Endoexpedition - Use of a Serious Game to Deliver Patient Information and Decision Aid for Individuals With Endometriosis.

Endometriosis is a chronic inflammatory disease affecting approximately 10% of women of reproductive age and is commonly associated with pelvic pain, dysmenorrhea, dyspareunia, reduced quality of life, and infertility. Despite the high prevalence and substantial impact on physical and psychological well-being, diagnosis is often delayed for several years. Adequate patient education is essential for informed decision-making, treatment adherence, and patient empowerment. However, patient information is traditionally delivered through written materials, which may not meet the needs and learning preferences of all individuals.

Interactive educational technologies, including serious games, have emerged as promising tools for patient education. Serious games combine educational content with engaging and interactive elements that may improve motivation, knowledge acquisition, and long-term retention of information. Previous research in other chronic diseases suggests that game-based learning can improve patient engagement and self-management, but no randomized controlled trial has evaluated this approach in individuals with endometriosis.

The EndoExpedition trial is a national multicenter, open-label, randomized controlled trial conducted at the four Swedish National Highly Specialized Care (NHV) centers for advanced endometriosis. Adults with suspected or confirmed endometriosis will be randomized in a 1:1 ratio to receive either standard written patient information or access to EndoExpedition, a serious game specifically developed to provide evidence-based information about endometriosis and its treatment options.

The serious game is based on current international guidelines and covers anatomy, pathophysiology, symptoms, diagnostic procedures, hormonal treatment, surgical treatment, and common misconceptions regarding endometriosis. Educational content is delivered through interactive storytelling, visual novel elements, puzzles, three-dimensional models, and feedback mechanisms designed to promote meaningful learning and user engagement.

The primary objective is to determine whether delivery of patient information through a serious game improves patient satisfaction compared with standard written information. Patient satisfaction will be measured using the validated Quality from the Patient's Perspective (QPP) questionnaire immediately after the intervention.

Secondary objectives include evaluating knowledge acquisition, knowledge retention after one year, perceived meaningfulness and engagement, and objective measures of game use, including active time, completed modules, access frequency, interactions, and drop-off patterns. The study will also explore whether demographic factors such as age, education level, and prior gaming experience influence learning outcomes and preferences for educational format.

A total of 250 participants will be enrolled. The results will provide evidence regarding the effectiveness of serious games as a patient education and decision-support tool for individuals with endometriosis and may inform future implementation of digital educational interventions within routine gynecological care.

Inclusion criteria

• Age 18 years or older.
• Suspected or confirmed endometriosis.
• Able to understand written Swedish.
• Able to provide informed consent.

Exclusion criteria

• Inability to independently complete the Swedish-language educational game.
• Unwillingness or inability to provide informed consent.