In the studies of end of life conversation games, small groups sat at a table with a stack of question cards and no one leading. Players rated the talks as satisfying, their mood right after didn’t drop, and the talk stayed on people, values, and stories. The studies are small and mostly lack a comparison group, so they describe what happened after playing. They can’t show that the game caused it.
This post is for hosts of death cafés and game nights who want to try a game about death and dying. It covers how the tested sessions were set up, what players did afterward, what two reviews add, and where the evidence stops. At the end there’s a setup you can copy for your next session.
What a game changes at the table
A game moves three jobs away from the host. The card asks the question, so nobody has to be the person who brought up death. Turns share the time, so one guest can’t hold the floor all evening. And the end is set in advance, so everyone knows how long they’ve agreed to stay.
The research team behind several of these studies asked players about the format itself. In a first study, 70 healthy volunteers played in 18 groups of families, friends, or strangers. Each group discussed 20 questions about death, dying, and end-of-life care over about two hours. In focus groups, players described the game as an enjoyable experience and said a game was a good frame for talking about the end of life (Van Scoy et al. 2016a).
The same team recorded 17 games played by groups of 2–6 people, with no facilitator in the room. The researchers transcribed the games and sorted what was said into four themes (Van Scoy et al. 2016b):
- people, relationships, and roles in end-of-life decisions
- values, beliefs, and preferences about care and dying
- preparing for what happens after one’s death
- stories and past experiences that shape one’s own wishes
For a host, the absence of a facilitator is the useful detail. Left alone with the cards, these tables talked about things that matter. The authors judged the topics to be substantive.
How players felt during and after
One worry a host may hear is that a guest will leave feeling worse. The first study measured this. On a seven-point scale, players rated their conversations as satisfying (mean 6.1), realistic (5.6), and high in quality (5.7). Their emotional state right after the game showed no negative effect (Van Scoy et al. 2016a).
A 2020 study held game events at 53 community venues across the US, with African American adults playing in groups of 4–6 for 60 minutes. The mean satisfaction score was 6.21 out of 7, and no adverse events led anyone to withdraw from the study (Van Scoy et al. 2020).
What players did in the months after
Two studies followed players over time. In a pilot with 68 volunteers in 17 sessions in Hershey, Pennsylvania, and Lexington, Kentucky, researchers measured readiness for advance care planning before the game and 3 months after. Within 3 months, 78% had taken some step in advance care planning, and 73% had moved up at least one stage of readiness (Van Scoy et al. 2017).
In the 2020 study, 220 players were reached at follow-up, 3–11 months later. Of those 220, 80% (176) had discussed their end-of-life wishes with loved ones, and 41% (91) had completed a new advance directive (Van Scoy et al. 2020).
What two reviews add
Two reviews pulled the game studies together. A 2021 systematic review and meta-analysis found 11 articles from 10 studies of advance care planning games, and 6 of the 10 studies were feasibility studies. The quantitative part of 7 of 8 studies was rated low in quality. Pooled results showed gains in self-efficacy, readiness, knowledge, and planning behavior, and players found the games acceptable and enjoyable. The authors called the games promising and asked for well-designed randomized trials (Liu et al. 2021).
An integrative review of card games with adult palliative care patients found 685 articles and kept 9. It reported high satisfaction and concluded that card games helped open talk about sensitive end-of-life topics (Fernandes et al. 2024). Those players were patients, so the setting is further from a café table than the volunteer studies.
Where the evidence stops
The limits are plain once the designs are listed. The 2017 pilot and the 2020 study had no comparison group, so nobody can say how many players would have talked to family anyway. Volunteers who sign up for an evening about death may already be ready for it. Five of the seven sources in this post come from one research team. And in the first study, players had mixed views on the ideal group make-up, so the evidence doesn’t settle whether strangers, friends, or family make the better table.
A randomized trial has been designed to test this. Its protocol, published in 2022, describes three arms across 75 community venues: an end-of-life conversation game, a workshop format for these conversations, and an attention-control game. The main outcome is a completed advance directive 6 months after the event (trial protocol 2022). A game night is a conversation format, and a guest who needs more support can be pointed to a professional.
Setting up a session like the ones studied
The steps below follow the studied format: small groups, a fixed length, and cards doing the asking. They work with question cards, the Thesis deck, or words on slips of paper.
- Seat 2–6 people per table. The recorded games ran with 2–6 players, and the 2020 events used groups of 4–6. A larger room splits into several tables.
- Agree on passing first. The Thesis rules open with “Before you start, agree together how passing works.” A guest who can pass can sit through a round and listen.
- Set the length. The 2020 events ran for 60 minutes. Say the end time out loud before the first card.
- Let the card ask. Draw, read, and answer in turn. The host plays as one more guest.
- Close with a round. The Thesis rules end with “each player names one thing they discovered about someone at the table today.”
If a table wants prompts beyond the cards, these eight follow the four themes from the 2016 recordings:
- Who would you want in the room near the end?
- Who in your family makes the hard calls?
- What matters most to you on an ordinary day?
- What would a good last week look like?
- What would you want people to do with your things?
- What should happen at your goodbye, and what shouldn’t?
- Whose death changed how you think about your own?
- What did you learn from watching someone you loved grow old?
After any answer, the Thesis rule card offers three follow-ups:
What did that feel like? Who else was there? Has it always meant that to you?
Three words for a table about death
A Thesis card has an idea on one side and an everyday thing on the other. A single word asks less than a full question, and each player decides where it goes.
Duty has Ticket on its other side. Duty fits the first theme from the recordings: who is expected to make decisions and who is expected to show up. A ticket brings up a trip taken to reach someone in time, or one that came too late.
Forgiveness has Door on its other side. Conversations near the end of life can turn to what was left unsaid. The door side is gentler: a house someone left, a room nobody went into for months.
Enough has Photograph on its other side. Enough asks when a life has had what it needed. A photograph brings up whose picture stays on the shelf, and a guest can tell that story early in the evening.
Trying it tonight
Draw a card, choose a side, and roll the die. Its faces are MEMORIES · BODY · PEOPLE · VALUES · CHILDHOOD · FUTURE. “Look at the word from that side.” Then pass the die to the left.
The online table runs in a browser, so a group can play on a shared screen. If you’re planning a full evening, see how to host a death cafe. For more on using it with a group that meets around loss, see Thesis for therapy groups.
Before your next session, pick one number to tell a guest who isn’t sure about coming: 70 volunteers rated a game like this at 6.1 out of 7 for satisfaction. Then tell them they can pass.
The word pages for Duty, Forgiveness, and Enough have more on each card. The research behind the deck explains where the words came from, and the rules and the box are on the product page. For surveys on how often people talk about death, see talking about death: what the research says.