Exploring the Impact of " ACP Board Game for Life" on Death Preparation and Anxiety in Patients With Stage 4 and 5 Chronic Kidney Diseases: A Pilot Study

Chronic Kidney Disease Clinical Trial

Official title:

Exploring the Impact of " ACP Board Game for Life" on Death Preparation and Anxiety in Patients With Stage 4 and 5 Chronic Kidney Diseases: A Pilot Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT06046261
• Other study ID #: B-ER-110-472
• Status: Completed
• Phase: N/A
• Start date: January 1, 2022
• Est. completion date: February 28, 2023

Study information

• Verified date: September 2023
• Source: National Cheng-Kung University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study was to explore the impacts of participating in "ACP board game for life" on death preparation, death anxiety, end-of-life care preferences, and intervention perception in stage 4-5 CKD patients with advanced chronic kidney diseases in a medical center.

Description:

This study was to explore the impacts of participating in "ACP board game for life" on death preparation, death anxiety, end-of-life care preferences, and intervention perception in stage 4-5 CKD patients with advanced chronic kidney diseases in a medical center. A nonrandomized two-arm pretest and posttest quasi-experimental design was used. Patients in the control group received routine care while patients in the experimental group received routine care and ACP board game for life. The ACP board game, death preparation subscale, Chinese Likert death anxiety scale, self-created questionnaires and brief interview were used for data collection.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 69
• Est. completion date: February 28, 2023
• Est. primary completion date: February 28, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 21 Years to 78 Years

Eligibility

Inclusion Criteria:

• Stage 4-5 chronic kidney disease patients
• Chinese nationality
• Over 20 years old
• Consciousness clear, can communicate and express their opinions in Mandarin and Taiwanese

Exclusion Criteria:

• Patients express that talking about death makes them feel scared or cause anxiety
• The doctor assesses that the patient's condition is in the stage of septic shock, hemodynamic instability, asthma, pulmonary edema, hypoxemia or acute myocardial infarction
• Patients with contact or airborne precautions
• Patients without legal capacity

Related Conditions & MeSH terms

• Advance Care Planning
• Anxiety Disorders
• Chronic Kidney Disease
• Chronic Renal Failure
• Chronic Renal Insufficiency
• Death
• End of Life Care
• Kidney Diseases
• Kidney Failure, Chronic
• Renal Insufficiency
• Renal Insufficiency, Chronic

Intervention

Other:
• ACP board game for life
The research subjects will be assigned to the experimental group or the control group according to their wishes. Those who are willing to participate the ACP board game will be assigned to the experimental group. The intervention time for each board game is around 2 hours. There are 60 cards in this ACP board game; the focus of the game is to know the participants' thoughts on the card options. Questionnaires need to be filled in before and after intervention.

Locations

Country	Name	City	State
Taiwan	National Cheng Kung University Hospital	Tainan

Sponsors (1)

Lead Sponsor	Collaborator
National Cheng-Kung University Hospital

Country where clinical trial is conducted

Taiwan, 

References & Publications (63)

Abdel-Khalek AM, El Nayal MA. Death anxiety in Lebanese college students in 1998 and 2015. Death Stud. 2019;43(9):542-546. doi: 10.1080/07481187.2018.1500006. Epub 2018 Sep 5. — View Citation

An E, Lo C, Hales S, Zimmermann C, Rodin G. Demoralization and death anxiety in advanced cancer. Psychooncology. 2018 Nov;27(11):2566-2572. doi: 10.1002/pon.4843. Epub 2018 Aug 20. — View Citation

Ang YG, Heng BH, Saxena N, Liew STA, Chong PN. Annual all-cause mortality rate for patients with diabetic kidney disease in Singapore. J Clin Transl Endocrinol. 2016 Jan 27;4:1-6. doi: 10.1016/j.jcte.2016.01.002. eCollection 2016 Jun. — View Citation

Axelsson L, Alvariza A, Lindberg J, Ohlen J, Hakanson C, Reimertz H, Furst CJ, Arestedt K. Unmet Palliative Care Needs Among Patients With End-Stage Kidney Disease: A National Registry Study About the Last Week of Life. J Pain Symptom Manage. 2018 Feb;55(2):236-244. doi: 10.1016/j.jpainsymman.2017.09.015. Epub 2017 Sep 21. — View Citation

Bekker YAC, Suntjens AF, Engels Y, Schers H, Westert GP, Groenewoud AS. Advance care planning in primary care: a retrospective medical record study among patients with different illness trajectories. BMC Palliat Care. 2022 Feb 14;21(1):21. doi: 10.1186/s12904-022-00907-6. — View Citation

Caserta M, Utz R, Lund D, Supiano K, Donaldson G. Cancer Caregivers' Preparedness for Loss and Bereavement Outcomes: Do Preloss Caregiver Attributes Matter? Omega (Westport). 2019 Dec;80(2):224-244. doi: 10.1177/0030222817729610. Epub 2017 Sep 8. — View Citation

Chan HL, Li IF, Tseng LC, Hsiung Y. Exploring Behavioral Readiness and Program Strategies to Engage Older Community Residents in Advance Care Planning: A Pilot Mixed-Method Study in Taiwan. Int J Environ Res Public Health. 2020 Jun 16;17(12):4285. doi: 10.3390/ijerph17124285. — View Citation

Chan TH, Chan FM, Tin AF, Chow AY, Chan CL. Death preparation and anxiety: a survey in Hong Kong. Omega (Westport). 2006-2007;54(1):67-78. doi: 10.2190/6478-6572-v704-1545. — View Citation

Cross SH, Lakin JR, Mendu M, Mandel EI, Warraich HJ. Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States. J Pain Symptom Manage. 2021 Jan;61(1):112-120.e1. doi: 10.1016/j.jpainsymman.2020.08.001. Epub 2020 Aug 10. — View Citation

Davison SN. End-of-life care preferences and needs: perceptions of patients with chronic kidney disease. Clin J Am Soc Nephrol. 2010 Feb;5(2):195-204. doi: 10.2215/CJN.05960809. Epub 2010 Jan 14. — View Citation

Delanaye P, Jager KJ, Bokenkamp A, Christensson A, Dubourg L, Eriksen BO, Gaillard F, Gambaro G, van der Giet M, Glassock RJ, Indridason OS, van Londen M, Mariat C, Melsom T, Moranne O, Nordin G, Palsson R, Pottel H, Rule AD, Schaeffner E, Taal MW, White C, Grubb A, van den Brand JAJG. CKD: A Call for an Age-Adapted Definition. J Am Soc Nephrol. 2019 Oct;30(10):1785-1805. doi: 10.1681/ASN.2019030238. Epub 2019 Sep 10. — View Citation

Deodhar J, Nagaraju SP, Kirpalani AL, Nayak AM. Shared Decision-Making, Advance Care Planning for Chronic Kidney Disease Patients. Indian J Palliat Care. 2021 May;27(Suppl 1):S33-S36. doi: 10.4103/ijpc.ijpc_71_21. Epub 2021 May 30. — View Citation

Desta BZ, Dadi AF, Derseh BT. Mortality in hemodialysis patients in Ethiopia: a retrospective follow-up study in three centers. BMC Nephrol. 2023 Jan 4;24(1):3. doi: 10.1186/s12882-022-03053-6. — View Citation

Douglas CA. Palliative care for patients with advance chronic kidney disease. J R Coll Physicians Edinb. 2014;44(3):224-31. doi: 10.4997/JRCPE.2014.309. — View Citation

Durepos P, Sussman T, Ploeg J, Akhtar-Danesh N, Punia H, Kaasalainen S. What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia? Am J Hosp Palliat Care. 2019 May;36(5):436-446. doi: 10.1177/1049909118814240. Epub 2018 Dec 5. — View Citation

Galiana L, Oliver A, De Simone G, Linzitto JP, Benito E, Sanso N. A Brief Measure for the Assessment of Competence in Coping With Death: The Coping With Death Scale Short Version. J Pain Symptom Manage. 2019 Feb;57(2):209-215. doi: 10.1016/j.jpainsymman.2018.11.003. Epub 2018 Nov 15. — View Citation

Gonzalez AM, Gutman T, Lopez-Vargas P, Anumudu S, Arce CM, Craig JC, Dunn L, Eckardt KU, Harris T, Levey AS, Lightstone L, Scholes-Robertson N, Shen JI, Teixeira-Pinto A, Wheeler DC, White D, Wilkie M, Jadoul M, Winkelmayer WC, Tong A. Patient and Caregiver Priorities for Outcomes in CKD: A Multinational Nominal Group Technique Study. Am J Kidney Dis. 2020 Nov;76(5):679-689. doi: 10.1053/j.ajkd.2020.03.022. Epub 2020 May 31. — View Citation

Gotze H, Brahler E, Gansera L, Schnabel A, Gottschalk-Fleischer A, Kohler N. Anxiety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death. Eur J Cancer Care (Engl). 2018 Mar;27(2):e12606. doi: 10.1111/ecc.12606. Epub 2016 Nov 17. — View Citation

Holley JL, Davison SN. Advance care planning for patients with advanced CKD: a need to move forward. Clin J Am Soc Nephrol. 2015 Mar 6;10(3):344-6. doi: 10.2215/CJN.00290115. Epub 2015 Feb 13. No abstract available. — View Citation

Holley JL. Advance care planning in CKD/ESRD: an evolving process. Clin J Am Soc Nephrol. 2012 Jun;7(6):1033-8. doi: 10.2215/CJN.00580112. Epub 2012 Mar 29. — View Citation

Holley JL. Palliative care in end-stage renal disease: focus on advance care planning, hospice referral, and bereavement. Semin Dial. 2005 Mar-Apr;18(2):154-6. doi: 10.1111/j.1525-139X.2005.18208.x. — View Citation

Hong YA, Chung S, Park WY, Bae EJ, Yang JW, Shin DH, Kim SW, Shin SJ; Committee on Ethical Issues of the Korean Society of Nephrology. Nephrologists' Perspectives on Decision Making About Life-Sustaining Treatment and Palliative Care at End of Life: A Questionnaire Survey in Korea. J Palliat Med. 2021 Apr;24(4):527-535. doi: 10.1089/jpm.2020.0248. Epub 2020 Sep 30. — View Citation

Hovland C. When Death With Dementia Is "A Memory Seared in My Brain": Caregivers' Recommendations to Health Care Professionals. J Appl Gerontol. 2020 Nov;39(11):1195-1202. doi: 10.1177/0733464819884267. Epub 2019 Oct 23. — View Citation

Hovland CA, Kramer BJ. Barriers and Facilitators to Preparedness for Death: Experiences of Family Caregivers of Elders with Dementia. J Soc Work End Life Palliat Care. 2019 Jan-Mar;15(1):55-74. doi: 10.1080/15524256.2019.1595811. Epub 2019 Apr 18. — View Citation

Khodarahimi S, Veiskarami HA, Mazraeh N, Sheikhi S, Rahimian Bougar M. Mental Health, Social Support, and Death Anxiety in Patients With Chronic Kidney Failure. J Nerv Ment Dis. 2021 Nov 1;209(11):809-813. doi: 10.1097/NMD.0000000000001386. — View Citation

Ladin K, Neckermann I, D'Arcangelo N, Koch-Weser S, Wong JB, Gordon EJ, Rossi A, Rifkin D, Isakova T, Weiner DE. Advance Care Planning in Older Adults with CKD: Patient, Care Partner, and Clinician Perspectives. J Am Soc Nephrol. 2021 Jun 1;32(6):1527-1535. doi: 10.1681/ASN.2020091298. Epub 2021 Apr 7. — View Citation

Liu L, Chan HY, Ho TC, Chow RS, Li MM, Cheung EW, Gu C, Wang Y. A serious game for engaging older adults in end-of-life care discussion: A mixed method study. Patient Educ Couns. 2023 Aug;113:107787. doi: 10.1016/j.pec.2023.107787. Epub 2023 May 3. — View Citation

Liu L, Zhao YY, Yang C, Chan HY. Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis. Palliat Med. 2021 Jun;35(6):1005-1019. doi: 10.1177/02692163211005343. Epub 2021 Mar 29. — View Citation

Loosman WL, Rottier MA, Honig A, Siegert CE. Association of depressive and anxiety symptoms with adverse events in Dutch chronic kidney disease patients: a prospective cohort study. BMC Nephrol. 2015 Sep 21;16:155. doi: 10.1186/s12882-015-0149-7. — View Citation

Luckett T, Spencer L, Morton RL, Pollock CA, Lam L, Silvester W, Sellars M, Detering KM, Butow PN, Tong A, Clayton JM. Advance care planning in chronic kidney disease: A survey of current practice in Australia. Nephrology (Carlton). 2017 Feb;22(2):139-149. doi: 10.1111/nep.12743. — View Citation

Maddalena V, O'Shea F, Barrett B. An Exploration of Palliative Care Needs of People With End-Stage Renal Disease on Dialysis: Family Caregiver's Perspectives. J Palliat Care. 2018 Jan;33(1):19-25. doi: 10.1177/0825859717747340. Epub 2017 Dec 27. — View Citation

Maniam R, Tan MP, Chong MC. End of life care preference among hemodialysis population: Revisit Q methodology. Patient Educ Couns. 2022 Jun;105(6):1495-1502. doi: 10.1016/j.pec.2021.09.026. Epub 2021 Sep 29. — View Citation

McLeod-Sordjan R. Death preparedness: a concept analysis. J Adv Nurs. 2014 May;70(5):1008-19. doi: 10.1111/jan.12252. Epub 2013 Sep 15. — View Citation

Merces CAMF, Souto JDSS, Zaccaro KRL, de Souza JF, Primo CC, Brandao MAG. Death Anxiety: Concept Analysis and Clarification of Nursing Diagnosis. Int J Nurs Knowl. 2020 Jul;31(3):218-227. doi: 10.1111/2047-3095.12260. Epub 2019 Sep 20. — View Citation

Miller-Lewis L, Tieman J, Rawlings D, Parker D, Sanderson C. Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course. Omega (Westport). 2020 Jun;81(2):242-271. doi: 10.1177/0030222818765813. Epub 2018 Mar 26. — View Citation

Nair D, Bonnet K, Wild MG, Umeukeje EM, Fissell RB, Faulkner ML, Bahri NS, Bruce MA, Schlundt DG, Wallston KA, Cavanaugh KL. Psychological Adaptation to Serious Illness: A Qualitative Study of Culturally Diverse Patients With Advanced Chronic Kidney Disease. J Pain Symptom Manage. 2021 Jan;61(1):32-41.e2. doi: 10.1016/j.jpainsymman.2020.07.014. Epub 2020 Jul 22. — View Citation

Navise NH, Mokwatsi GG, Gafane-Matemane LF, Fabian J, Lammertyn L. Kidney dysfunction: prevalence and associated risk factors in a community-based study from the North West Province of South Africa. BMC Nephrol. 2023 Jan 30;24(1):23. doi: 10.1186/s12882-023-03068-7. — View Citation

Nelson-Becker H, Victor C. Dying alone and lonely dying: Media discourse and pandemic conditions. J Aging Stud. 2020 Dec;55:100878. doi: 10.1016/j.jaging.2020.100878. Epub 2020 Sep 23. — View Citation

O'Riordan J, Noble H, Kane PM, Smyth A. Advance care plan barriers in older patients with end-stage renal disease: a qualitative nephrologist interview study. BMJ Support Palliat Care. 2020 Dec;10(4):e39. doi: 10.1136/bmjspcare-2018-001759. Epub 2019 Jun 25. — View Citation

Oskoui T, Pandya R, Weiner DE, Wong JB, Koch-Weser S, Ladin K. Advance Care Planning Among Older Adults With Advanced Non-Dialysis-Dependent CKD and Their Care Partners: Perceptions Versus Reality? Kidney Med. 2020 Jan 31;2(2):116-124. doi: 10.1016/j.xkme.2019.11.002. eCollection 2020 Mar-Apr. — View Citation

Qiu Q, Zhang S, Lin X, Ban C, Yang H, Liu Z, Wang J, Wang T, Xiao S, Abdel-Khalek AM, Li X. Psychometric Properties of the Chinese Version of the Arabic Scale of Death Anxiety. Shanghai Arch Psychiatry. 2016 Jun 25;28(3):139-146. doi: 10.11919/j.issn.1002-0829.216033. — View Citation

Raghavan D, Holley JL. Conservative Care of the Elderly CKD Patient: A Practical Guide. Adv Chronic Kidney Dis. 2016 Jan;23(1):51-6. doi: 10.1053/j.ackd.2015.08.003. — View Citation

Rai NK, Wang Z, Drawz PE, Connett J, Murphy DP. CKD Progression Risk and Subsequent Cause of Death: A Population-Based Cohort Study. Kidney Med. 2023 Jan 21;5(4):100604. doi: 10.1016/j.xkme.2023.100604. eCollection 2023 Apr. — View Citation

Richards CA, Liu CF, Hebert PL, Ersek M, Wachterman MW, Reinke LF, Taylor LL, O'Hare AM. Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD. Clin J Am Soc Nephrol. 2019 Sep 6;14(9):1324-1335. doi: 10.2215/CJN.01560219. Epub 2019 Aug 29. — View Citation

Robbins RA. Death competency: a study of hospice volunteers. Death Stud. 1992 Nov-Dec;16(6):557-69. doi: 10.1080/07481189208252598. — View Citation

Saeed F, Sardar MA, Davison SN, Murad H, Duberstein PR, Quill TE. Patients' perspectives on dialysis decision-making and end-of-life care . Clin Nephrol. 2019 May;91(5):294-300. doi: 10.5414/CN109608. — View Citation

Sahan E, Eroglu MZ, Karatas MB, Mutluer B, Ugurpala C, Berkol TD. Death anxiety in patients with myocardial infarction or cancer. Egypt Heart J. 2018 Sep;70(3):143-147. doi: 10.1016/j.ehj.2018.04.003. Epub 2018 Apr 30. — View Citation

Sellars M, Clayton JM, Detering KM, Tong A, Power D, Morton RL. Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis. PLoS One. 2019 May 31;14(5):e0217787. doi: 10.1371/journal.pone.0217787. eCollection 2019. — View Citation

Sellars M, Clayton JM, Morton RL, Luckett T, Silvester W, Spencer L, Pollock CA, Walker RG, Kerr PG, Tong A. An Interview Study of Patient and Caregiver Perspectives on Advance Care Planning in ESRD. Am J Kidney Dis. 2018 Feb;71(2):216-224. doi: 10.1053/j.ajkd.2017.07.021. Epub 2017 Nov 11. — View Citation

Sharif Nia H, Pahlevan Sharif S, Koocher GP, Yaghoobzadeh A, Haghdoost AA, Mar Win MT, Soleimani MA. Psychometric Properties of the Death Anxiety Scale-Extended among Patients with End-Stage Renal Disease. Omega (Westport). 2020 Feb;80(3):380-396. doi: 10.1177/0030222817733220. Epub 2017 Oct 5. — View Citation

Skulason B, Hauksdottir A, Ahcic K, Helgason AR. Death talk: gender differences in talking about one's own impending death. BMC Palliat Care. 2014 Mar 11;13(1):8. doi: 10.1186/1472-684X-13-8. — View Citation

Soleimani MA, Bahrami N, Zarabadi-Pour S, Motalebi SA, Parker A, Chan YH. Predictors of death anxiety among patients with heart disease. Death Stud. 2020;44(3):160-167. doi: 10.1080/07481187.2018.1527416. Epub 2018 Nov 8. — View Citation

Soleimani MA, Lehto RH, Negarandeh R, Bahrami N, Chan YH. Death Anxiety and Quality of Life in Iranian Caregivers of Patients With Cancer. Cancer Nurs. 2017 Jan/Feb;40(1):E1-E10. doi: 10.1097/NCC.0000000000000355. — View Citation

Song MK, Ward SE, Fine JP, Hanson LC, Lin FC, Hladik GA, Hamilton JB, Bridgman JC. Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates. Am J Kidney Dis. 2015 Nov;66(5):813-22. doi: 10.1053/j.ajkd.2015.05.018. Epub 2015 Jun 30. — View Citation

Templer DI. The construction and validation of a Death Anxiety Scale. J Gen Psychol. 1970 Apr;82(2d Half):165-77. doi: 10.1080/00221309.1970.9920634. No abstract available. — View Citation

Uslu-Sahan F, Terzioglu F, Koc G. Hopelessness, Death Anxiety, and Social Support of Hospitalized Patients With Gynecologic Cancer and Their Caregivers. Cancer Nurs. 2019 Sep/Oct;42(5):373-380. doi: 10.1097/NCC.0000000000000622. — View Citation

Van Scoy LJ, Green MJ, Reading JM, Scott AM, Chuang CH, Levi BH. Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning? Am J Hosp Palliat Care. 2017 Sep;34(8):754-761. doi: 10.1177/1049909116656353. Epub 2016 Jul 12. — View Citation

Van Scoy LJ, Levi BH, Witt P, Bramble C, Richardson C, Putzig I, Levi AR, Wasserman E, Chinchilli V, Tucci A, Green MJ. Association of Participation in an End-of-Life Conversation Game With Advance Care Planning Behavior and Perspectives Among African American Individuals. JAMA Netw Open. 2020 May 1;3(5):e204315. doi: 10.1001/jamanetworkopen.2020.4315. — View Citation

Van Scoy LJ, Reading JM, Hopkins M, Smith B, Dillon J, Green MJ, Levi BH. Community Game Day: Using an End-of-Life Conversation Game to Encourage Advance Care Planning. J Pain Symptom Manage. 2017 Nov;54(5):680-691. doi: 10.1016/j.jpainsymman.2017.07.034. Epub 2017 Jul 23. — View Citation

Van Scoy LJ, Reading JM, Scott AM, Chuang C, Levi BH, Green MJ. Exploring the Topics Discussed During a Conversation Card Game About Death and Dying: A Content Analysis. J Pain Symptom Manage. 2016 Nov;52(5):655-662. doi: 10.1016/j.jpainsymman.2016.03.021. Epub 2016 Sep 17. — View Citation

Wasylynuk BA, Davison SN. An overview of advance care planning for patients with advanced chronic kidney disease: The basics. CANNT J. 2016 Jan-Mar;26(1):24-9. — View Citation

Wen FH, Hsieh CH, Chou WC, Su PJ, Hou MM, Shen WC, Chen JS, Chang WC, Tang ST. Factors associated with cancer patients' distinct death-preparedness states. Psychooncology. 2023 Jul;32(7):1048-1056. doi: 10.1002/pon.6146. Epub 2023 Apr 27. — View Citation

Yang CH, Wu CY, Low JTS, Chuang YS, Huang YW, Hwang SJ, Chen PJ. Exploring the Impact of Different Types of Do-Not-Resuscitate Consent on End-of-Life Treatments among Patients with Advanced Kidney Disease: An Observational Study. Int J Environ Res Public Health. 2021 Aug 2;18(15):8194. doi: 10.3390/ijerph18158194. — View Citation

* Note: There are 63 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Death Preparation	The death preparation subscale total of 8 items measure death preparation.The range of total scores of the subscale is 8-40. It shows that the higher scores, the better death preparedness.	2hours
Primary	Death Anxiety	The Chinese Likert death anxiety scale was used, with a total of 15 items, using a Likert scale of 1 to 5 (1 means completely disagree, 2 means disagree, 3 means fair, 4 means agree, and 5 means completely agree) ), the total scores of the scale ranges from 15 to 75. The higher total scores, the higher degree of death anxiety.	2hours
Primary	End-of-Life Care Preferences	A self-made questionnaire on end-of-life care preferences for patients with stage 4-5 CKD was used. There were 2 items in the scale. The item type was multiple choice, the scoring method is based on the number of times and percentages chosen by the participants.	2hours
Primary	Intervention Perception	A self-made questionnaire on the feelings of CKD stage 4-5 patients after participating in the " ACP board game for life " was used. There are 4 items in the scale, using a Likert scoring method of 1 to 5 points (1 point means completely disagree, 2 points means disagree, 3 points means neither agree nor disagree, 4 points means agree, 5 points means strongly agree), the scoring method is based on the participant's options for Mean±SD, frequency and percentage statistics.	2hours