Image Credits: re-mission.net
Re-mission was released in 2006 and was created for adolescents and young adults battling cancer. Players would guide a nanobot through the bodies of cancer patients and destroy cells, fight bacterial infections and manage the side effects associated with cancer treatments. The game was used as an educational tool to teach patients about their condition, and encourage them to stay on their treatments, which would often include painful and difficult side effects. A study on the affects of Re-Mission indicated an improvement of key behavioral and psychological factors associated with successful cancer treatments. Participants in the study maintained higher levels of chemotherapy, and adhered to their antibiotic protocols more consistently than the patients in the control group, suggesting that the game had a positive impact on a biological level. The study also showed that participants who played Re-Mission acquired faster cancer-related knowledge and an increase in self-efficacy. The results of the study suggest that a well-thought out video game could have a positive impact on health behavior in younger patients with a chronic condition. After the initial success of Re-Mission, HopeLab created Re-Mission 2 which is accessible online.
The researchers of the study hypothesized that motivational processes including knowledge about the therapy and its relationship to health, perceptions of the patient’s ability to influence health outcomes (perceived control), and confidence in the patient’s ability to meet specific demands of cancer treatment and recovery (cancer-specific self-efficacy) are likely to increase treatment adherence. The study asked participants to play Re-Mission for at least one hour per week during the three-month study period. The elements of the game were designed based on research that identified as critical for optimal patient participation in cancer treatment. To win the game, players were required to strategically ensure that the virtual patients engaged in positive self-care behaviors, including treatment adherence to fight cancer cells, antibiotic adherence to prevent infections, and other medication and self-care techniques to prevent bowel perforations, combat mucositis, learning relaxation techniques to reduce stress, and healthy eating to keep the patient energized and healthy. The game was designed in a manner in which the characters did not “die” if they failed to meet their objectives, but their nanobot character would simply power down and allow the player to start over. Players were required to successfully finish each mission before they were able to move to the next level. The participants were a mix of ethnicities and socio-economic backgrounds.
The study results were consistent with social learning theory, and suggested that changes in cancer-specific self-efficacy and knowledge about cancer contributed to treatment adherence. While the study showed an improvement in some areas of treatment adherence, there were areas that showed no significant improvement, or in some cases the improvements were not determined to be related to a specific factor of the game itself.
While the results of this game indicated that adherence to treatment was improved in some cases, and an increase in illness education was noted, it is interesting that the approach to the game design differed from that of Squire’s Quest, Escape from Diab, and Nanoswarm. These games were developed with an emphasis on a robust story line, while Re-Mission was more focused on individual gameplay and education through activities. The results of the Re-Mission study suggest that a fully developed story line is not necessary in behavioral modification or motivation. The Re-Mission study was developed for participants who were undergoing treatment for a chronic condition, while the other game studies were developed as tools to modify behavior in a manner that was focused on preventative health. It could be concluded that the results of the Re-Mission study were significant due to the existing motivation of participants to adhere to treatment, as opposed to the participants in the other studies who may not have been as motivated to adhere to preventative lifestyle changes. It should also be noted that the availability of the necessary adherence measures was more likely for the Re-Mission study in that the participants were ensured to have access to their medications, while the other studies required participants to make healthy eating decisions and food purchases that may have required more active participation outside of a clinical setting.
The results of the Re-Mission study suggest that the use of a video game designed for patients diagnosed with a health condition would be likely to benefit from education through gameplay. The study is not wholly conclusive in regards to the current project because it was only partially successful, and it was conducted on a small percentage of patients relegated to a very specific age range. It did not determine if game play would be an effective means of patient education in a wider range of patient populations.
Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. H. (2008). A Video Game Improves Behaviroal Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial. Pediatrics, 122(2), 305-317. Retrieved February 6, 2016.