Healing Gardens: Leveraging serious games to deliver accessible pain-CBT and pharmacologic support for patients with advanced cancer managing pain - Project Summary Pain affects approximately two-thirds of patients with advanced cancer, significantly impacting their physical, psychological, and social well-being. While opioids are essential for managing cancer pain, up to 60% of patients experience inadequate relief. Cognitive Behavioral Therapy for pain (pain-CBT) is the gold standard psychological treatment for chronic pain. It is shown to improve pain intensity, disability, and quality of life. However, traditional pain-CBT (60-minute sessions over 3-4 months) remains impractical for most advanced cancer patients due to logistical barriers and disease burden. To address this, our group used the ORBIT model of behavioral treatment development to develop and pilot test a pain-CBT mHealth app that integrates multi-media cancer pain education, symptom reporting algorithms, and mini-serious games designed specifically for patients with advanced cancer and chronic pain. In pilot testing, engagement was high. However, most felt that the survey component of the app was burdensome, and many expressed a desire for a more comprehensive, standalone serious game experience. Our pilot data demonstrate the promise of the Healing Gardens intervention, but also the need for further refinement and testing prior to an efficacy study. The goal of this current proposal is to optimize and pilot test, Healing Gardens, a serious game that delivers pain-CBT tailored to support advanced cancer patients as they self-manage chronic pain using opioids. The intervention leverages our previously developed multi-media cancer pain education integrated with mini games and gamified elements, such as 2D animations, interactive feedback, and visuals/ metaphors to enhance engagement and skill-building while overcoming the stigma associated with psychological pain treatment. In Aim 1, with our community advisory board (patient and clinician experts), we will refine Healing Gardens through a series of qualitative wireframe interviews (n=10) to optimize the ratio of content versus gameplay, module length, and delivery prompts. Then, we will conduct a series of mini pre-pilot trials (n=9, 3 sets of 3) to assess feasibility and acceptability allowing for optimization. In Aim 2, we will conduct a randomized pilot trial with 60 patients recruited from outpatient palliative care clinics, randomizing patients 1:1 to Healing Gardens or app-based symptom tracking and cancer pain education for 4 weeks. Patients will complete surveys at baseline, 4 and 8 weeks to evaluate changes in primary (worst pain) and secondary outcomes (e.g., pain interference, pain self-efficacy, quality of life). Feasibility will be assessed by recruitment, retention, survey completion, and gameplay benchmarks to guide the design of a future efficacy trial. Triangulated with quantitative findings, qualitative debriefing interviews will explore the role of gameplay in skill transfer to daily life and identify facilitators/barriers to engagement to inform the intervention dose for the future trial. If successful, Healing Gardens can provide an innovative, scalable solution to deliver psychological pain care and improve advanced cancer pain self-management for millions suffering from debilitating pain.
