How to Play TEP

TEP is designed to be played in a small group and moderated by a facilitator. An effective facilitator would be anyone who has expertise in communication, is trained in VitalTalk materials, or is an experienced palliative care provider with an enthusiasm for communication, explained Dr Hudnall. Although the game’s developers recommend playing TEP in small groups of 3 to 4 players with 1 facilitator per group, it can be played by several small groups with the facilitator circulating among the groups. When playing in groups with no facilitator, the developers suggest mixing players of different experience levels within the groups.

The facilitator should review the facilitator guide that comes with the game before initiating game play. It describes the concept of the empathy statements and provides tips for giving feedback.

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The deck of cards is placed face down on the table. Play begins with the first player flipping the top card and reading it out loud. Each card contains a challenging patient or family comment such as “It’s my fault. I should have gotten the mammogram sooner” or “I just don’t understand why they can’t give him a new liver.” After hearing the statement, the players in the group write down their responses, which they then read to the group in turn. As each response is shared with the group, the facilitator guides the players in evaluating whether the response is an attempt to fix a problem, provide an intellectual explanation, or encourages emotional processing. The response that best encourages emotional processing is chosen by group consensus, with that player capturing the card as the “winner” of the round.1 The length of the game depends on the number of people playing and how much time is available for discussion.1

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The statements on the cards are written with an eye towards pushing people out of their communication comfort zones. “We all have our go-to statements. Anybody who has been seeing patients for a while tends to have their canned statements in their normal mode of conversation,” Dr Hudnall explained. “The idea was here we are with a communication learning tool and we want to help people push beyond their normal boundaries a bit and get them out of their comfort zones. It’s really just to give people the idea that there are all sorts of tools in communication.”

Reach Out

The authors encourage those who are interested in the game or would like some help initiating it to reach out to them. They are happy to talk about how they made it work and offer any support necessary. “We feel passionate about empathy as a skill that needs to be practiced, used, explored, and learned by all of us taking care of patients and each other. We really want to support our colleagues in using whatever tools are available to them,” said Dr Hudnall.


  1. Hudnall JA, Kopecky KE. The Empathy Project: a skills development game: innovations in empathy development [published online February 28, 2020].  J Pain Symptom Manage. doi: 10.1016/j.jpainsymman.2020.02.008
  2. Responding to emotion: respecting. VitalTalk. Accessed April 22, 2020.

This article originally appeared on Oncology Nurse Advisor