of health-based computer games and special effort to identify and organize them in order to better take advantage. Therefore, it is required to design and create this technology which not only define the design stages of these modern and effective tools, but also focus on how to apply for improving the effective learning toward healthy life and also to optimize disease management. Finally, the game designers must be in direct contact to physicians, and researchers of health information technology field. Direct relation can be assisted to combine entertainment and training aspects in order to develop health-based games and empower patient to control disease, promotion of self-management, and knowledge level.

The game planners must be in direct contact with physicians and researchers of health information technology, as part of this effort, in order to develop health based games which combine the value of entertainment with training, leading to the empowerment of the patient to control their disease, promote their self-management, and increase their knowledge level.


 > Conclusion Top


In conclusion, using electronic games can promote behavioral changes in cancer patients by improving patient empowerment, promoting self-management, enhancing the quality of life, increasing patient engagement, and changing the health and related behaviors; leading to the optimization of cancer care.

 
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