Interest and participation in support group programs among patients with colorectal cancer

Do members of cancer peer support groups know more about cancer than non-members? Results from a cross-sectional study in Germany

PURPOSE

This study aims to assess whether cancer-specific knowledge (CSK) is associated with membership in a cancer peer support group (PSG) and other factors.

METHODS

A cross-sectional study investigated the CSK of 1121 cancer patients of various entities across Germany. CSK was measured with the BCKS-14, a 14-item knowledge instrument which was previously participatory developed with patient representatives and oncologists. Associations between CSK and PSG membership, sociodemographic factors, internet use, and preferences in medical decision-making were analysed with t-tests and multiple linear regressions.

RESULTS

The t-test showed a statistically significant difference in CSK between members and non-members of PSGs. Knowledge for PSG members was on average 0.97 points higher (p < 0.001) and varied between 2 and 14 points compared to 0-14 points for non-members. Regression analysis revealed age, gender, time since diagnosis, education, internet use, and PSG activity to be statistically significant predictors. Younger (β =  - 0.15; p < 0.001), female (β = 0.10; p = 0.001), higher educated patients (β = 0.27; p < 0.001) with and a diagnosis longer ago (β = 0.10; p = 0.002) who use the internet frequently for information seeking (β = 0.20; p ≤ 0.001) and members of cancer PSGs (β = 0.18; p ≤ 0.001) showed a higher CSK.

CONCLUSION

Overall, CSK of the participants shows a high degree of variance. CSK should be promoted for all patients and especially for older, newly diagnosed patients with low educational levels and PSGs introduced early on as they contribute to improving CSK among other benefits.

Perioperative experiences and needs of patients who undergo colorectal cancer surgery and their family caregivers: a qualitative study

PURPOSE

Colorectal cancer (CRC) surgeries are major, complex, and often associated with debilitating symptoms or significant deconditioning that may impair patients' quality of life. Little is known about how patients and family caregivers cope and their unmet needs during this daunting perioperative phase. This study aimed to explore the experiences and needs of CRC patients who undergo surgery and their family caregivers.

METHODS

An exploratory qualitative design was adopted. A total of 27 participants comprising fifteen outpatients who had undergone colorectal cancer surgery and twelve family caregivers were recruited through purposive sampling from a public tertiary hospital in Singapore between December 2019 and November 2020. Individual, audio-recorded, semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Four themes emerged: initial reactions to the diagnosis, impact of the illness and surgery, personal coping, and external support. The lack of apparent assessments on the psychological well-being of patients was found despite several participants exhibiting early signs of distress. Access to psychological support provided by healthcare professionals or peers was selective, and knowledge deficit was prevalent, especially in the preoperative stage.

CONCLUSION

Psychological priming and strengthening are important for CRC patients' and their caregivers' adaptive coping throughout the treatment continuum. Technology-based, dyadic psychoeducation should be offered preoperatively to ease CRC patients' acceptance of their diagnosis and adjustment to life after surgery while at the same time reduce the burden of family carers.

Implementation of programming for survivors of violence-related trauma at a level 1 trauma center

Background

Prior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism.

Methods

VOCARP was established in 2017 at our center, and all patients who engaged with programming (n=1019) were prospectively recorded. Patients are offered services in the emergency department, on inpatient floors and at outpatient clinic visits. Two control groups (patients sustaining violent injuries without VOCARP use (n=212) and patients with non-violent trauma (n=201)) were similarly aggregated.

Results

During 22 months, 96% of patients accepted education materials, 31% received financial compensation, 27% requested referrals, and 22% had crisis interventions. All other resources were used by <20% of patients. Patients who used VOCARP resources were substantially different from those who declined services; they were less often male (56% vs. 71%), more often single (79% vs. 51%), had greater unemployment (63% vs. 51%) and were less frequently shot (gunshot wound: 26% vs. 37%), all p<0.05. Overall recidivism rate was 9.4%, with no difference between groups. Use of mental health services was linked to lower recidivism rates (4.4% vs. 11.7%, p=0.016). While sexual assault survivors who used VOCARP resources had lower associated recidivism (2.4% vs. 12%, p=0.14), this was not statistically significant.

Discussion

This represents the largest violence intervention cohort reported to date to our knowledge. Despite substantial engagement, efficacy in terms of lower recidivism appears limited to specific subgroups or resource utilization.

Level of evidence

Level II. Therapeutic.

Assessment of Self-Efficacy as a Way to Help Identify Cancer Patients Who Might Benefit from Self-Help Group Attendance?

Participating in patient self-help groups is highly recommended to patients in cancer care. Yet, engagement is relatively rare. A total of 253 patients participated in our study conducted as a paper-and-pencil questionnaire. A binominal logistic regression, with interest in participation in self-help groups being the dependent variable, was run. General interest in self-help was high among the respondents. Female gender, higher age, higher education and low self-efficacy were found to significantly predict interest in self-help. Patients reported a lack of information provided by medical professionals. Self-efficacy as a predictor might contribute to characterizing patients who might benefit from self-help group participation.

Quality of Life and Its Influencing Factors Among Chinese Patients With Permanent Colostomy in the Early Postoperative Stage: A Longitudinal Study

BACKGROUND

Colorectal cancer is one of the most common cancers worldwide. Although colostomies are necessary for disease treatment, they unavoidably affect patient quality of life (QOL), especially in the early postoperative stage.

OBJECTIVE

The aim of this study was to investigate the dynamic changes and factors influencing QOL among Chinese patients with permanent colostomy.

METHODS

We investigated 74 patients before discharge and at 1 and 3 months after discharge. Instruments included the Quality of Life Questionnaire for People With Ostomy-Chinese version, Stoma Self-efficacy Scale, Stoma Self-care Scale-Early Stage Version, and a demographic and stoma-related information questionnaire.

RESULTS

The average QOL increased significantly after discharge (P < .01). Multivariate linear regression showed that the influencing factor of QOL was self-efficacy (before discharge, explained 22.9% of the variance); self-efficacy, truth-telling, average time of stoma care, communicating with friends with colostomy, and family relationship (1 month after discharge, explained 48.8% of the variance); and self-efficacy, body image loss, and participating in activities of patients with colostomy (3 months after discharge, explained 85.2% of the variance).

CONCLUSIONS

Clinicians need to give attention to improving the QOL of colostomy patients especially 1 month after discharge. Interventions aimed at improving self-efficacy, preoperative education regarding the surgery, colostomy care ability, family relationship, stoma self-acceptance, and involvement in activities of friends with colostomy should be considered to improve QOL among Chinese patients in this setting.

IMPLICATIONS FOR PRACTICE

Transitional care should be provided for colostomy patients especially 1 month after discharge. Interventions should focus on enhancing self-efficacy, stoma self-management, and social-environmental support.

Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period

BACKGROUND

The primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources.

METHODS

Trauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient's medical records.

RESULTS

From May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had 'direct contact' (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2-15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2-10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018.

CONCLUSIONS

Hospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary.

LEVEL OF EVIDENCE

Level II therapeutic.

How does the process of group singing impact on people affected by cancer? A grounded theory study

OBJECTIVE

This study aimed to build an understanding of how the process of singing impacts on those who are affected by cancer, including patients, staff, carers and those who have been bereaved.

DESIGN

A qualitative study, informed by a grounded theory approach.

SETTING AND PARTICIPANTS

Patients with cancer, staff, carers and bereaved who had participated for a minimum of 6 weeks in one of two choirs for people affected by cancer.

METHODS

31 participants took part in Focus Group Interviews lasting between 45 min and an hour, and 1 participant had a face-to-face interview.

FINDINGS

Four overarching themes emerged from the iterative analysis procedure. The overarching themes were: building resilience, social support, psychological dimensions and process issues. Following further analyses, a theoretical model was created to depict how building resilience underpins the findings.

CONCLUSION

Group singing may be a suitable intervention for building resilience in those affected by cancer via an interaction between the experience and impact of the choir.

Preferences for models of peer support in the digital era: A cross-sectional survey of people with cancer

OBJECTIVE

Many people with cancer report an unmet need for peer support, yet participation rates are low. This study examined cancer patients' preferences for participating in peer support, and the characteristics associated with having or wanting to participate in peer support.

METHODS

Adult cancer patients were recruited from outpatient oncology clinics at 5 hospitals in Australia. Participants were invited to self-complete 2 questionnaires: one at recruitment assessing their demographic and cancer characteristics, and another 4 weeks later assessing their preferences for participating in cancer-related peer support.

RESULTS

The peer support questionnaire was completed by 177/273 (65%) of participants. Most (59%, n = 104) had or wanted to participate in peer support. More than half reported that it was important the people they connected with had the same cancer treatment (56%, n = 99) or type of cancer (53%, n = 94) as themselves. Half had or wanted to participate in 1-to-1 peer support (52%, n = 92). Half had or wanted to connect with peers face-to-face (53%, n = 93). Only 13% (n = 23) were receptive to connecting with peers over the internet. Being aged ≤65 years was significantly associated (OR = 2.3; 95% CI: 1.1-5.1) with reporting a preference for participating in peer support.

CONCLUSIONS

Cancer patients are interested in participating in peer support, particularly those who are younger. Despite the digital era, traditional forms of peer support continue to be important in supporting people with cancer. Greater understanding of the barriers to cancer patients' involvement in potentially low cost and high reach web-based models of peer support is required.

Peer support for CKD patients and carers: overcoming barriers and facilitating access

BACKGROUND

Peer support is valued by its users. Nevertheless, there is initial low take-up of formal peer support programmes among patients with chronic kidney disease (CKD), with fewer patients participating than expressing an interest. There is little evidence on reasons for low participation levels. Few studies have examined the perspectives of carers.

OBJECTIVE

To explore with CKD patients and carers their needs, wants and expectations from formal peer support and examine how barriers to participation may be overcome.

METHODS

Qualitative interviews with a sample of 26 CKD stage five patients and carers. Principles of Grounded Theory were applied to data coding and analysis.

SETTING

Six NHS Hospital Trusts.

RESULTS

Whilst informal peer support might occur naturally and is welcomed, a range of emotional and practical barriers inhibit take-up of more formalized support. Receptivity varies across time and the disease trajectory and is associated with emotional readiness; patients and carers needing to overcome complex psychological hurdles such as acknowledging support needs. Practical barriers include limited understanding of peer support. An attractive peer relationship is felt to involve reciprocity based on sharing experiences and both giving and receiving support. Establishing rapport is linked with development of reciprocity.

CONCLUSIONS

There is potential to facilitate active uptake of formal peer support by addressing the identified barriers. Our study suggests several facilitation methods, brought together in a conceptual model, including clinician promotion of peer support as an intervention suitable for anyone with CKD and their carers, and opportunity for choice of peer supporter.

Predicting cancer patients' participation in support groups: a longitudinal study

OBJECTIVE

Few patients participate in cancer support groups despite their benefits. This study investigated the importance of Theory of Planned Behaviour variables in predicting group participation, relative to disease impact, existing support, coping and demographic variables.

METHODS

Longitudinal study of patients with colorectal, lung or prostate cancer recruited from a specialist oncology centre. Patients self-completed surveys at baseline and six-month follow up. Baseline measures included Theory of Planned Behaviour (TPB) variables, distress and control over cancer (IPQ-R), coping (Brief COPE), social support (MSPSS), health related quality of life (EORTC QLQ-C30) and readiness to participate (PAPM). Group participation and recommendations to participate were measured at follow up. Univariable and Random Forest analyses investigated predictors of baseline readiness to participate and participation by six-month follow up.

RESULTS

N=192 patients completed baseline questionnaires. N=13 participated in a group and N=59 did not by six-month follow up. Baseline readiness to participate was associated with inadequate support and positive views of support groups. Lower cognitive functioning, recommendations and readiness to participate predicted group participation by six-month follow up.

CONCLUSION AND PRACTICE IMPLICATIONS

Practitioners may facilitate group participation by promoting positive views of groups, recommending participation and focusing on patients experiencing greater disease impact and less existing support.

Determinants of engagement in face-to-face and online patient support groups

Background

Although peer-to-peer contact might empower patients in various ways, studies show that only a few patients actually engage in support groups.

Objective

The objective of our study was to explore factors that facilitate or impede engagement in face-to-face and online peer support, using the Theory of Planned Behavior.

Methods

A questionnaire was completed by 679 patients being treated for arthritis, breast cancer, or fibromyalgia at two Dutch regional hospitals.

Results

Our results showed that only a minority of the patients engaged in organized forms of peer support. In total 10% (65/679) of the respondents had engaged in face-to-face meetings for patients in the past year. Only 4% (30/679) of the respondents had contact with peers via the Internet in the past year. Patients were more positive about face-to-face peer support than about online peer support (P < .001). In accordance with the Theory of Planned Behavior, having a more positive attitude (P < .01) and feeling more supported by people in the social environment (P < .001) increased the intention to participate in both kinds of peer support. In addition, perceived behavioral control (P = .01) influenced the intention to participate in online peer support. Nevertheless, the intention to engage in face-to-face and online peer support was only modestly predicted by the Theory of Planned Behavior variables (R² = .33 for face-to-face contact and R² = .26 for online contact).

Conclusion

Although Health 2.0 Internet technology has significantly increased opportunities for having contact with fellow patients, only a minority seem to be interested in organized forms of peer contact (either online or face-to-face). Patients seem somewhat more positive about face-to-face contact than about online contact.

What should a support program for people with lung cancer look like? Differing attitudes of patients and support group facilitators

INTRODUCTION

Patients with lung cancer have higher levels of unmet need for psychosocial support than those with other cancers. However, uptake of existing support programs by patients with lung cancer is low. We explored this issue by seeking the views of patients and support group facilitators.

METHODS

Surveys of a convenience sample of 100 patients with lung cancer and all support group facilitators registered with Cancer Council Victoria (n = 145) were performed. Respondents were asked about preferred content, location, running, and potential barriers to attendance of a lung cancer support program.

RESULTS

The response rate from facilitators was 51%. Fifty-three percent of patients reported willingness to attend a support program, although only 12% had previously attended a group. Patients showed a preference for any program to be held at a hospital (p = 0.01), whereas facilitators preferred a community setting (p < 0.001). Patients preferred facilitation by a health professional, rather than a volunteer p < 0.001), whereas facilitators preferred a volunteer. Patients preferred sessions primarily focused on cancer information provision rather than emotional support, whereas facilitators rated emotional support as highly as cancer information. Overall, patients perceived fewer barriers to attendance than facilitators. Both agreed that a group environment, discussing their cancer, parking, and travel were barriers to attendance.

CONCLUSIONS

Disparities in the views of patients and facilitators about the preferred location, type of facilitator, and content of a support program may in part explain the poor uptake of existing support programs by patients with lung cancer and should be considered in the design of future programs.

Is there an "ideal cancer" support group? Key findings from a qualitative study of three groups

The objective of this study was to study differently composed cancer support groups to generate insights into what groups are attractive to the widest range of participants, and how they might be best structured and composed. This study applied a qualitative design utilizing participant observation at three cancer support groups (a group for women with metastatic cancer, a colorectal cancer support group, and a group for Chinese cancer patients) and in-depth interviews (N = 23) with group members as the primary data collection methods. Despite the diverse composition of the groups, their perceived benefits were similar, and informants highlighted the information, acceptance, and understanding they received in the support group environment. However, gender and cultural differences were found in attendance patterns and the desired content of group meetings. Importantly, participants' motivations for attending cancer support groups also changed as they moved through the treatment trajectory: over time the need for information was at least partially replaced by a need for support and understanding. This study supports prior research findings that there is no ideal support group, nor is there a "magical formula" for attracting and retaining a diverse audience. However, including an educational component in support groups may increase the participation of currently underrepresented populations such as men and patients from culturally diverse backgrounds.

Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer

OBJECTIVES

The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post-treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended.

METHODS

Ten databases were searched via Ovid and Web of Science. Papers were systematically extracted by title, abstract and full paper according to the inclusion/exclusion criteria. Full papers were assessed by two authors.

INCLUSION CRITERIA

participants at any stage of a cancer diagnosis, > or =50% male and aged 18+; psychosocial and/or behavioural post-treatment interventions, using any format; a one-three level of evidence. Couple/carer/family interventions were excluded.

RESULTS

From 9948 studies initially identified, 11 were finally included in the review. They implemented cognitive behaviour therapy, hypnosis or psychoeducational interventions. All studies had some positive results, however, lack of reporting of intervention content and methodological issues limit the findings. No studies intervened with single men, and none provided comparative outcomes for marital status.

CONCLUSIONS

Effectiveness of interventions was difficult to assess as, while all had benefits, their generalisability was limited due to methodological and reporting limitations. Improved reporting procedures are required to allow for replication.

Use of cancer support groups among Latina breast cancer survivors

INTRODUCTION

Although Latina women diagnosed with breast cancer may be at greater risk of psychosocial morbidity compared to white women, few utilize support services such as support groups. Reasons for this under-use among Latinas are unknown.

METHODS

A cross-sectional telephone survey examined the association of predisposing, enabling, and need factors with use of cancer support groups among 330 Latina breast cancer survivors recruited from a population-based tumor registry in counties with Spanish language support groups.

RESULTS

Thirty-two percent had ever used a support group. Among the 225 (68%) women who had never used one, major reasons for not using a support group included receiving enough support from other sources (20%), not needing one (18%), and being unaware of groups in their local area (17%). Women receiving quite a bit or a lot of encouragement from family members to attend a cancer support group were seven times more likely to have ever attended one than women receiving little or no encouragement (OR = 7.04, 95% CI 3.72, 13.30). Spiritual well-being was inversely associated with ever having attended a support group (OR = 0.93, 95% CI 0.89, 0.98).

DISCUSSION

Results suggest that families play an important role in promoting use of support groups among Latina breast cancer survivors, and that spirituality may offer an alternative source of support.

IMPLICATIONS FOR CANCER SURVIVORS

More effort should be directed toward providing culturally and linguistically appropriate support services to breast cancer survivors, and increasing awareness of these services among oncologists, patients and family members.

`Blokes Don't Like That Sort of Thing'

Research has demonstrated that gender is a barrier to men's participation in self-help groups. In this article I analyse how four men and seven women negotiate their identities as members of cancer self-help groups. Their accounts were transcribed and analysed using a synthetic approach to discursive psychology. Women's accounts were organized around the notion of receiving help whereas men appeared to resist this type of identity. I explore how men attended to the presentation of a masculine identity and focus on how men negotiated `legitimately masculine' reasons to be engaged in self-help groups.

A qualitative analysis of reasons for leaving, or not attending, a cancer support group

Factors that influence participation and long-term retention in cancer support groups were examined, through a study of 87 individuals who had dropped out of a cancer support group, and 26 individuals who had never attended such groups, using a combination of interviews and open-ended questionnaire responses. Support group attrition or non-attendance was positioned as resulting from both individual and group factors. Individual factors included resisting or leaving behind a cancer patient identity, presence of existing support, practical issues, and styles of coping. Group factors included mismatches between the group and the individual, lack of knowledge or nonreferral to groups, and problems within individual groups. These disparate factors underlying support group non-attendance need to be taken into consideration when planning support services, when developing programs of education, or when referrals to cancer support groups are made.

Use of health-related and cancer-specific support groups among adult cancer survivors

BACKGROUND

Data from the National Health Interview Survey suggest that the utilization of mental health services among cancer survivors is low and unmet needs are high for some. However, to the authors' knowledge little is known regarding the prevalence and predictors of participation in health-related support groups.

METHODS

A total of 9187 participants in the California Health Interview Survey Complementary and Alternative Medicine (CHIS-CAM) study completed a telephone interview in 2003 (1844 participants with cancer and 4951 participants with other chronic health problems). Participants were asked to describe previous/ current support group use, benefits of support group use, and physician involvement in decisions regarding support groups. Weighted logistic regression analyses were conducted using SUDAAN software to examine patterns of support group use.

RESULTS

The prevalence of support group use was found to be higher among cancer survivors (23.7%) than those with another chronic health condition (14.5%). Predictors of support group use were found to be similar across groups and included female gender, greater education, use of complementary and alternative medicine (CAM), depression, and anxiety. Age, health insurance, and presence of depression predicted support group use differently for cancer survivors and those with other conditions. The percentages of those perceiving support groups to be beneficial varied from 35.1% for those with skin cancer to 96% for those with cervical cancer. The percentage of participants reporting that their physician recommended a support group was low (10.2%).

CONCLUSIONS

Health-related support groups are used by nearly 1 in 4 cancer survivors, but levels of utilization differ across subgroups. An understanding of how cancer survivors use support groups highlights shortcomings in psychosocial care and suggests that additional efforts to overcome barriers to care are needed.

An Evaluation of Internet Websites Provided by Radiotherapy Departments

The research identifies and evaluates the content and readability of Websites of all radiotherapy departments that provide a Website. As more patients are being referred for radiotherapy treatment each year, the information needs of the public on this subject is growing. Fifty-two per cent of radiotherapy departments within the United Kingdom (UK) and Ireland were identified as providing a Website. These Websites were evaluated, over a period of 2 weeks, using an adapted Website evaluation tool. Five criteria – content, authority, navigation, design and technical aspects – were identified as important aspects of a Website. For each criterion a number of statements were listed and using a Likert scale were marked. Flesch–Kincaid readability tests were used to analyse the readability level of the Websites. Data analysis resulted in the ranking of the Websites. Evaluation scores varied greatly and the readability tests showed 92% of the Websites were written at a level too high for the public. This shows the varying quality of radiotherapy department Websites with scores ranging from 48 to 115, and the varying readability level of these Websites. The research makes suggestions for the improvement of radiotherapy department Websites including the provision of a dedicated Website team within the department, educated in Website design.

Reliability and Validity of the Colorectal Cancer Screening Belief Scale in Turkey

Colorectal cancer is the third leading cause of cancer death in Turkey. The emphasis of the healthcare services in Turkey is on curative rather than preventive and rehabilitative approaches. Although the Ministry of Health provides many healthcare services for prevention and early detection, their availability and accessibility are very low. The purpose of this study was to test the reliability and validity of the Turkish language version of Champion's Health Belief Model Scales in measuring Turkish women's and men's beliefs about colorectal cancer. This study was carried out in Izmir, the third most populous city in Turkey. The Champion's Health Belief Model Scales was translated using a back-translation technique. A convenience sample of 470 individuals was recruited from January 2004 through March 2004. Descriptive statistics were computed for the demographic characteristics. Reliability was assessed by interpreting the item-total subscale score correlation, test-retest reliability, and Cronbach alpha coefficients. For testing the relationship between item performance and scale performance, corrected item-total correlations ranged from 0.41 to 0.79 for all 5 subscales. Cronbach alpha coefficients for the 5 subscales ranged between .54 and .88, and test-retest reliability coefficients ranged from 0.72 to 0.91. The study showed that the Turkish version of the Champion's Health Belief Model Scales has good structural characteristics and is a reliable and valid instrument that can be used for measuring beliefs related to colorectal cancer.

Support group participation among persons with HIV: Demographic characteristics and perceived barriers

Support groups are widely available for persons living with HIV and some evidence supports their efficacy. However, limited information exists regarding characteristics of those who utilize HIV support groups. The present study examined demographic characteristics and perceived barriers of attenders and non-attenders of HIV support groups via a mail survey. The 35 respondents were predominantly white (71.4%), male (65.7%), homosexual/bisexual (57.1%) and diagnosed with HIV within the last five years (62.8%). Results suggested that HIV support group attenders had higher educational attainment and a longer time since diagnosis than non-attenders. Respondents who expressed interest in HIV support group participation were diagnosed more recently than those who did not express interest. Respondents who had attended other types of support groups reported fewer perceived barriers to participation in HIV support groups. Overall, findings suggest that the perception of barriers may be related to interest and participation in support groups for HIV and other problems.

Closing the divide: diverse populations and cancer survivorship

Currently, there is a "divide" between cancer survivorship initiatives and minority participation. The level of participation is nearly nonexistent in many cancer support and control initiatives. Cancer survivorship resources that facilitate access to treatment, psychosocial interventions, clinical trials, and research are key components to eliminating this divide. Differences in cancer results among minority populations are caused by several factors, including biologic reactions to environmental activities, socioeconomic status, perceived beliefs and notions of medical professionals, a lack of resources to participate in cancer support groups, and having personal contact with cancer survivors. Health professionals, advocates, and researchers hold the key to opening more opportunities for the improvement of cancer survivorship among minorities. The belief that "one size fits all" is unrealistic. These beliefs can influence participation in innovative clinical trials, decisions about treatment, emotional responses, and social support relationships. To help ensure participation in these programs, researchers and health workers must understand the role of social and psychosocial implications and results of the assessment, strategies, and sustainability that must be included in the development stage of any cancer support and survivorship initiatives. For this article, the authors examined mechanisms that can be used by cancer-control researchers and program staff to limit the divide between cancer survivorship initiatives and minority participation. They identified three strategies that must be used to address this divide effectively: the inclusion of minorities in clinical trials, intervention studies, treatment, and research programs; the development of culturally sensitive environments; and the ability to sustain minority participation. In summary, cancer survivorship includes many components that are developed individually and collectively to formulate sound strategies for including minorities in cancer-control initiatives. These programs should go beyond basic support groups and should include research studies, clinical trials, and alternative treatments for increasing cancer survival rates and quality of life among minorities. The divide can be addressed only through a proactive initiative that brings cancer survivorship initiatives and minority communities together in full partnership.

Use of complementary and alternative medicine in cancer patients: a European survey

BACKGROUND

The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries.

METHODS

A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients.

RESULTS

Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient.

CONCLUSIONS

It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire

PURPOSE

Ostomies may be performed for bowel or urinary diversion, and occur in both cancer and non-cancer patients. Impact on physical, psychological, social and spiritual well-being is not unexpected, but has been minimally described in the literature. The City of Hope Quality of Life (COH-QOL)-Ostomy Questionnaire is an adult patient self-report instrument designed to assess quality of life. This report focuses on the revision and psychometric testing of this questionnaire.

PATIENTS AND METHODS

The revised COH-QOL-Ostomy Questionnaire involved in-depth patient interviews and expert panel review. The format consisted of a 13-item disease and demographic section, a 34-item forced-choice section, and a 41-item linear analogue scaled section. A mailed survey to California members of the United Ostomy Association resulted in a 62% response rate (n = 1513). Factor analysis was conducted to refine the instrument. Construct validity involved testing a number of hypotheses identifying contrasting groups.

RESULTS

Factor analysis confirmed the conceptual framework. Reliability of subscales ranged from 0.77 to 0.90. The questionnaire discriminated between subpopulations with specific concerns.

CONCLUSIONS

Overall, the analyses provide evidence for the validity and reliability of the COH-QOL-Ostomy Questionnaire as a comprehensive, multidimensional self-report questionnaire for measuring quality of life in patients with intestinal ostomies.

Breast cancer: evaluation of the Common Journey Breast Cancer Support Group

BACKGROUND

Most studies of cancer support groups have focused on the effects of groups established for research purposes, from the exclusive perspective of the group participants.

AIM

This Roy Adaptation Model-based programme evaluation project focused on identifying the experiences of both participants in and facilitators of a community hospital-sponsored breast cancer support group.

DESIGN

Repeated measures survey methodology.

METHODS

Ten women with breast cancer and two Registered Nurse group facilitators participated in the programme evaluation project. Qualitative data were analysed using content analysis. Themes extracted from the data were categorized according to the Roy Adaptation Model modes of adaptation. The group participants completed Initial and End of Year Interview Guides and Group Voices Forms; the group facilitators completed the Facilitators' Voices Form. The Institutional Review Committee of a community hospital approved the programme evaluation project.

RESULTS

The Common Journey Breast Cancer Support Group is a community hospital-sponsored cancer support group established to meet the informational, emotional support, and social support needs of women with breast cancer who reside in a rural state in the New England region of the USA. Responses of participants and facilitators, which reflected all four of the Roy model modes of adaptation, indicated that the combination of information and emotional and social support was effective.

CONCLUSIONS

Nurses and other health professionals who establish community-based cancer support groups should consider formal evaluation of the outcomes, from the perspectives of both participants and facilitators, and should publish the results. The results of this programme evaluation project are limited to one breast cancer support group with a small number of female participants and two facilitators. Results cannot be generalized to support groups for other types of cancer or to cancer support groups for men.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other health professionals should consider establishing and facilitating community hospital-sponsored support groups for women with breast cancer, which have the potential to meet the women's informational, emotional support, and social support needs.

Assessing self-help issues for patients with prostate cancer, interstitial cystitis, erectile dysfunction and urinary diversion

OBJECTIVE

To determine the prevalence of self-help (which is widely available and can assist clinicians to educate and empower patients) for several urological diseases.

PATIENTS AND METHODS

Using a structured interview, the prevalence of self-help use and awareness was assessed in patients with prostate cancer, interstitial cystitis, erectile dysfunction and urinary diversion. Patients were also asked to report levels of support and information they required and to specify how well these needs were being met. Consecutive patients (120, 30 from each group) were recruited from an outpatient urology clinic in a tertiary-care health centre.

RESULTS

Patients with interstitial cystitis and erectile dysfunction reported having the greatest need but were least satisfied with the level of support and information they currently receive. Inversely, patients with prostate cancer reported having the least need and were most satisfied. Excluding brochures, the use and awareness of self-help were low in all groups but most patients claimed they would use many types of self-help if they were available. Many patients are not directed to self-help resources by their urologist or family physician.

CONCLUSION

Most patients would like to use more self-help but many do not. The low percentage of patients referred to self-help by their physician probably contributes to, or causes, this problem. It is important for clinicians to encourage and refer patients to specific resources to ensure that the patient receives accurate and pertinent information. As most patients read brochures it is logical to use them to provide basic information and to direct them to other more sophisticated forms of self-help. We have used urology patients as a model but consider that many of our findings could be applied to other medical and surgical specialties.