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

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.