Peer support in health care and prevention: cultural, organizational, and dissemination issues

As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patient-centered medical homes and chronic health homes; and (f) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts--intended audience, health problems, organizational and cultural settings--and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.

Sources of social support and adjustment among Chinese cancer survivors: gender and age differences

INTRODUCTION

Social support has shown to improve adjustment among cancer survivors. However, it is unclear how health benefits of social support depend on the source of support, age, and gender. Chinese culture emphasizes relationship harmony and interdependence, providing a unique opportunity to address these questions. This study investigated how support from different sources was associated with adjustment to cancer and how the association was moderated by gender and age.

METHODS

Chinese cancer survivors (N = 238) from Beijing completed a questionnaire packet assessing support from different sources (e.g., family, friends, special others, society, and cancer organization) and adjustment (e.g., quality of life and positive and negative affect).

RESULTS

Perceived support from family was greater than support from other sources among Chinese cancer survivors. After controlling for support from other sources, greater support from family and society was associated with higher quality of life, more positive affect, and less negative affect. Support from family showed a stronger negative correlation with negative affect among males, and support from special others showed a stronger negative correlation with negative affect among females. Support from society had a stronger positive association with quality of life, and support from friends had a stronger negative association with quality of life among younger survivors than among older survivors.

CONCLUSIONS

Findings highlight that health benefits of social support depend on the source of support, gender, and age among Chinese cancer survivors. The study has implications for delivering individualized healthcare services tailored to the preferences of cancer survivors based on their cultural backgrounds and demographic characteristics.

Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment

Background

This longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors.

Patients and methods

A population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors.

Results

Distinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain.

Conclusion

Although HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors.

The use of motivational interviewing to promote peer-to-peer support for cancer survivors

Motivational interviewing (MI) as a counseling approach has gained empirical support for its use in a number of settings and for a variety of behaviors. However, the majority of practitioners trained to use MI have been professionals rather than laypeople. This article presents the rationale, design, and evaluation of an MI-based training for cancer survivors and caregivers to deliver peer support. The training and evaluation of the peers ("guides") to encourage practice and increase research knowledge for using MI-based peer support models for cancer care are discussed. Thirteen cancer survivors and two caregivers received two-day DVD-based MI training, as well as supplemental monthly sessions for six months. The guides demonstrated MI proficiency as assessed by the MI Treatment Integrity scale and other process evaluation assessments. MI can be adapted to train laypeople to provide support for groups such as cancer survivors.

A nurse- and peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial

Background

Women who undergo radiotherapy for gynaecological cancer (GC) can experience distressing side effects which impact on psychosocial functioning and intimate relationships. Cancer-related distress may be ameliorated by comprehensive preparation for treatment and addressing women’s informational, physical, psychological and psychosexual needs. This paper describes the protocol for a multisite randomised controlled trial (RCT) testing a novel intervention package which combines tailored specialist nursing consultations and telephone peer support with the primary aim to reduce psychological distress. Secondary aims assess patient quality of life, symptom distress, unmet supportive care needs, preparation for treatment, psychosexual functioning and vaginal stenosis.

Methods/design

This multifaceted intervention comprises four nurse-led consultations coupled with four phone calls from a peer support volunteer (GC survivor). The evidence-based intervention will be delivered at critical points in the illness trajectory: pre-treatment, mid-treatment, treatment completion and post-treatment. Nurses and peers undergo 2-day intensive training workshops, are guided by comprehensive study intervention manuals and receive ongoing supervision and support. Eligible patients will have a diagnosis of GC, be scheduled to receive curative radiotherapy, be aged 18 years or over and speak English. Three-hundred and six participants will be randomized to receive usual care or usual care with the intervention package. Study outcome measures will be collected at baseline, day 1 of radiotherapy and 1, 6 and 12 months post radiotherapy. Clinical assessments of vaginal toxicity will occur at baseline, and 3, 6, and 12 months post radiotherapy.

Discussion

This timely research has the potential to substantially reduce the physical, psychosexual and supportive care needs of women with GC. Using a telephone peer support model, the intervention package ensures equitable access to support services for geographically isolated patients. The novel intervention engages peer volunteers who liaise with nurses to encourage adherence to professionally-delivered information and provide emotional support. It has been designed to be potentially transferable to a range of treatment settings and diseases. Based on pilot data, the proposed intervention was found to be useful and acceptable to patients and clinicians. If effective and feasible in the multisite RCT, the program could be widely disseminated.

Trial registration

Australian New Zealand Clinical Trial Registry ACTRN12611000744954

Woman to woman: a peer to peer support program for women with gynecologic cancer

Gynecologic cancer has significant emotional and psychosocial implications for patients and their families. This article describes the origin and implementation of a peer to peer support program providing emotional support and information to women in treatment for gynecologic cancer and their families, in collaboration with medical and social work staff in a large, urban medical center. A formative evaluation of the program is included which suggests program participants view the program as a helpful source of support throughout treatment.

ProsCan for Couples: a feasibility study for evaluating peer support within a controlled research design

BACKGROUND

The present study assessed the feasibility of delivering peer support for couples coping with prostate cancer within a trial design.

METHODS/DESIGN

Ten peer volunteers completed training in research protocols and delivering tele-based couples support to men with prostate cancer and their partners. Twenty couples received an eight session intervention and were assessed before surgery and 3 and 6 months subsequently for adjustment outcomes. A focus group investigated the peers' experiences.

RESULTS

Peers were motivated by altruism, a belief in research, and reported personal growth. The research protocol at times conflicted with lay models of helping, and the focus on sexuality and couples was challenging. Distress decreased over time but more so for partners; unmet sexuality needs did not improve.

CONCLUSION

Peer support appears promising as a model to support couples facing prostate cancer.

When peer support may be most beneficial: the relationship between upward comparison and perceived threat

OBJECTIVE

Currently, the mechanism by which dyadic peer support programs may facilitate positive psychological adjustment for cancer patients is unclear. This study utilized social comparison theory to examine the effects of peer support on the psychological adjustment of women with breast cancer.

METHODS

A cross-sectional survey of 251 recently diagnosed breast cancer patients (52% response), who had received a dyadic peer support intervention, was undertaken assessing anxiety, depression, perceived threat, and upward comparison.

RESULTS

Perceived cancer threat significantly moderated the relationship between positive upward comparison and depression levels (p = 0.017). Women who engaged in upward comparisons and who perceived their diagnosis to be more threatening had lower depression levels than women who were less threatened.

CONCLUSIONS

Peer support services that provide support from cancer survivors may be especially beneficial for people who appraise their cancer diagnosis as more threatening. The application of theoretical models to future evaluation designs will further increase understanding of the psychological mechanisms involved in the effects of peer support and inform program development.

Peers for progress: promoting peer support for health around the world

INTRODUCTION

Peers for Progress, a global initiative of the American Academy of Family Physicians Foundation, developed out of the World Health Organization (WHO) Consultation on Peer Support Programmes in Diabetes as a strategic approach to promote best practices in peer support for health around the world. Why peer support. People often find themselves on their own to manage complex factors for behaviour change. Peer support can link people sharing experiences to provide the practical, emotional, and ongoing support that is critical to sustained behaviour change. The need. Diabetes is a global epidemic that affects all aspects of people's lives for the rest of their lives. The complexity of self-management requires ongoing support for effective and sustained management. Key principles, strategies, activities. Peers for Progress aims to strengthen evidence of the value of peer support through evaluation grants, encourage recognition of a state-of-the-art in peer support through defining key functions of support that can be tailored and applied globally, and promote peer support through networking with programmes and leaders around the world.

CONCLUSIONS

People seeking to prevent or manage health conditions can be a powerful source of support to each other to manage complex behaviors. Peers for Progress has a defined functional framework for peer support's core functions, and is evaluating the scope and impact of peer support interventions based on this framework and a set of consensus evaluation measures. Peers for Progress looks to raise the visibility and applicability of peer support as good health care for all people.

Evaluation of a pilot 'peer support' training programme for volunteers in a hospital-based cancer information and support centre

PURPOSE

Volunteers from Peter MacCallum Cancer Centre (Peter Mac) Patient Information and Support Centre (PISC) assist the Cancer Support Nurse by helping patients and families/carers find information and provide face-to-face peer support. Benefits of shared personal experiences between volunteer and patient are clearly different from professional support. Volunteers require specific skill sets and detailed preparation for this role.

MATERIALS AND METHODS

Volunteers completed a 3-day training programme adapted from the Cancer Council Victoria's 'Cancer Connect Telephone Peer Support Volunteer' training programme. The focus was role expectations and boundaries for peer support volunteers, debriefing, communication skills training, support services, complementary and alternative therapies and internet information. Assessment included a quiz and observation for a range of competencies. Role-play with simulated patients developed appropriate support skills.

RESULTS

Eight volunteers participated. Pre-training questionnaires revealed all volunteers highly self-rated existing skills supporting people affected by cancer. During training, volunteers recognised these skills were inadequate. All agreed that role-play using an actor as a 'simulated patient' helped develop communication skills; however, the experience proved challenging. Post-training all reported increased knowledge of role definition and boundaries, supportive communication skills, supports available for patients and families/carers and importance of self-care. Facilitators recommended seven of the eight participants be accredited PISC Peer Support Volunteers. One volunteer was assessed unsuitable for consistently overstepping the boundaries of the peer support role and withdrew from training.

CONCLUSION

Success of the programme resulted in a trained 'face-to-face peer support volunteer' group better equipped for their role. Sixteen months following training, all who completed the programme remain active volunteers in the PISC. Planned educational updates include needs identified by the volunteers. The training programme would require adapting for future peer support volunteers.

Amazon heart: an exploration of the role of challenge events in personal growth after breast cancer

High-profile events where in response to the experience of breast cancer women take on adventure activities to raise awareness and/or funds for breast cancer are increasing. These activities offer physical and psychological challenges within a peer support group setting. We investigated the experiences of 21 breast cancer survivors who participated in a 7-day breast cancer awareness motorcycle ride. Assessments included a qualitative pre/postinterview, solicited diary, pre-6-month follow-up survey. Measures included satisfaction with life, distress, happiness, global well being, meaning in life. Motivators were a desire for peer support, to promote breast cancer awareness, enjoyment, and personal growth. The ride incorporated physical and emotional challenge. A positive peer support experience led to feelings of inner peace, accomplishment, self-learning, a positive perspective, and improved social support. For a minority of women peer support or recreational expectations were not met resulting in negative feelings. No significant changes were observed over time in adjustment measures. Adventure events where women undertake emotional and physical challenge in an environment of group peer support provide opportunity for personal growth. In this context, peer support may provide the catalyst for the experience to become transformational and so is critical to generating positive outcomes. Realistic expectations of the ride are also influential.

Systematic review of peer-support programs for people with cancer

OBJECTIVE

To identify models of peer support for cancer patients and systematically review evidence of their effectiveness in improving psychosocial adjustment.

METHODS

CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and PsychINFO databases were used to identify relevant literature published from 1980 to April 2007. Data on characteristics of the peer-support program, sample size, design, measures, and findings were extracted and papers were also rated with respect to research quality (categories 'poor', 'fair' or 'good').

RESULTS

Forty-three research papers that included data from at least 1 group were reviewed in detail, including 26 descriptive papers, 8 non-randomized comparative papers, and 10 papers reporting eight randomized controlled trials (RCTs). Five models of peer support were identified: one-on-one face-to-face, one-on-one telephone, group face-to-face, group telephone, and group Internet.

CONCLUSION

Papers indicated a high level of satisfaction with peer-support programs; however, evidence for psychosocial benefit was mixed.

PRACTICE IMPLICATIONS

One-on-one face-to-face and group Internet peer-support programs should be given priority when considering ways to offer peer support. Nevertheless, the other models discussed in this review should not be dismissed until further research is conducted with a wide range of cancer populations.

One-to-one volunteer support programs for people with cancer: a review of the literature

OBJECTIVE

To conduct a systematic review of literature reporting on the use of volunteers in support programs for people with cancer.

METHODS

PsycINFO, Medline and CINAHL were used to identify papers published up to April 2007 reporting one-to-one support programs using volunteers. Program data were extracted from the papers, which were rated on research quality and descriptions of the program, volunteers and support recipients.

RESULTS

Twenty-eight papers were reviewed. Nineteen (69%) reported peer-support programs, with four (14%) pertaining to the Reach to Recovery program for women with breast cancer, and eight (28%) describing other peer-support programs for women with breast cancer. Few papers described the programs sufficiently to enable a good understanding of support recipients, volunteers, and what transpired between volunteers and support recipients. Twenty papers (71%) were research studies: 10 (36%) with one group descriptive data, 6 (21%) were non-randomized comparative studies and 4 (14%) were randomized controlled trials.

CONCLUSION

While most papers reported that programs were beneficial, few presented data from studies using rigorous research methodologies to support these claims.

PRACTICE IMPLICATIONS

Using volunteers in cancer care may have merits; however, papers need to provide more information regarding these programs and further evidence is required to determine their effectiveness.

Effects of Mutual Dyad Support on Quality of Life in Women With Breast Cancer

This study examined the effects of a mutual dyadic support intervention between survivors and women newly diagnosed with breast cancer on the quality of life and interpersonal relationships of the participants. This matched-pairs, baseline-postintervention study included 31 survivors and 31 newly diagnosed women with stage I or II breast cancer. The women met in mutually supportive, self-directed dyads at least twice a week for 8 weeks. Instruments included contact Logs and Meaningful Observations Journals. Content analysis of the Logs showed that most dyad interactions were by telephone. Most participant dyadic conversations focused on the health and functioning of newly diagnosed partners, with survivors providing informational and emotional support. Meaningful Observations Journal thematic analysis supported the social exchange theory to describe dyad partner relationships. Most dyadic relationships were supportive, some were reciprocal, and some experienced conflict. Themes varied little between groups and from baseline to postintervention. Themes across time were support of others, health, changing priorities, and faith. Further quantitative study is needed to examine the effects of a dyad support intervention on quality of life in more diverse populations of women with breast cancer. Nurses need to evaluate the existing social-network support systems of patients with breast cancer and consider the need for dyadic peer support.

A Randomized Controlled Trial of Psychosocial Interventions Using the Psychophysiological Framework for Chinese Breast Cancer Patients

This study aimed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients. Participants were randomly assigned into 3 intervention groups, namely, Body-Mind-Spirit (BMS), Supportive-Expressive (SE), and Social Support Self-Help (SS) groups; a no-intervention group was used as control. Salivary cortisol was used as the physiological stress marker. Distress level, mental adjustment, emotional control, and social support were measured. Data were collected at baseline, 4 month, and 8 month. Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects. It enhanced positive social support, reduced psychological distress, emotional control, and negative mental adjustment. Total salivary cortisol was lowered after 8 months. Most participants in SE groups indicated the treatment helpful, but changes in psychophysiological outcomes were not statistically significant. Participants in SS groups seemed less likely to benefit from the intervention. The no intervention control group indicated a reduction in social support. These outcomes suggest that active professional intervention is more likely to yield therapeutic effects. In particular, psychosocial intervention attending to the spiritual dimension contributes to positive outcomes.

The tiered model of psychosocial intervention in cancer: a community based approach

Clinical practice guidelines for the management of psychosocial distress in people with cancer have been produced in Australia and North America and these provide direction for the provision of psychosocial care for patients with cancer and their families. This report describes a tiered intervention model to operationalise psychosocial care in oncology in the community and outlines a framework for integrating services across sectors.

Depression experienced by young women newly diagnosed with breast cancer

Breast cancer is the most common type of cancer among women. While almost a quarter of women diagnosed with breast cancer are 50 or younger, few studies are focused on them. Compared to older women, young women have more difficulty adjusting to the breast cancer diagnosis, report more symptoms of distress and a lower quality of life. This study examined depressive symptoms among an ethnically diverse sample of 331 young women, newly diagnosed with breast cancer. The focus was to determine the relative importance of biological, psychological and social variables as correlates of their level of depression. A hierarchical multiple regression analysis indicated that a model combining these variables is more highly correlated with depressive symptoms than using biological, psychological or social variables separately. Single measures including bodily pain, self-esteem, level of emotional support and age had independent effects in the combined regression model. Early intervention may prevent these biopsychosocial symptoms progressing to major depression and, thus, enhance the quality of life.

Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory

OBJECTIVE

To develop and test a measure for assessing peer support for men attending prostate cancer support groups, and to describe socio-demographic, medical and adjustment characteristics of Australian men who attend these support groups.

PATIENTS AND METHODS

In all, 1224 men (51% response) from 44 prostate-cancer support groups across Australia were recruited by mail. Men completed self-report measures that included the Prostate Cancer Peer Support Inventory (PCSI), the UCLA Prostate Cancer Index bother scales, psychological distress, quality of life (QoL), bother from pain and tiredness, perception of the clinician's support for group participation. Group-level variables were also included in the analyses.

RESULTS

Peer support was rated positively by most men; a high satisfaction with support groups was related to better QoL, lower pain, younger age, higher perceived clinician support for group participation, use of alternative therapies, lower education, and regular attendance; dissatisfaction with support groups was related to higher psychological distress, lower QoL, and lower perceived clinician support for group participation. Group variables did not predict positive or negative support. Overall QoL was similar to community norms and psychological distress was low, with only 8% of men reporting high distress. The most common physical symptom was sexual bother, with 74% of men reporting moderate or high bother.

CONCLUSIONS

The PCSI was a useful measure of peer support. Perception of the benefits of peer support was related to individual but not group differences. The clinicians' attitudes to participation in support groups influenced the men's experience of these groups, and this finding has implications for developing support services for these men.