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