A Serious Game to Support Advance Care Planning in Pediatrics: Usability Study of L’Arbre

A Serious Game to Support Advance Care Planning in Pediatrics: Usability Study of L’Arbre | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Serious Game to Support Advance Care Planning in Pediatrics: Usability Study of L’Arbre Margot Bonvin, Tatiana Delieutraz-Petit, Christine Clavien This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9083918/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Purpose Advance care planning discussions are increasingly recognized as an important component of adequate care. However, they involve discussions about worst-case and end-of-life scenarios, which are difficult to address. Few conversational tools exist to facilitate these sensitive discussions with children and their family caregivers. We have developed a game – L’Arbre – to initiate these discussions. In this study, we assessed the usability of the first version of the game (design, user-friendliness, learnability, relevance, and endorsement). Methods In two gaming sessions, six participants (two children, two parents, and two health professionals) evaluated the game. The test involved a rapid desirability test, a think-aloud procedure, answers to questionnaires (including Single Ease Question, Attrakdiff) and qualitative feed-back. Usability problems were listed, described, categorized and rated for severity. An expert workshop was organized to validate the analysis and decide on modifications. Results Participants successfully completed the think-aloud tasks with some assistance. The mean ease-of-task score was 5.42 (± 0.97, on a 1–7 Likert scale). Twenty-seven usability problems were identified, mostly related to complex game rules, unclear instructions, and some confusing design elements. All issues could be addressed through minor adjustments and targeted training for health professionals. Overall, participants expressed strong endorsement, with high scores across all evaluation criteria. Conclusion The first version of the game demonstrated its potential to support ACP communication. The test supported the development of a revised version of the game and a complementary training program. L’Arbre is now ready for feasibility testing in clinical settings to evaluate its integration into practice. advance care planning usability serious game conversation tool pediatrics Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1V1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 10 Apr, 2026 Reviews received at journal 08 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor invited by journal 12 Mar, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 10 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9083918","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619191726,"identity":"d8e7df3c-e992-4022-91cf-cfcc1824c809","order_by":0,"name":"Margot Bonvin","email":"","orcid":"","institution":"University of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Margot","middleName":"","lastName":"Bonvin","suffix":""},{"id":619191727,"identity":"4382a5a5-3778-4226-8f81-f1f7caf46e02","order_by":1,"name":"Tatiana Delieutraz-Petit","email":"","orcid":"","institution":"University of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Tatiana","middleName":"","lastName":"Delieutraz-Petit","suffix":""},{"id":619191728,"identity":"45f8337b-6d6a-4731-8b0b-d0bea78aad79","order_by":2,"name":"Christine Clavien","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIie2PMUvDQBTHXwnU5UHWF5D6FU6EtELxs9whZCougnSqASEuVtdAv0QmVy/c0CUfIKJDsndxu0pAL03BgonSTeR+w/He/e/HewdgsfxFCEBuToBeUxyEAHwbdSu8SRsF5e/K9sVGqW/4bvQddzEv07UeXbjgFHIdjQZDb+UXxfvYRGH7kNclU8jp0gv7LJ1HdHK6mAyZuA9MJFsVRgEo8xeRSASJmSleJj6JO2Ui3qmk2ihPRkmrjK6T56xWPn5UJNZTAEHhlDjL0SeuZadCuVkMAxKx6jN1OKXjJAuuSITnSHm74saB86bHM/Fwe1OWKzY7Ykv16OnqbODG7coXzm7Ti8yee1LtK1gsFss/5hNgFV4uxEG9yAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Geneva","correspondingAuthor":true,"prefix":"","firstName":"Christine","middleName":"","lastName":"Clavien","suffix":""}],"badges":[],"createdAt":"2026-03-10 12:24:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9083918/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9083918/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106725010,"identity":"71d90c70-9632-48bc-9b52-bf7198f0d724","added_by":"auto","created_at":"2026-04-12 18:30:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":562342,"visible":true,"origin":"","legend":"","description":"","filename":"DraftArbreUsabilityTestV1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9083918/v1_covered_565becb9-32b5-4fb9-a96c-e99278846d6c.pdf"},{"id":106458721,"identity":"d93a3d2c-c315-49fc-b19b-589835b89788","added_by":"auto","created_at":"2026-04-08 18:55:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":733543,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1V1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9083918/v1/b5b5956319d762113d98cabf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Serious Game to Support Advance Care Planning in Pediatrics: Usability Study of L’Arbre","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"advance care planning, usability, serious game, conversation tool, pediatrics","lastPublishedDoi":"10.21203/rs.3.rs-9083918/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9083918/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eAdvance care planning discussions are increasingly recognized as an important component of adequate care. However, they involve discussions about worst-case and end-of-life scenarios, which are difficult to address. Few conversational tools exist to facilitate these sensitive discussions with children and their family caregivers. We have developed a game \u0026ndash; \u003cem\u003eL\u0026rsquo;Arbre\u003c/em\u003e \u0026ndash; to initiate these discussions. In this study, we assessed the usability of the first version of the game (design, user-friendliness, learnability, relevance, and endorsement).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn two gaming sessions, six participants (two children, two parents, and two health professionals) evaluated the game. The test involved a rapid desirability test, a think-aloud procedure, answers to questionnaires (including Single Ease Question, Attrakdiff) and qualitative feed-back. Usability problems were listed, described, categorized and rated for severity. An expert workshop was organized to validate the analysis and decide on modifications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants successfully completed the think-aloud tasks with some assistance. The mean ease-of-task score was 5.42 (\u0026plusmn;\u0026thinsp;0.97, on a 1\u0026ndash;7 Likert scale). Twenty-seven usability problems were identified, mostly related to complex game rules, unclear instructions, and some confusing design elements. All issues could be addressed through minor adjustments and targeted training for health professionals. Overall, participants expressed strong endorsement, with high scores across all evaluation criteria.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe first version of the game demonstrated its potential to support ACP communication. The test supported the development of a revised version of the game and a complementary training program. \u003cem\u003eL\u0026rsquo;Arbre\u003c/em\u003e is now ready for feasibility testing in clinical settings to evaluate its integration into practice.\u003c/p\u003e","manuscriptTitle":"A Serious Game to Support Advance Care Planning in Pediatrics: Usability Study of L’Arbre","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 18:55:45","doi":"10.21203/rs.3.rs-9083918/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"238820086027252282171355387567514746708","date":"2026-04-10T17:17:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T17:40:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50896421398018861496041533087480002537","date":"2026-04-08T17:06:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T17:33:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-12T07:20:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T07:39:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T07:38:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-03-10T12:16:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"954e4dc1-3a42-4c98-ae1a-23ab8192c314","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T18:55:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 18:55:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9083918","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9083918","identity":"rs-9083918","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}