an intelligent serious game for supporting african and african caribbean men during pre- and post-...
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An Intelligent Serious Game for Supporting African and African Caribbean Men during Pre- and Post- Diagnosis of
Prostate Cancer
David Brown, Georgina Cosma, Giovanni Acampora, Sarah Seymour-Smith, and Alex Close
School of Science and Technology, Nottingham Trent University
NG11 8NS Nottingham, United Kingdom
Email: david.brown, georgina.cosma, giovanni.acampora@ntu.ac.uk
School of Social Sciences
Nottingham Trent University
NG1 BU Nottingham, United Kingdom
Email: sarah.seymoursmith@ntu.ac.uk
Prostate Cancer Project
• Serious Game is part of a funded project titled: Towards a Better
Understanding of the Poor Prognostic Outcomes for Prostate
Cancer in the African Caribbean Community
• Project funded by the Nottingham City Clinical Commissioning
Group
• Aim:
–Understanding Barriers for Early Presentation
–Patient Support and the Promotion of wellbeing and engagement
–Developing applications to promote relevant health behaviours in undiagnosed and post-diagnosed men.
•An Intelligent Serious Game for Supporting African and African Caribbean Men during Pre- and Post- Diagnosis of Prostate
Cancer
Introduction
• Over 40, 000 men are diagnosed with prostate cancer every year and one
in four Black men will develop prostate cancer at some point in their lives
• Men are not seeking medical attention in a timely manner and this
increases the number of mortality rates. Even those at greater risk might
not speak to their GP about PC
• Barriers to timely intervention include unawareness of risk and symptoms
of prostate cancer, fear and potential consequences of treatments for
prostate cancer, and trust/mistrust of healthcare services
• After diagnosis men may experience severe psychological stress, and
increased risk of suicide
• There is a need for understanding and developing culturally sensitive
interventions to enhance knowledge of understanding of PC
Risks and barriers among African Caribbean Men to seeking medical attention
Healthcare:
• Problems with health professional-patient communication, stereotyping and insensitivity of
some staff, lack of coordination between services and agencies
• Mortality of AAM is twice that of Caucasian Men, and is developed at a younger age. Accurate
estimates cant be accurately obtained due to variation in the registration systems, and
incident rate variation due to differences in use of detection methods and underlying risk
Fear of tests:
• Undergo DRE less often, are more concerned about PC and have higher screening fear scores
• Different clinical interventions are needed to address these fears
Environmental and Genetic factors:
• Higher incidence rates of prostate cancer could be attributed to environmental factors and
socio-economic status
• Strong correlations for diets high in polyunsaturated fats, inconclusive results for risk factors
including smoking, energy intake, sexual activity, marital status, vasectomy, social factors,
physical activity, and anthropometry
• Patients with a positive family history have an increased risk of contracting prostate cancer
The benefits of addressing these risks and barriers using serious gaming
• 1) Provide an alternative source of
information for those who have come to
mistrust health services. Moving from an
acute to chronic care model.
• 2) Provide accurate clinical information
for those unaware of the risks and
symptoms, the types of test, to support
decision making in treatment options and
maximise impact or treatment
• 3) Be co-designed to develop culturally
sensitive interventions – as with young
adults with ID and from the BME
community
• 4) Reduce fears of screening - as with
cockroach/driving phobias
• 5) Give successful psychological support -
e.g. for PTSD. Games can increase self
care behaviours
• 6) Can be adaptable based on user profile
and in-game responses to produce timely
cues for action
Serious Game Design
• User interacts with the virtual environment and data is collected
via game playing
–User provides data by interacting with environment
–Game flow adapted based on user input
–Material adapted based on user input (personalised information), e.g. if user is concerned about a particular aspect then the system will display tailored information
Survey Responses on Serious Game Design
Target Population
Considerations
• Age range 30-70
• Education level
• Language barriers
• Psychological state
• Personal preferences
Survey: gathering serious game requirements. Results will influence the design of the game and the way information is presented
• Potential users embraced the idea of a serious
game to raise awareness of prostate cancer.
• Humour is one aspect they would like within the
game.
• They would like to see familiar characters (Patty
Dumplin)
Some feedback
Serious Game Framework We are proposing: An Intelligent Serious Game for Supporting African Caribbean Men
during Pre- and Post- Diagnosis of Prostate Cancer
Serious Game Framework
• Shows the data to be collected during game playing
• The game will have hidden levels and these will discretely map to the framework’s layers.
• It will evaluate user risk of prostate cancer based on their input to layers 1 and 2.
If High risk then material adapted to encourage users to see GP.
Information adapted based on test results
Information on health and well being after diagnosis
Game provides information to support user in decision making
Data for Risk Prediction: Survey Findings
• Data is needed for creating rules for risk prediction
• Survey in progress to gather data: cancer family history, test
results and urinary symptoms
• So far: 16 responses from Black African Caribbean men who
undertook prostate cancer tests
–14 positive, and 2 negative
• Age when diagnosed with prostate cancer:
–50-60: 4
–61-70: 4
–70+: 3
–Age not provided: 3
Survey Findings: Clinical Test Results
Normal Abnormal Inconclusive Total Missing
PSA 2 10 1 13 1
DRE 5 5 1 11 3
Biopsy 1 9 2 12 2
• No single test is reliable enough to diagnose prostate cancer on its own (uncertainty)
• None of the PC positive respondents had all three tests negative
• Some of the PC positive respondents had all test results positive
• We are in the process of obtaining more results
Test results of those diagnosed with prostate
cancer
Survey findings: Urinary Symptoms • International Prostate Symptom Score (I-PSS)
• Questions on Urinary Symptoms appear on the American Urological
Association (AUA) Symptom Index which, based on patient responses,
categorises symptoms as: Mild, Moderate, Severe
– Incomplete emptying
– Frequency
– Urgency
– Weak stream
– Straining
– Nocturia
• International Scientific Committee (SCI) recommends that, for a basic
diagnostic workup, physicians consider history; physical exam; DRE or
other evaluation to rule out prostate cancer.
I-PSS Urinary Test Results
IPSS Score of those with Prostate Cancer
Score Frequency
Mild Urinary Symptoms: 4
Moderate Urinary Symptoms: 6
Severe Urinary Symptoms: 3
Total 13
• Not everyone with Prostate Cancer has severe urinary
symptoms, some may have mild or be unaware of their
symptoms
• We are in the process of obtaining more results
Risk Evaluation of Prostate Cancer
• Data gathered from the user (i.e. layer 1 and 2) will be used by
computational intelligence algorithms to evaluate the user’s risk of
prostate cancer.
Computational Intelligence • Computational intelligence algorithms hidden in the serious game will
make predictions on patient risk
• These algorithms will be used for training a system to make an accurate
prediction based on past data
• Due to uncertainty in test results and symptoms, computational
intelligence algorithms such an ANN, and Fuzzy Logic and suitable for
evaluating risk
Artificial Neural Network
Computational Intelligence • The algorithms will create rules for predicting risk of prostate cancer
• Rules will also be created with assistance from experts (urologists)
• The game flow will be adapted based on the outcome of these rules, which
will:
– Make an expert evaluation on a user’s risk of prostate cancer
– Allow the game to display personalised information tailored to the needs of the users
• In essence, this expert system will be used to raise awareness, and prepare
the user for their visit to GP by educating them appropriately about their
own risk, and possible tests they could take.
Options in which to implement the game
•As an App
•As a Flash Game
(Job Seekers)
•As a3D Unity Game
(SGSCC)
Acknowledgements
• Black and Minority Ethnic (BME) Cancer Communities - Rose Thompson BME
cancer Information Specialist
• Friends and Bredrins Support Group (FAB) - Mr Roydon Allen Chair of FAB
• NCC – Nottingham Council Commissioning Group
• John Van Geest Cancer Research Centre NTU - Prof Graham Pockley, Associate
Director / Professor of Immunobiology
Contact
Prof. David J. Brown and the
Interactive Systems Research Group
Computing and Technology Team
NTU, UK.
Tel: +44 115 848 8350
david.brown@ntu.ac.uk
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