{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T02:45:39Z","timestamp":1777430739236,"version":"3.51.4"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T00:00:00Z","timestamp":1673568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Portuguese funds","award":["UIDB\/4255\/2020"],"award-info":[{"award-number":["UIDB\/4255\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Communication between the multidisciplinary team, the person, and the family in palliative and end-of-life situations implies, in most situations, a high negative emotional burden. Therefore, innovative strategies are needed to reduce it. The goal of this study is to describe the various stages of development and validation of a collaborative card game for people in palliative care and their families. Phase one is an exploratory study, Phase two is a Delphi study, and Phase three is a multiple case study. Participants for phases 2 and 3 were recruited using a convenience sampling method. The results demonstrate in an organized and structured way the different phases required to build a collaborative card game. The use of the game was found to be useful and effective. Four categories emerged from the content analysis of the open-ended responses: usability, evaluation tool, communication and therapeutic relationship, and meaning when using the game. A collaborative game in palliative care helps to create a space for individuals and families to express feelings and experiences, meeting the myriad of physical, psychosocial, and spiritual needs. The \u201cPallium game\u201d is a useful and impactful approach to discussing sensitive topics in palliative care.<\/jats:p>","DOI":"10.3390\/ijerph20021449","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T01:30:26Z","timestamp":1673573426000},"page":"1449","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Developing a Card Game for Assessment and Intervention in the Person and the Family in Palliative Care: \u201cPallium Game\u201d"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7251-5829","authenticated-orcid":false,"given":"Carla S\u00edlvia","family":"Fernandes","sequence":"first","affiliation":[{"name":"Nursing School of Porto, Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5451-5849","authenticated-orcid":false,"given":"M. Bel\u00e9m","family":"Vale","sequence":"additional","affiliation":[{"name":"Nursing in Hospital da Luz-P\u00f3voa de Varzim, 4490-592 P\u00f3voa de Varzim, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6049-8646","authenticated-orcid":false,"given":"Bruno","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Portuguese Oncology Institute of Porto (IPO), 4200-072 Porto, Portugal"},{"name":"Oncology Nursing Research Unit IPO Porto Research Center (CI-IPOP), Portuguese (IPO Porto) Comprehensive Cancer Centre (Porto. CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal"},{"name":"School of Health, University of Tr\u00e1s-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1190-9899","authenticated-orcid":false,"given":"Jo\u00e3o P.","family":"Castro","sequence":"additional","affiliation":[{"name":"Wecare Sa\u00fade\u2014Continuous Integrated and Palliative Care Unit, 4490-492 P\u00f3voa de Varzim, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6453-2311","authenticated-orcid":false,"given":"Marta D.","family":"Azevedo","sequence":"additional","affiliation":[{"name":"Wecare Sa\u00fade\u2014Continuous Integrated and Palliative Care Unit, 4490-492 P\u00f3voa de Varzim, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5953-788X","authenticated-orcid":false,"given":"Marisa","family":"Louren\u00e7o","sequence":"additional","affiliation":[{"name":"Nursing School of Porto, Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"j878","DOI":"10.1136\/bmj.j878","article-title":"Palliative care from diagnosis to death","volume":"356","author":"Murray","year":"2017","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Fernandes, C.S., Louren\u00e7o, M., and Vale, B. (2021). Patient card games in palliative care: Integrative review. BMJ Support. Palliat. Care.","DOI":"10.1136\/bmjspcare-2021-003300"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.nedt.2015.11.026","article-title":"To be involved\u2014A qualitative study of nurses\u2019 experiences of caring for dying patients","volume":"38","author":"Andersson","year":"2016","journal-title":"Nurse Educ. Today"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4158","DOI":"10.1111\/jocn.14603","article-title":"\u201cOperating in the dark\u201d: Nurses\u2019 attempts to help patients and families manage the transition from oncology to comfort care","volume":"27","author":"Canzona","year":"2018","journal-title":"J. Clin. Nurs."},{"key":"ref_5","unstructured":"Arantes, A.C.Q. (2019). Death Is a Day Worth Living, Oficina do Livro."},{"key":"ref_6","first-page":"122","article-title":"Early integration of palliative care into oncology: Evidence, challenges and barriers","volume":"4","author":"Zhi","year":"2015","journal-title":"Ann. Palliat. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"713","DOI":"10.9789\/2175-5361.2019.v11i3.713-717","article-title":"Palliative Care and the Importance of Communication between Nurse and Patient, Family and Caregiver","volume":"11","author":"Andrade","year":"2019","journal-title":"Rev. De Pesqui. Cuid. E Fundam."},{"key":"ref_8","first-page":"e03309","article-title":"Giving Voice to Caregivers: A game for family caregivers of dependent individuals","volume":"52","author":"Fernandes","year":"2018","journal-title":"Rev. Da Esc. De Enferm. Da USP"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/NJH.0000000000000310","article-title":"Familial Interaction Patterns During the Palliative Phase of a Family Member Living With Cancer","volume":"19","author":"Sandgren","year":"2017","journal-title":"J. Hosp. Palliat. Nurs."},{"key":"ref_10","first-page":"315","article-title":"A qualitative study of family carers views on how end-of-life communication contributes to palliative-oriented care in nursing home","volume":"56","author":"Gonella","year":"2020","journal-title":"Ann. Dell\u2019istituto Super. Di Sanita"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1177\/1049909118761386","article-title":"The Use of Simulation to Teach Nursing Students and Clinicians Palliative Care and End-of-Life Communication: A Systematic Review","volume":"35","author":"Smith","year":"2018","journal-title":"Am. J. Hosp. Palliat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Parry, R., Whittaker, B., Pino, M., Jenkins, L., Worthington, E., and Faull, C. (2022). Real Talk evidence-based communication training resources: Development of conversation analysis-based materials to support training in end-of-life-related health and social care conversations. BMC Med. Educ., 22.","DOI":"10.1186\/s12909-022-03641-y"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1080\/13557858.2017.1357068","article-title":"Community-based game intervention to improve South Asian Indian Americans\u2019 engagement with advanced care planning","volume":"24","author":"Radhakrishnan","year":"2019","journal-title":"Ethn. Health"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bardin, L. (2011). Content Analysis, Edi\u00e7\u00f5es 70.","DOI":"10.1553\/eco.mont-3-1s70"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1177\/1074840716667972","article-title":"Application of the Calgary Family Assessment and Intervention Models","volume":"22","author":"Leahey","year":"2016","journal-title":"J. Fam. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/j.1741-3729.2002.00130.x","article-title":"A Family Resilience Framework: Innovative Practice Applications","volume":"51","author":"Walsh","year":"2002","journal-title":"Fam. Relat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/00012272-200009000-00006","article-title":"Experiencing transitions: An emerging middle-range theory","volume":"23","author":"Meleis","year":"2000","journal-title":"Adv. Nurs. Sci."},{"key":"ref_18","first-page":"170","article-title":"Constru\u00e7\u00e3o de uma Escala de Capacidade para Cuidar em Paliativos: Processo de valida\u00e7\u00e3o de conte\u00fado","volume":"33","author":"Reigada","year":"2015","journal-title":"Rev. Port. De Sa\u00fade Publica"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s11136-005-0449-7","article-title":"The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): Validation study of the Thai version","volume":"15","author":"Silpakit","year":"2006","journal-title":"Qual. Life Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1017\/S1478951517000098","article-title":"Testing the feasibility of using the Edmonton Symptom Assessment System (ESAS) to assess caregiver symptom burden","volume":"16","author":"Tanco","year":"2018","journal-title":"Palliat. Support. Care"},{"key":"ref_21","first-page":"121","article-title":"Prospective validation of patient fatigue questionnaire (FACIT-F) for fatigue assessment in nab-paclitaxel plus gemcitabine therapy","volume":"8","author":"Okada","year":"2018","journal-title":"Mol. Clin. Oncol."},{"key":"ref_22","first-page":"3174","article-title":"Adapta\u00e7\u00e3o transcultural do General Comfort Questionnaire para brasileiros com infarto do mioc\u00e1rdio","volume":"71","author":"Almeida","year":"2018","journal-title":"Rev. Bras. De Enferm."},{"key":"ref_23","unstructured":"Hale, P.J. (2000). Family systems stressors strengths inventory (FS3I). Real World Community Health Nursing: An Interactive CD-ROM, C.V. Mosby."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1007\/s00520-019-05003-9","article-title":"The usefulness and prognostic value of Memorial Symptom Assessment-Short Form and Condensed Memorial Symptom Assessment Scale in assessment of lung cancer patients","volume":"28","author":"Bircan","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Antunes, B., and Ferreira, P.L. (2020). Validation and cultural adaptation of the Integrated Palliative care Outcome Scale (IPOS) for the Portuguese population. BMC Palliat. Care, 19.","DOI":"10.1186\/s12904-020-00685-z"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/NJH.0000000000000607","article-title":"Using Cards to Facilitate Conversations About Wishes and Priorities of Patients in Palliative Care","volume":"22","author":"Pranter","year":"2020","journal-title":"J. Hosp. Palliat. Nurs."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1089\/jpm.2015.0390","article-title":"Conversation Game Effectively Engages Groups of Individuals in Discussions about Death and Dying","volume":"19","author":"Reading","year":"2016","journal-title":"J. Palliat. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e204315","DOI":"10.1001\/jamanetworkopen.2020.4315","article-title":"Association of Participation in an End-of-Life Conversation Game With Advance Care Planning Behavior and Perspectives Among African American Individuals","volume":"3","author":"Levi","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_29","first-page":"44","article-title":"Card Game Makes End-of-Life Discussions Easier on Patients With Cancer and Caregivers","volume":"7","author":"Kaplan","year":"2016","journal-title":"Oncol. Nurse Advis."},{"key":"ref_30","first-page":"80","article-title":"Conce\u00e7\u00f5es E Experi\u00eancias Em Cuidados Paliativos No Norte De Minas Gerais","volume":"15","author":"Muniz","year":"2019","journal-title":"Hygeia Rev. Bras. De Geogr. M\u00e9dica E Da Sa\u00fade"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1089\/jpm.2018.0431","article-title":"National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition","volume":"21","author":"Ferrell","year":"2018","journal-title":"J. Palliat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1590\/S1809-98232014000100002","article-title":"Perce\u00e7\u00e3o da equipe multiprofissional sobre cuidados paliativos","volume":"17","author":"Silveira","year":"2014","journal-title":"Rev. Bras. De Geriatr. E Gerontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4273","DOI":"10.1007\/s00520-016-3260-9","article-title":"Advanced cancer patients\u2019 reported wishes at the end of life: A randomized controlled trial","volume":"24","author":"Williams","year":"2016","journal-title":"Support. 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