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Patient card games in palliative care: integrative review
  1. Carla Silvia Fernandes1,2,
  2. Marisa Lourenço1 and
  3. Belem Vale3
  1. 1Nursing School of Porto, Porto, Portugal
  2. 2Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
  3. 3LUZ Hospital, Póvoa de Varzim, Portugal
  1. Correspondence to Carla Silvia Fernandes, Nursing School of Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal; carlasilviaf{at}


Background In the context of palliative care, a new approach has been documented that allows for sensitive end-of-life conversations to be established through a game of cards.

Objective This study aimed to identify the use of card games with patients in palliative care, assess self-reported satisfaction and synthesise findings on the effectiveness of its application.

Design We performed an integrative review study. The studies were collected from five databases, with no time limit until February 2021: Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioral Sciences Collection, SCOPUS and Scientific Electronic Library Online. The inclusion criteria were studies describing the use of card games in adult patients undergoing palliative care, in which the authors performed some type of evaluation. The methodological evaluation of the studies was carried out using the different standardised assessment tools from the Joanna Brigg’s Institute.

Results Of the 685 articles identified, 9 met the inclusion criteria. Regarding methodological aspects, 4 studies were quantitative, 4 mixed-method methodologies, and 1 was qualitative. Card games have been in use for the last decade. The use of card games not only allows for participation in the game without any inhibitions and with a high degree of satisfaction, but also allows for the discussion of sensitive topics related to the end of life, motivating participants to engage in advanced care planning behaviours.

Conclusion Our findings suggest that using a card game to facilitate conversations with patients in palliative care is a useful and effective approach to discussing uncomfortable topics of death, dying and end-of-life care.

  • terminal care
  • clinical assessment
  • communication
  • end of life care

Data availability statement

Data are available upon reasonable request. Not applicable’.

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Data availability statement

Data are available upon reasonable request. Not applicable’.

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  • Correction notice This article has been corrected since it was first published.

  • Contributors CSF and ML were responsible to the Study design. All authors (CSF, ML and BV) were responsible for data collection and data analysis. CSF drafted the initial manuscript. CSF, ML and BV revised the manuscript critically for important intellectual content. All authors gave the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.