Utilising Card Game to Promote Advance Care Planning in Thailand: An Innovative Approach

Background/aims: Advance Care Planning (ACP) enables individual to conceptualise and express their preferences of care in the case of future incapacitation or towards end-of-life. The ACP uptake and its awareness remain low amongst healthcare professionals and the public in Thailand. Peaceful Death, a community driven organisation, seeks to raise ACP awareness and increases its uptake through the use of the Life Unlocking Care Game. The card game empowers the lived experience of people, facilitates the socially constructed experience and tacit knowledge around death and dying, is culturally appropriate and empowers ACP discussion and documentation that goes beyond end-of-life care as well as medical care preferences for Thais.

Methods: From 2018-2020, Peaceful Death conducted three-day online training with ACP facilitators, focusing on communication skills and how to facilitate the card game session. Facilitators were also introduced to Baojai book, a jargon-free booklet that allows individuals to record their advance directive thus making it legally-binding. After the training, facilitators went to their communities and led the card game session initiatives for the public. Online survey were sent and 4 focus groups were conducted to evaluate the impact of the training programme.

Results: Nine cohorts of facilitators were trained. 107/283 participants completed the online survey and 22 joined the focus groups. In total, the trained participants reached out to 26993 people. Of which, 15,555 joined the ACP sessions and 9,588 subsequently completed their advance directives. Team reflexivity indicates the card game to be appropriate in Thai context due to its i) cultural appropriateness that addresses relational autonomy; ii) normalisation of ACP conversation in a non-threatening environment.

Conclusions: This project demonstrates a wide-scale training of ACP in a resource-limited setting. Findings resonated with Thai palliative care policies that aim to implement ACP nation-wide and should be further utilised.