One-to-one peer support in cancer care: a review of scholarship published between 2007 and 2014

A randomized controlled trial of the effectiveness of a one-to-one peer support intervention on resilience, social support, and salivary cortisol in recently diagnosed women with breast cancer

PURPOSE

Peer support has been suggested as a way to help women diagnosed with breast cancer to better cope with their situation, but studies on its effectiveness have conflicting results. This randomized controlled trial aimed to study the effectiveness of a one-to-one peer support intervention on psychological resilience, social support, and salivary cortisol among breast cancer patients.

METHODS

The sample consisted of 121 newly diagnosed women at Onkologikoa Hospital. Patients who were prescribed chemotherapy were randomly assigned to Intervention Group 1 (IG1) or Control Group 1 (CG1). Similarly, those prescribed adjuvant radiotherapy were assigned to IG2 or CG2. Women in IG1 received 8 biweekly social support sessions from volunteer survivors who had successfully overcome breast cancer, while IG2 received 6 biweekly sessions. CG1 and CG2 only received standard care. Resilience, social support, and salivary cortisol were assessed at baseline (T1) and at the end of the intervention (T2).

RESULTS

We found a non-significant, yet a small to moderate size increase in resilience from T1 to T2 in IG1 (p = 0.246; dDc = 0.47). Upon regression analysis, we observed that this increase was determined by changes in cortisol (β = -0.658, p = 00.010), affective support (β = -0.997, p = 00.014), and emotional support (β = 0.935, p = 00.008). We also found a significant decrease in resilience levels in CG2 from T1 to T2 (p = 0.003; dDc = 0.88).

CONCLUSION

The present study suggests that peer support can exert a protective psychological influence on women diagnosed with breast cancer, and further indicates an exciting avenue for future intervention development in the breast cancer care continuum.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05077371.

"A Mission and Purpose to Make Some Sense out of Everything That Was Happening to Me": A Qualitative Assessment of Mentorship in a Peer-to-Peer Gynecologic Cancer Program

This study aimed to elucidate the relationship between mentorship, survivorship, and identity construction in people who have had gynecologic cancer and participated as mentors in a peer mentorship program. A qualitative descriptive study was designed, and hour-long semi-structured interviews with peer mentors were conducted. Interviews investigated how serving as a peer mentor influenced understanding of mentors' own cancer experiences. Thematic analysis was then conducted. All authors open-coded a subset of interviews to develop a codebook, which was then used to code the remaining transcripts. This qualitative inductive analysis of over 7 h of data was managed with NVivo 12. Seven peer mentor participants (N = 7) were interviewed. Four main themes emerged: serving in the social role of mentor gave participants (i) a sense of daily direction in their lives, (ii) an opportunity to give back to others in the cancer community, (iii) an explanatory reason for their cancer journey, and (iv) the ability to reify their own status as survivor. Providing support through a peer mentorship program helped our participants make meaning in their own cancer experience.

Study Protocol for the Social Interventions for Support During Treatment for Endometrial Cancer and Recurrence (SISTER) study: a community engaged national randomized trial

Aim: Social isolation in cancer patients is correlated with prognosis and is a potential mediator of treatment completion. Black women with endometrial cancer (EC) are at increased risk for social isolation when compared with White patients. We developed the Social Interventions for Support during Treatment for Endometrial Cancer and Recurrence (SISTER) study to compare and evaluate interventions to address social isolation among Black women with high-risk EC in USA. The primary objective of the SISTER study is to determine whether virtual support interventions improve treatment completion compared with Enhanced Usual Care. Secondary objectives include comparing effectiveness virtual evidence-based interventions and evaluating barriers and facilitators to social support delivery. Patients & methods: This is a multi-site prospective, open-label, community-engaged randomized controlled trial, consisting of three intervention arms: enhanced usual care, facilitated support group and one-to-one peer support. Primary outcome will be measured using relative dose. Qualitative semi-structured interviews will be conducted with a subset of participants to contextualize the relative degree or lack thereof of social isolation, over time. Data analysis: Primary analysis will be based on an intent-to-treat analysis. Multivariable analysis will be performed to determine the effect of the intervention on the primary and secondary outcomes of interest, relative dose and social isolation score. Semi-structured interviews will be qualitatively analyzed using inductive and deductive approaches of content analysis. Discussion/conclusion: Endometrial cancer mortality disproportionately affects Black women, and social isolation contributes to this disparity. The SISTER study aims to identify whether and to what extent differing social support vehicles improve key outcomes for Black women in the United States with high-risk EC. Clinical Trial Registration: NCT04930159 (ClinicalTrials.gov).

Peer support impact on therapeutic adherence in patients with multiple sclerosis: a mixed-methods pilot trial protocol

INTRODUCTION

Patient partnership is a key component of patient-centred care. One form of partnership is individual peer support, which can improve patients' quality of life and adherence to treatment. Patient with multiple sclerosis could benefit from this type of support, but such an intervention has not been explored in the literature.We propose in this article a pilot study protocol to assess the feasibility and acceptability of healthcare-integrated individual peer support, and the feasibility of a large-scale efficacy trial.

METHODS AND ANALYSIS

The PAIR-SEP study is a mixed-methods pilot clinical trial combining quantitative and qualitative approaches. Sixty patients with relapsing-remitting multiple sclerosis undergoing drug therapy from the Neurology centre of Nantes University Hospital (France) will be randomised on a 1:1 ratio to receive either usual care only or usual care combined with peer support (three individual sessions at 1, 3 and 5 months with a peer helper).We will evaluate clinical outcomes in preparation of the large-scale trial: therapeutic adherence 6 months after baseline, therapeutic compliance, quality of life, anxiety and depression, social support. All dimensions will be assessed using validated health questionnaires at baseline and at 6 months.Intervention's acceptability and feasibility will be evaluated using qualitative methods: undirected interviews with patients from the intervention group and separate focus-groups with the peer helpers the healthcare team.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the local ethics committee on 1 October 2022. This study was designed in collaboration with multiple sclerosis peer helpers.The trial findings will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05519553.

Explaining how and why social support groups in hospice day services benefit palliative care patients, for whom, and in what circumstances

Background

Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life.

Objectives

This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients.

Design

Qualitative research using observations of hospice day services and interviews with service providers.

Methods

Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service.

Results

Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances.

Conclusion

Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.

Integrating one-to-one peer support into psycho-oncological care in Germany: multi-perspective, mixed-methods evaluation of the isPO onco-guide service

PURPOSE

One-to-one peer supporters called isPO onco-guides (isPO OGs) are an integral part of the new German psycho-oncological form of care 'integrated, cross-sectoral Psycho-Oncology' (isPO), additionally to professional care. The isPO OGs are cancer survivors with experiential knowledge, offering information on local support services and answering questions 'all around cancer' to newly diagnosed cancer patients. We aimed to evaluate the isPO OG service from three perspectives: patients, isPO OGs, and professional service providers.

METHODS

A mixed-methods approach was pursued. We conducted interviews and focus groups with the three person groups, and applied qualitative content analysis on the reported resources, processes and outcomes regarding the isPO OG service. Relations with patients' utilisation and isPO OGs' work satisfaction were identified with regression and correlation analyses of questionnaire and isPO care data. We compared isPO care networks (CN) with X2-tests or ANOVA. Qualitative and quantitative results were integrated during interpretation phase.

RESULTS

Qualitatively, the three person groups agreed on the benefits of the isPO OG service. The implementation's maturity differed between the CN concerning established processes and resource availability. Attitudes of professional service providers appeared to be crucial for patients' utilisation of the isPO OG service. Quantitative results emphasised the differences between the CN.

CONCLUSION

Beyond differences in the CN, the isPO OG service has two psychosocial benefits: providing relevant, reliable, and understandable information; and offering the encouraging example that surviving and living with cancer is possible.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.

Exploring the experiences and perceptions of participating in a peer-support intervention for adults with chronic non-cancer pain: a qualitative systematic review

OBJECTIVE

This review explored the experiences and perceptions of adults with chronic non-cancer pain who participated in peer-support interventions. This included adults' perceptions of intervention components, strengths and limitations of interventions, and barriers and facilitators for their implementation.

INTRODUCTION

Chronic pain, defined as pain that persists beyond 12 weeks or past normal tissue healing time, is a prevalent and costly issue. Peer-support interventions could play a pivotal role in the management of chronic pain. Studies have been conducted examining the perspectives of people with chronic pain on peer-support interventions; however, a systematic review had yet to be conducted to synthesize this evidence.

INCLUSION CRITERIA

This review included qualitative studies of any design that explored the experiences of adults (defined by the study's country of origin) with chronic pain during and after participation in a peer-support intervention.

METHODS

The methods for this review followed JBI methodological guidance for systematic reviews of qualitative evidence. AMED, CINAHL, MEDLINE, PsycArticles, and SPORTDiscus (all via EBSCOhost); Embase and PsycINFO (both via Ovid); and Web of Science databases were searched for published studies. EBSCO Open Dissertations, EThOS (British Library), the Networked Digital Library of Theses and Dissertations (Global ETD), and Google Scholar were searched for gray literature. Databases were searched from inception to April 2020, and all languages were considered for inclusion. All studies identified by the search were examined against the inclusion criteria. Papers selected for inclusion were assessed by 2 independent reviewers for methodological quality prior to inclusion in the review. Qualitative research findings were extracted and pooled. Findings were assembled and categorized based on similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings.

RESULTS

Seven studies with a total of 214 participants were included in the review. Most of the studies (5/7) were of moderate to high quality, following critical appraisal. From these studies, 53 findings were extracted and grouped into 14 categories. Four synthesized findings were compiled by aggregating the categories. Broadly, these synthesized findings related to the unique relationships formed between peers, benefits for both parties, essential intervention components, and barriers to implementation.

CONCLUSIONS

This was the first systematic review to summarize the experience of participating in a peer-support intervention for adults with chronic non-cancer pain. The synthesized findings from this review can be used by organizations to develop and implement peer-support interventions for adults with chronic non-cancer pain. Another main finding is the lack of research in this area, as only 7 studies were included after a comprehensive search. Furthermore, no evidence was found in the areas of intervention format, length of intervention, or frequency of contact between peer-support volunteers and participants. As such, these areas require further research. The generalizability of the included studies is also limited, as the studies represented only 4 countries (Canada, China, the United Kingdom, and the United States). The results, therefore, present the experiences of people from high-income settings and may not be contextualized to low- and middle-income countries; this warrants further research to be conducted in the latter countries.

REVIEW REGISTRATION

PROSPERO CRD42021245085.

How effective is peer-to-peer support in cancer patients and survivors? A systematic review

PURPOSE

Core components of peer-to-peer (PTP) support for cancer survivors include informational, emotional, and psychosocial aspects. Previous literature on peer support in cancer includes both professionally and peer-led support. Our objective was to summarize studies on the effects of non-professionally led PTP support in cancer.

METHODS

We performed a systematic research on studies in PTP support of adult cancer survivors with an interventional design, comparing outcomes of PTP support against any control. We included all studies with a precise definition of a PTP support, published from January 2000 up to March 2023 in peer-reviewed journals in English or German.

RESULTS

Out of N = 609 identified publications, we were are able to include n = 18 randomized-controlled trials (RCTs) fulfilling our inclusion criteria. Main settings were dyadic support via telephone, face-to-face (FTF), and web-based online support. Most common outcomes were distress, depressive symptoms, anxiety, and quality of life (QoL). Overall, we found only small effects of PTP support on depression/anxiety, coping, or sexual functioning. Beneficial effects associated with the PTP intervention were apparent in particular in BRCA, in FTF settings, and in assessments of cancer-specific QoL outcomes.

CONCLUSION

This review shows that there are a few RCT investigating the effect of PTP support with short-term effects. Overall, there is a need for more RCTs with high methodological standards to evaluate the effectiveness of PTP support.

Cancer-Peer Connection in the Context of Adolescent and Young Adult Cancer: A Qualitative Exploration

Purpose: This qualitative study examined experiences and attitudes related to cancer-peer interactions among adolescent and young adult (AYA) cancer survivors. Methods: Twenty-six survivors, aged 16-24 years who were diagnosed with cancer between the ages of 14 and 18, completed one-on-one semistructured interviews as part of a larger study. Interviews were coded and analyzed using an iterative consensus and data-driven approach. Results: The data for this study revealed three main themes related to cancer peers, including the unique aspects of shared illness experience (i.e., personalizing of support from lived experience, inspiration from upward comparisons, space to be scared and to joke about cancer), benefits of providing support to other patients/survivors (i.e., giving back, healing after cancer, and incorporating cancer into life as a survivor), and considerations and concerns when connecting with cancer peers (i.e., exposure to adverse outcomes, "ignorance is bliss": blocking cancer out, guilt and cancer imposter syndrome). Conclusion: Study findings demonstrate the importance of cancer-peer connection and support in AYA cancer care, both during treatment and in survivorship. Future research should explore the ways in which peer-to-peer support programs could be tailored to best serve the AYA population in the context of cancer care.

Cancer-Related Stigma in Malawi: Narratives of Cancer Survivors

PURPOSE

Stigma is an impediment across the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life. The goal of this study was to qualitatively examine the drivers, manifestations, and impacts of cancer-related stigma among individuals who received cancer treatment in Malawi, and to identify opportunities to address stigma.

METHODS

Individuals who had completed treatment for lymphoma (n = 20) or breast cancer (n = 9) were recruited from observational cancer cohorts in Lilongwe, Malawi. Interviews explored the individual's cancer journey, from first symptoms through diagnosis, treatment, and recovery. Interviews were audio-recorded and translated from Chichewa to English. Data were coded for content related to stigma, and thematically analyzed to describe the drivers, manifestations, and impacts of stigma along the cancer journey.

RESULTS

Drivers of cancer stigma included beliefs of cancer origin (cancer as infectious; cancer as a marker of HIV; cancer due to bewitchment), perceived changes in the individual with cancer (loss of social/economic role; physical changes), and expectations about the individual's future (cancer as death sentence). Cancer stigma manifested through gossip, isolation, and courtesy stigma toward family members. The impacts of cancer stigma included mental health distress, impediments to care engagement, lack of cancer disclosure, and self-isolation. Participants suggested the following programmatic needs: community education about cancer; counseling in health facilities; and peer support from cancer survivors.

CONCLUSION

The results highlight multifactorial drivers, manifestations, and impacts of cancer-related stigma in Malawi, which may affect success of cancer screening and treatment programs. There is a clear need for multilevel interventions to improve community attitudes toward people with cancer, and to support individuals along the continuum of cancer care.

It Has Become a Part of Me: Living With Low Anterior Resection Syndrome After Ostomy Reversal: A Phenomenological Study

PURPOSE

The purpose of this study was to explore challenges of individuals living with low anterior resection syndrome (LARS) 1 year or more after ostomy reversal and formulate a greater understanding of their needs.

DESIGN

Qualitative study with a phenomenological approach.

SUBJECTS AND SETTING

The sample comprised 2 women and 5 men. All participants had undergone low anterior resection in the Comprehensive Cancer Center of a Swiss university hospital. The mean age of participants was 66 years (range, 61-71 years).

METHODS

Interviews were conducted 12 to 42 months after ostomy reversal. Data were collected from one-on-one in-depth interviews using a standardized interview guide with open-ended questions. An interpretative phenomenological analysis was used to interpret data.

RESULTS

Analysis revealed 3 central categories addressing the burden of living with LARS: "Internalizing new living conditions"; "Actively planning a new everyday life"; and "Knowing the body and controlling symptoms." "Unpredictability" emerged as the key challenge. Being informed in advance about the problems expected to arise, having the possibility to talk about problems, as well as receiving peer support and structured aftercare were identified as means to ease patients' challenges when living with LARS.

CONCLUSIONS

Twelve to 42 months after stoma reversal, participants had internalized their new living conditions. Their level of acceptance of their situation was substantial. There are indications that a culture of open information before ostomy reversal contributed to being mentally prepared for the situation after surgery. Talking openly about their problems helped participants organize their everyday life.

Feasibility of Patient Reported Outcome Measures in Psychosocial Palliative Care: Observational Cohort Study of Hospice Day Care and Social Support Groups

Palliative care patients can be at risk of social isolation or loneliness. Interventions that can provide effective social support, and particularly emotional support, could facilitate healthy coping that bolsters quality of life and reduces depression in palliative care patients. This is an observational cohort study which recruited thirty patients (n = 30) from the day services of four independent hospices in England. Participants completed patient reported outcome measures in perceived social support, loneliness, and depression, at up to three time points. Age range was 56-91 years, males and females were equally represented, and the sample was 93% white British. In participants that provided two or more timepoints, perceived social support increased, and loneliness and depression decreased. Largest changes with the least variation between participants was in emotional support (p = 0.165) and loneliness (p = 0.104). These results suggest that the psychosocial patient reported outcome measures used (MOS-SS, UCLA, BEDS) could be sensitive to change aligned with the goals of this intervention in palliative care. Participants in this study were observed to derive psychosocial benefit from attending the hospice day service.

A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic?

INTRODUCTION

Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes.

METHODS

An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018.

RESULTS

Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services.

CONCLUSIONS

The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.

Peer support interventions on quality of life, depression, anxiety, and self-efficacy among patients with cancer: A systematic review and meta-analysis

OBJECTIVE

Peer support is a common form of social support that is provided by individuals with the same disease, which is cost-effective and has enhanced health outcomes for patients. This study aimed to determine the effectiveness of peer support interventions on quality of life (QOL), depression, anxiety, and self-efficacy among patients with cancer.

METHODS

A systematic search of seven databases were conducted from inception to January 2021. Studies were screened and assessed by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software, and the standardized mean difference was used to calculate pooled effect sizes.

RESULTS

Seventeen studies were included in current review. The meta-analysis indicated significant beneficial effects of peer support on QOL (SMD = 0.48, 95% CI 0.21-0.75; p < 0.001), depression (SMD = -0.23, 95% CI -0.39 to -0.07; p = 0.005), anxiety (SMD = -0.24, 95% CI -0.45 to 0.03; p = 0.03), and self-efficacy (SMD = 0.22, 95% CI 0.03-0.42; p = 0.03) relative to controls. The subgroup analysis for QOL revealed that peer support delivered in the mixed mode contributed more than peer support delivered in the single mode (e.g., face-to-face or telephone).

CONCLUSION

Peer support has significant effects on improving QOL and self-efficacy as well as alleviating depression and anxiety among patients with cancer. Additional randomized controlled trials with rigorous design and larger sample sizes are warranted in the future.

PRACTICE IMPLICATIONS

Peer support programs might benefit patients with cancer and could be used as a complementary approach to traditional healthcare services during cancer rehabilitation.

Development of an intervention influencing activity limitations in older breast cancer survivors: A modified Delphi study

INTRODUCTION

Older breast cancer survivors have difficulty accessing rehabilitation interventions addressing activity limitations. Stakeholder input may improve accessibility of interventions. We sought expert consensus on intervention content and delivery features (e.g., where, mode, duration) to inform development of more accessible interventions for this population.

MATERIALS AND METHODS

We conducted a modified Delphi process with patient, clinical, administrative, and research experts. In Round 1, experts evaluated content and delivery features according to domains of feasibility and prioritization. In Round 2, panelists were asked to re-rank or confer agreement of content and delivery features that met Round 1 consensus. Ranking was based on median score. Consensus was defined as a percentage of panelists that ranked an option within one unit of the median. For nominal data, consensus was defined as percent agreement.

RESULTS

Panelists (n = 20) prioritized physical activity strategies (Median Rank: 2; Consensus: 85%) and adaptive skills training (3; 65%). Panelists also prioritized delivery through outpatient services (1; 100%), post-treatment (1; 100%), combination mode of delivery (100%), duration of three months or less (100%) and occurring one to two days per week (100%).

DISCUSSION

Cancer rehabilitation interventions should be designed with input from stakeholders. The stakeholder intervention priorities identified in this study (e.g., content, setting, and mode) may improve relevance and accessibility of future cancer rehabilitation interventions. Interventions delivered in outpatient clinics and post-treatment using virtual and in-person visits may improve accessibility. Future research should examine the effectiveness and implementation of these intervention characteristics.

Identification and Characterization of Peer Support for Cancer Prevention and Care: A Practice Review

Research across the cancer care continuum indicates peer support can improve patient outcomes, yet little is known about how cancer peer support programs are implemented in practice. This study aimed to describe cancer peer support programs in "real world" (i.e., non-research) settings. A web search identified 100 programs in a wide variety of settings and locations; 48 published contact information on their website and were invited to participate in semi-structured interviews. Twenty-nine program leaders participated. From the interviews, we observed eight primary themes, which centered on challenges and responses regarding training and content of peer support services as well as program organization and support. Obstacles include inconsistent funding, reliance on volunteers, and physician concerns about peer supporters' advice to patients, while increasing diversity, reach, and accessibility are future priorities. Peer support should be recognized and funded as a routine part of cancer care in order to expand its reach and address priorities such as increasing the diversity of supporters and those they help.

Peer support in patients with hematologic malignancies: a systematic review

BACKGROUND

Peer support has been utilized and associated with clinical outcomes (e.g., improved mood) in patients with solid malignancies. However, to date, there is minimal literature examining peer support among patients with hematologic malignancies and/or patients who have undergone hematopoietic stem cell transplantation (HSCT).

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we completed a systematic review using five databases to assess the relationship between peer support and clinical outcomes (e.g., distress, physical symptoms) among patients with hematologic malignancies or HSCT recipients.

RESULTS

The eight included studies examined peer support in a total of 574 patients. Four intervention studies highlighted the potential benefits of peer support, such as improved physical symptoms. Two studies, one interventional and one cross-sectional, highlighted the need for more empirically based peer support interventions in the HSCT population.

CONCLUSION

Among patients with hematologic malignancies and/or HSCT recipients, there is a dearth of literature examining the association between peer support and outcomes, although few studies have described a positive association between peer support and better health outcomes. More randomized controlled studies are needed to better understand the role of peer support and peer support interventions on outcomes in these vulnerable populations.

Family caregiver ambassador support for caregivers of patients with newly diagnosed hematological cancer: a feasibility study

PURPOSE

This study investigated the feasibility of a one-on-one peer support intervention in family caregivers of newly diagnosed patients with a hematological cancer during initial treatment.

METHODS

The study was a one-arm feasibility study including family caregivers of newly diagnosed patients with hematological cancer (n = 26) and caregiver ambassadors who were family caregivers of previously treated patients as peer supporters (n = 17). The one-on-one peer support intervention consisted of three components: a caregiver ambassador preparatory course; 12 weeks of one-on-one peer support, and caregiver ambassador network meetings.

RESULTS

Family caregivers reported high satisfaction with the delivery and flexibility of one-on-one peer support and improved in most psychosocial outcomes over time. Telephone and text messages were the most used form of contact between the peers. Caregiver ambassadors reported high satisfaction with the preparatory course and used the available support from the network meetings. No adverse events were reported.

CONCLUSION

One-on-one peer support provided by a caregiver ambassador is feasible and safe in family caregivers of newly diagnosed hematological cancer patients during their initial treatment. Utilizing volunteer caregiver ambassadors has the potential to be a new support model in family caregivers of hematological cancer patients across diagnostic groups within a clinical setting.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04039100, July 29, 2019.

First-time mothers' experiences of receiving proactive telephone-based peer support for breastfeeding in Australia: a qualitative study

Background

The RUBY randomised controlled trial was found to be effective in promoting breastfeeding continuation, in the setting of a high income country, through a program of proactive telephone-based peer support in the first 6 months postpartum. This paper explores women’s experiences of receiving the peer support intervention in the RUBY trial.

Methods

Ten in-depth, face-to-face interviews were conducted between December 2015 and November 2016 in Metropolitan Melbourne, and regional Victoria, Australia. Participants were women who received the peer support intervention in the RUBY trial and were between 11 and 15 months postpartum at the time of interview. Interviews were underpinned by social support theories and were analysed using inductive thematic analysis.

Results

A global theme of ‘non-judgemental support and guidance’ was identified, which included five organising themes. Four of the organising themes centred on the support from the peer, in which women felt the support was a ‘positive experience with empathy and understanding’, ‘non-judgemental’, ‘practical advice’, and a ‘social connection that was more than just breastfeeding’. In contrast to the support from peers was the theme ‘not all support from family and friends is supportive’.

Conclusion

Participants, including those who considered that they had adequate and available family and friend support for breastfeeding, valued and appreciated the non-judgemental, empathetic and understanding support from peers. This support, facilitated by the anonymity of the telephone-based program, allowed open and honest conversations, normalising women’s experiences and helping them feel less alone in their challenges with breastfeeding and transition to motherhood. These findings can inform the design, and upscaling, of innovative and sustainable peer support models, ensuring delivery of effective and engaging support with a broad population reach.

Stakeholder engagement and participation in the design, delivery, and dissemination of the ostomy self-management telehealth (OSMT) program

PURPOSE

Stakeholder engagement is increasingly integrated into clinical research processes. We conducted a mixed methods analysis to describe stakeholders' (peer ostomates, ostomy nurses, telehealth engineers) perceptions of their engagement and participation in a multisite, randomized trial of a telehealth-delivered curriculum for cancer survivors with ostomies.

METHODS

Stakeholder notes were analyzed using narrative analysis. We constructed a 15-item survey that assessed the following areas: adherence to stakeholder engagement principles, engagement/influence throughout the study process, impact on perceived well-being, and satisfaction. Stakeholders were invited to complete the survey anonymously. Quantitative survey data were tabulated through summary statistics.

RESULTS

Across intervention sessions, an average of 7.7 ± 1.4 stakeholders attended and 2.6 ± 1.4 submitted a note per session. The survey response rate was 73% (11/15). Stakeholders reported high agreement that the study adhered to engagement principles (91% reciprocal relationships, 100% co-learning, partnership, and transparency/honesty/trust). They felt highly engaged (18% moderate, 73% great deal) and that they had influence on study initiation (27% moderate, 55% great deal), intervention delivery (9% moderate, 82% great deal), fidelity assessment (18% moderate, 73% great deal), analysis and interpretation (55% moderate, 27% great deal), and dissemination (45% moderate, 45% great deal). They reported high overall satisfaction with roles (91% great deal), believed the program was helpful for participants (91%), and that serving on study team benefited their own well-being (100%).

CONCLUSIONS

Our strategy of stakeholder inclusion led to high engagement, input, satisfaction, and belief in success of program, which could be mirrored in other trials.

Peer support for people with chronic conditions: a systematic review of reviews

Background

People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions.

Methods

A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis.

Results

The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects.

Conclusions

The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07816-7.

Disambiguation of psychotherapy: a search for meaning

This analysis identifies the significant problem of ambiguity, variation and vagueness in relation to the intervention described as 'psychotherapy'. Its purpose is to raise international awareness of this problem and alternative solutions.

Facilitators of peer coaching/support engagement and dissemination among women at risk for and surviving with breast cancer

One-on-one peer coaching/support programs hold promise in promoting healthy outcomes among women at risk for and surviving with breast cancer, with the potential to bridge gaps in "whole person care." Although popularly cited for their benefits, emerging evidence is mixed and suggests that peer support program impacts may be attenuated by individual- and community-specific factors. We evaluated a national not-for-profit breast cancer organization's peer support program outcomes (2015-2018) serving women from predominantly Jewish backgrounds to examine program engagement, facilitation, and satisfaction. Of the N = 392 women sampled, 37% utilized the peer support program: the majority were referred by a family member/friend (40%) or had connected with the program online (34%). Logistic regression modeling revealed that mothers (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.04 to 3.19), women at increased genetic risk for breast cancer (OR = 2.07; 95% CI = 1.08 to 3.94), and those who connected with the organization through a family member/friend (OR = 1.97; 95% CI = 1.23 to 3.15) were significantly more likely to utilize peer support (all p's < .05). Satisfaction with peer support was high and reliably measured (M = 42.8 out of possible 50; α = .95). These findings emphasize opportunities for peer support programs to serve a range of needs among breast cancer previvors and survivors and increase health care's organizational capacity to reach and impact this community through trusted and well-trained lay coaches.

When Cancer Is the Self: An Interpretive Description of the Experience of Identity by Hematology Cancer Patients

BACKGROUND

The term "cancer" is imbued with identity signals that trigger certain assumed sociocultural responses. Clinical practice with hematological cancer patients suggests the experience of these patients may be different than that of solid tumor cancer patients.

OBJECTIVE

We sought to explore the research question: How are identity experiences described and elucidated by adult hematological cancer patients?

METHODS

This qualitative study was guided by interpretive description as the methodological framework.

RESULTS

Preexisting identity labels and assumptions assigned to the overarching "cancer" diagnosis were viewed by patients as entirely inadequate to fully describe and inform their experience. Instead, findings revealed the propensity of adult hematology oncology patients to co-create and enact new identities increasingly reflective of the nonlocalized nature of their cancer subtype. Three themes that arose from the data included the unique cancer-self, the invasion of cancer opposed to self, and the personification of the cancer within self.

CONCLUSIONS

Hematology oncology patients experience and claim a postdiagnosis identity that is self-described as distinct and highly specialized, and are distinct to solid tumor patients in aspects of systemic and total consumption of the self. This uniqueness is extended to the specific hematological cancer subtype down to genetics, indicating a strong "new" sense of self.

IMPLICATIONS FOR PRACTICE

The manner in which hematology oncology patients in this study embraced notions of transformed self and isolating uniqueness provides practitioners with a lens through which new and innovative interventions can be constructed to improve patient care and psychosocial outcomes.

Peer Mentors for People with Advanced Cancer: Lessons Learnt from Recruiting and Training Peer Mentors for a Feasibility Randomized Controlled Trial

Peer mentors may offer distinctive forms of support to people with advanced cancer. Whilst peer mentor programmes are known, little is understood about recruiting and training peer mentors to support those with advanced cancer. The purpose of this study is to determine the feasibility of recruiting and training peer mentors for a novel peer mentor intervention to promote well-being in people with advanced cancer. Feasibility study testing proactive introduction to a trained peer mentor for 12 weeks in the context of a randomized controlled two-arm trial and nested qualitative process evaluation was used. Peer mentors have/had cancer, recruited via an open call. Two-day training included a new bespoke module on coping with cancer. Descriptive recruitment and training data were captured, supplemented by qualitative interviews, analysed thematically. Forty-eight people expressed interest, mostly female (69%), with breast cancer (32%), and recruited via social media (49%). Twelve people completed training, with attrition often due to availability or mentors' own health; many had advanced cancer themselves. They wanted to 'give something back', but also formed supportive bonds with fellow mentors. It is feasible to recruit and train people with lived experience of cancer to be peer mentors, but those with particular characteristics may predominate. Broad social media based recruitment may have merit in widening the pool of potential peer mentors.

Isolation experienced by women with gestational cancer: could peer support and tailored information be the answer?

Women diagnosed with cancer during pregnancy (gestational cancer) are a small but vulnerable population, with experts suggesting they require greater psycho-social support than either other women with cancer or other pregnant women. However, information on their psychological needs remains sparse. This commentary describes our work exploring the psychological needs of women diagnosed with gestational cancer, areas of unmet need we identified, and our recommendations for future programs and research. We conducted in-depth, semi-structured interviews with 23 Australian women diagnosed with gestational cancer in the preceding 5 years. Our findings depicted a group of women for whom cancer diagnosis and treatment had resulted in a sense of isolation and loneliness. Women reported seeking tailored information about their condition and treatments as well as one-on-one peer support with other gestational cancer survivors, which was challenging for them to access and which existing services struggled to provide. To address these unmet needs, innovative solutions may be necessary. Technology has the potential to connect and match women with one-to-one peer support, and research exploring the efficacy and acceptability of such interventions is required. Creative solutions, such as virtual resource hubs monitored or moderated by experts, would potentially meet the information needs of this group. However, as gestational cancer is relatively rare, the development and evaluation of such interventions would require a collaborative effort across multiple sites, as well as international collaboration and data pooling.

Young adults with epilepsy: Relationships between psychosocial variables and anxiety, depression, and suicidality

BACKGROUND

People with epilepsy (PWE) are at an increased risk of anxiety, depression, and suicidality. Young adulthood is a critical developmental period which can be complicated by the unique challenges of having epilepsy. The risk factors of mental health difficulties in young adults with epilepsy (YAWE) have not been investigated.

AIMS

To examine the relationships between psychosocial variables (coping strategies and sources of social support) and mental health outcomes in YAWE, and determine whether these psychosocial variables independently predict mental health outcomes after controlling for sociodemographic and epilepsy-related factors.

METHOD

An online survey was completed by 144 YAWE (18-25-year-olds), which measured sociodemographic and epilepsy-related factors, coping strategies, sources of social support, and current mental health symptoms (anxiety, depression, and suicidality).

RESULTS

Avoidant-focused coping was positively correlated, and problem-focused coping and meaning-focused coping were negatively correlated, with symptoms of anxiety, depression, and suicidality. Social support from family, friends, and a special person all negatively correlated with mental health outcomes. Using multiple regression analyses, greater use of avoidant-focused coping strategies independently predicted higher symptoms of anxiety, depression, and suicidality. Greater support from friends independently predicted significantly lower anxiety and depression, whereas greater support from family independently predicted significantly lower suicidality.

CLINICAL IMPLICATIONS

These findings have implications for clinical practice in YAWE and suggest that screening for mental health symptoms and psychosocial variables to identify those at risk would be beneficial. Access to tailored psychological support is also needed.

Volunteer Impact on Health-Related Outcomes for Seniors: a Systematic Review And Meta-Analysis

Background

Volunteers are increasingly promoted to improve health-related outcomes for community-dwelling elderly without synthesized evidence for effectiveness. This systematic review and meta-analysis evaluates the effects of unpaid volunteer interventions on health-related outcomes for such seniors.

Methods

MEDLINE, EMBASE and Cochrane (CENTRAL) were searched up to November 2018. We included English language, randomized trials. Two reviewers independently identified studies, extracted data, and assessed evidence certainty (using GRADE). Meta-analysis used random-effects models. Univariate meta-regressions investigated the relationship between volunteer intervention effects and trial participant age, percentage females, and risk of bias.

Results

28 included studies focussed on seniors with a variety of chronic conditions (e.g., dementia, diabetes) and health states (e.g., frail, palliative). Volunteers provided a range of roles (e.g., counsellors, educators and coaches). Low certainty evidence found that volunteers may improve both physical function (MD = 3.2 points on the 100-point SF-36 physical component score [PCS]; 95% CI: 1.09, 5.27) and physical activity levels (SMD = 0.5, 95% CI: 0.14 to 0.83). Adverse events were not increased.

Conclusion

Volunteers may increase physical activity levels and subjective ratings of physical function for seniors without apparent harm. These findings support the WHO call to action on evidence-based policies to align health systems in support of older adults.

The patient advisor, an organizational resource as a lever for an enhanced oncology patient experience (PAROLE-onco): a longitudinal multiple case study protocol

BACKGROUND

Quebec is one of the Canadian provinces with the highest rates of cancer incidence and prevalence. A study by the Rossy Cancer Network (RCN) of McGill university assessed six aspects of the patient experience among cancer patients and found that emotional support is the aspect most lacking. To improve this support, trained patient advisors (PAs) can be included as full-fledged members of the healthcare team, given that PA can rely on their knowledge with experiencing the disease and from using health and social care services to accompany cancer patients, they could help to round out the health and social care services offer in oncology. However, the feasibility of integrating PAs in clinical oncology teams has not been studied. In this multisite study, we will explore how to integrate PAs in clinical oncology teams and, under what conditions this can be successfully done. We aim to better understand effects of this PA intervention on patients, on the PAs themselves, the health and social care team, the administrators, and on the organization of services and to identify associated ethical and legal issues.

METHODS/DESIGN

We will conduct six mixed methods longitudinal case studies. Qualitative data will be used to study the integration of the PAs into clinical oncology teams and to identify the factors that are facilitators and inhibitors of the process, the associated ethical and legal issues, and the challenges that the PAs experience. Quantitative data will be used to assess effects on patients, PAs and team members, if any, of the PA intervention. The results will be used to support oncology programs in the integration of PAs into their healthcare teams and to design a future randomized pragmatic trial to evaluate the impact of PAs as full-fledged members of clinical oncology teams on cancer patients' experience of emotional support throughout their care trajectory.

DISCUSSION

This study will be the first to integrate PAs as full-fledged members of the clinical oncology team and to assess possible clinical and organizational level effects. Given the unique role of PAs, this study will complement the body of research on peer support and patient navigation. An additional innovative aspect of this study will be consideration of the ethical and legal issues at stake and how to address them in the health care organizations.

Patient ambassador support in newly diagnosed patients with acute leukemia during treatment: a feasibility study

Purpose

This study investigated the feasibility of patient ambassador support in newly diagnosed patients with acute leukemia during treatment.

Methods

A multicenter single-arm feasibility study that included patients newly diagnosed with acute leukemia (n = 36) and patient ambassadors previously treated for acute leukemia (n = 25). Prior to the intervention, all patient ambassadors attended a 6-h group training program. In the intervention, patient ambassadors provided 12 weeks of support for patients within 2 weeks of being diagnosed. Outcome measures included feasibility (primary outcome), safety, anxiety, and depression measured by the Hospital Anxiety and Depression Scale, quality of life by the Functional Assessment of Cancer Therapy–Leukemia and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and symptom burden by MD Anderson Symptom Inventory, the Patient Activation Measure, and the General Self-Efficacy Scale.

Results

Patient ambassador support was feasible and safe in this population. Patients and patient ambassadors reported high satisfaction with the individually adjusted support, and patients improved in psychosocial outcomes over time. Patient ambassadors maintained their psychosocial baseline level, with no adverse events, and used the available support to exchange experiences with other patient ambassadors and to manage challenges.

Conclusion

The patient ambassador support program is feasible and has the potential to be a new model of care incorporated in the hematology clinical care setting, creating an active partnership between patients and former patients. This may strengthen the existing supportive care services for patients with acute leukemia.

Trial registration

NCT03493906

Patient ambassador support: Experiences of the mentorship between newly diagnosed patients with acute leukaemia and their patient ambassadors

Objective

The study explores how newly diagnosed patients with acute leukaemia and their patient ambassadors experience the mentorship during the patient ambassador support programme.

Methods

Explorative semi‐structured individual interviews (n = 28) were carried out in patients with acute leukaemia (n = 15) and their patient ambassadors (n = 13). Interpretive description was the methodological framework used for the thematic analysis of the qualitative interview data.

Results

Identified themes were as follows: (a) exchanging life experiences (subthemes: individualised support and a meaningful return); (b) existential cohesion; (c) interreflection; and (d) terms and conditions (subtheme: break in journey). Patients experienced a feeling of being understood, the cohesion leading to hope and a feeling of being able to cope with their situation. Patient ambassadors experienced a sense of meaningfulness and gratitude for life.

Conclusions

Patients and patient ambassadors experienced benefits from the individualised support. Their shared experiences created a connection and mutual mirroring, which led to a sense of hope and gratitude for life. Initiatives that introduce peer‐to‐peer support in newly diagnosed patients with acute leukaemia as part of treatment and in daily clinical practice are crucial. Future studies should further examine the feasibility of peer‐to‐peer support interventions along the trajectory of acute leukaemia.

The motivation to volunteer as a peer support provider to newly diagnosed patients with acute leukemia - A qualitative interview study

PURPOSE

To identify and describe the motivation to volunteer as a peer support provider (PSP) to newly diagnosed patients with acute leukemia (AL).

METHOD

A phenomenological individual interview study based on one open-ended question. The participants (n = 12) had previously been treated for AL and were recruited from an ongoing peer support feasibility study. The interviews were carried out prior to participation as a peer support provider. A phenomenological methodology developed by Amadeo Giorgi was used for the analysis of the data.

RESULTS

The essence of the phenomenon can be characterized by the following characteristics: "A wish to move on with life", "A wish to instill hope to those in a hopeless situation" and "Expecting own course of disease to become meaningful". The motivation reflected the experience that when helping others they also helped themselves.

CONCLUSION

Former patients treated for AL are motivated to undertake their new role as PSP because their own course of disease becomes meaningful, helps facilitate a better post-cancer recovery through greater self-confidence while instilling hope to newly diagnosed patients with AL.

CLINICAL IMPLICATIONS

It is important to identify readiness before recruiting former patients for the PSP role and to develop peer-to-peer programs to sustain motivation. Future studies should examine how motivation changes over time while practicing as a PSP to newly diagnosed patient with AL.

Social support for older adults with cancer: Young International Society of Geriatric Oncology review paper

Older adults with cancer have increasing needs in physical, cognitive, and emotional domains, and they can experience decline in all domains with the diagnosis and treatment of cancer. Social support plays a key role in supporting these patients, mitigating negative effects of diagnosis and treatment of cancer, and improving cancer outcomes. We review the importance of social support in older adults with cancer, describe the different components of social support and how they are measured, discuss current interventions that are available to improve social support in older adults, and describe burdens on caregivers. We also highlight Dr. Arti Hurria's contributions to recognizing the integral role of social support to caring for older adults with cancer.

A Study on Challenges to Health Care Delivery Faced by Cancer Patients in India During the COVID-19 Pandemic

INTRODUCTION

Access to health care and care delivery during the COVID-19 pandemic may be challenging for cancer patients. Several guidelines have been developed, which recommend treatment adjustments depending on the site of cancer, grade, and stage. However, few studies in India and across the globe have looked into the real challenges faced by cancer patients and assessed the effectiveness of the adopted interventions. This study was undertaken with the objective to study the challenges faced by cancer patients in India during the COVID-19 pandemic.

MATERIALS AND METHODS

This was a cross-sectional study undertaken between May 1, 2020 and May 15, 2020. A link to a prestructured questionnaire was sent through email to 100 randomly selected cancer patients in different stages of treatment and follow-up. Data were decoded and entered in Microsoft Excel 2010 and analyzed using descriptive statistics.

RESULTS

Slot availability for teleconsultation, network issues, deferral of radiotherapy dates and long waiting hours beyond appointment time, transportation problems from residence to hospital, restriction of visitors/attendants, deferral of surgery, deferral of tumor boards, delay and deferral of advice of the nutritionist, problems faced in extension of visa, unavailability of peer group support services and psychological counseling sessions, difficulty in maintaining precautionary measures, availability of chemotherapy medications and availability of chemotherapy slots in day care were cited as problems faced by cancer patients. Majority (91.7%) of the study respondents mentioned an increase in their anxiety levels.

CONCLUSION

As highlighted in the study, cancer patients faced challenges in cancer care delivery during the COVID-19 pandemic. This study suggests the need for larger studies on cancer patient care during a pandemic.

Could Peer Support Programs Be a Good Resource for Managing the Unmet Needs of Cancer Patients?

The number of cancer patients has been rapidly increasing, and while there have been wide variations, cancer survival rates also improved globally. Despite the improved survival rates, supportive care needs of cancer patients have been unmet in various domains. The current study aimed to investigate unmet needs that had potential to be managed by peer supports according to cancer trajectories. We used the comprehensive needs assessment tool in cancer (CNAT) and a modified CNAT to evaluate the unmet needs and peer support needs of cancer patients at the tertiary hospital of South Korea. Of the 402 participants, 335 (83.3%) needed peer support. For patients who had been diagnosed with cancer for more than 5 years, the highest proportion of peer support needs to unmet supportive care was reported in information domain (92.9%). Patients with advanced cancer reported peer support needs in the social/religious/spiritual (84.4%) and practical domains (81.1%). Most of stomach cancer patients needed peer supports to receive information (96.6%). The need for peer supports in the information domain was reported highest according to longer survival period and also according to advanced cancer stages. The proportion of peer support needs in unmet supportive care varied by cancer type. Further interventional studies are needed to investigate satisfaction with peer support in specific domains.

WeCanConnect: Development of a Community-Informed mHealth Tool for People with Disabilities and Cancer

BACKGROUND

Cancer care for people with disabilities (PWD) is rife with uncertainty and obstacles. Not only do PWD have to contend with cancer and treatment-related sequelae, but also its impact on disabling conditions and functional capacity, as well as a health care system lacking accessibility and disability competence. Peer support can address important needs for emotional and informational support. mHealth tools for smart phones, tablets, or laptops hold promise to deliver such support in an accessible and scalable manner. This concept is unexplored for use among PWD with cancer.

OBJECTIVES

To describe a community-based participatory study that 1) identifies consumer-reported support needs and priorities among PWD and cancer and 2) integrates consumer perspectives into the design of an mHealth cancer support tool to address these needs and priorities.

METHODS

Part 1 is a thematic analysis of semistructured, qualitative interviews with a purposive sample of experts in health and cancer care for PWD (n = 7) and a convenience sample of cancer survivors with preexisting disabilities (n = 9). In part 2, results were integrated to develop an mHealth peer support tool to addresses identified needs.

RESULTS

Themes included 1) barriers across the cancer care continuum, 2) strengths within the disability community, and 3) recommendations for mHealth and peer support. Based on the qualitative findings, we designed a mHealth tool for peer support and information sharing among PWD with cancer.

CONCLUSION

Consumer-informed mHealth tools hold great potential to leverage strengths in the disability community to address emotional and informational needs created by a lack of disability competence across the cancer care continuum.

A randomized controlled trial assessing the efficacy of a self-administered psycho-educational intervention for patients with cancer

OBJECTIVE

Bibliotherapy refers to psychological self-help interventions that utilize treatment books to improve psychological well-being. Research supports bibliotherapy as an efficacious intervention for a variety of mental health problems. Yet, few studies have investigated bibliotherapy in psychosocial oncology. The objective of this randomized controlled trial was to examine the efficacy of the NuCare intervention, delivered as a self-directed workbook, for enhancing empowerment, coping, and quality of life and reducing distress in patients with cancer.

METHODS

Eighty-nine adult patients with cancer were randomized to receive the workbook for 6 weeks or the control condition, usual care. Participants completed questionnaires at baseline, 6 weeks post-baseline, and 10 weeks post-baseline.

RESULTS

The increase of empowerment (main outcome) and quality of life and the decrease of distress in the NuCare group from pre-intervention to follow-up assessment differed significantly from the respective difference scores in the control group.

CONCLUSIONS

The self-administered NuCare workbook is a potentially cost-effective, minimal intervention addressing psychosocial needs of patients with cancer.

PRACTICE IMPLICATIONS

Evidence-based bibliotherapy can empower patients and has the promise of reducing the burden on the healthcare system while enhancing the immediacy of psychosocial support.

A qualitative exploration of race-based differences in social support needs of diverse women with breast cancer on adjuvant therapy

OBJECTIVE

Social support is a critical component of breast cancer care and is associated with clinical and quality of life outcomes. Significant health disparities exist between Black and White women with breast cancer. Our study used qualitative methods to explore the social support needs of Black and White women with hormone receptor-positive breast cancer on adjuvant endocrine therapy (AET).

METHODS

We conducted four focus group (FG) interviews (N = 28), stratified by race (ie, Black and White) and time on AET. FGs were audiotaped, transcribed, and analyzed according to conventions of thematic analysis.

RESULTS

Participants noted the importance of having their informational and emotional social support needs met by friends and family members. White participants reported support provided by others with breast cancer was crucial; Black women did not discuss other survivors as part of their networks. Notably, both White and Black participants used the FG environment to provide experiential social support to each other.

CONCLUSIONS

White participants noted that having other breast cancer survivors in their support network was essential for meeting their social support needs. However, Black participants did not reference other breast cancer survivors as part of their networks. Cancer centers should consider reviewing patients' access to experiential support and facilitate opportunities to connect women in the adjuvant phase.

Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature

OBJECTIVE

Evidence suggests peer support (PS) is as an effective strategy for enhancing prevention and control of chronic and infectious diseases, including cancer. This systematic scoping review examines the range and variety of interventions on the use of PS across the cancer care continuum.

METHOD

We used a broad definition of PS to capture a wide-range of interventions and characterize the current status of the field. Literature searches were conducted using PubMed, SCOPUS, and CINAHL to identify relevant articles published from January 2011 to June 2016. We screened the title and abstracts of 2087 articles, followed by full-text screening of 420 articles, resulting in a final sample of 242 articles of which the most recent 100 articles were reviewed (published June 2014 to May 2016).

RESULTS

A number of the recent intervention studies focused on breast cancer (32%, breast cancer only) or multiple cancer sites (23%). Although the interventions spanned all phases of the cancer care continuum, only 2% targeted end-of-life care. Seventy-six percent focused on clinical outcomes (e.g., screening, treatment adherence) and 72% on reducing health disparities. Interventions were primarily phone-based (44%) or delivered in a clinic setting (44%). Only a few studies (22%) described the impact of providing PS on peer supporters.

CONCLUSION

PS appears to be a widely used approach to address needs across the cancer care continuum, with many opportunities to expand its reach.

Oncology Volunteers: The Effect of a Personal Cancer History on Compassion and Psychological Well-Being

BACKGROUND

The impact of support work on volunteers with a personal history of cancer has rarely been examined, despite the possibility that supporting distressed individuals may become a psychological burden for someone who has faced a life-threatening disease themselves.

OBJECTIVES

The purpose of this study is to compare compassion, self-compassion, self-coldness, and psychological well-being of oncology volunteers to the general population and clinical samples.

METHODS

Volunteers completed questionnaires on demographic and volunteer work-related characteristics, the Compassion Toward Others Scale, the Self-Compassion Scale, and the Psychological General Well-Being Index.

FINDINGS

Overall, volunteers indicated higher levels of self-compassion and psychological well-being and lower levels of self-coldness than clinical and community samples. Peer volunteers were less satisfied with their volunteer work and reported worse general health and psychological well-being than volunteers without a cancer history.

A prospective and population-based inquiry on the use and acceptability of peer support for women newly diagnosed with breast cancer

The degree to which peer support is used and accepted as a supportive care approach by women with breast cancer is unclear. We examine peer support use across three major modalities (i.e. support groups, online platforms, one-on-one) and identify enablers and barriers to peer support using the beliefs framework of the theory of planned behaviour. A population-based sample of women newly diagnosed with breast cancer (n = 3105) who were on average 54.08 weeks since diagnosis completed mailed surveys at baseline measuring beliefs about peer support and intention. Peer support use was measured via telephone interview at baseline and prospectively at 12-month follow-up (n = 2780). In all, 37% of women had used at least one peer support service since diagnosis (support group = 20%, online = 18%, one-on-one = 10%). A path analysis examined what beliefs enabled or acted as barriers to peer support use at follow-up adjusting for past behaviour (i.e. baseline use), sociodemographic characteristics, and treatment. In order of relative strength, enablers included beliefs that peer support is an outlet for honest expression of feelings (β = .35), a source of empathy (β = .30), approved by doctors (β = .07), and approved by family/partner (β = .04). Barriers were beliefs that it encourages dwelling about breast cancer (β = - .06) and involves exposure to negative stories about this disease (β = - .04). Strategies which communicate the potential emotional support benefits of a shared illness experience and social approval by others, particularly the medical profession, may help to promote acceptance of peer support and encourage service uptake in breast cancer.

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 mentors delivering a physical activity intervention for cancer survivors: effects among mentors

To further inform implementation efforts of a telephone-based physical activity (PA) intervention for breast cancer survivors, we assessed the PA, fatigue, mood, and quality of life of the peer mentors/coaches who delivered the program. The coaches were volunteers with the American Cancer Society's Reach to Recovery program. The coaches (n = 18) delivered the PA intervention to 76 breast cancer survivors in a randomized controlled trial. Coaches completed assessments of PA (self-report), motivational readiness for PA, and standardized measures of psychosocial variables at the start of coaching and at study exit. At study exit, they also responded to an open-ended question on the benefits that they accrued from the study. We used generalized linear models to analyze the PA data and psychosocial variables. Chi-squared analyses were used for motivational readiness. The written responses to the open-ended question were analyzed to identify themes. Coaches' PA exceeded national recommendations at study entry and exit with no significant changes over time. Sixty-one percent were in the maintenance stage of motivational readiness, and 61% remained in the same stage at study exit. Psychosocial functioning also remained stable over time. Qualitative data revealed that the coaches' gains included helping themselves (with four subthemes) and helping others. Intervention delivery had no unintended negative consequences (PA, motivational readiness, and psychosocial functioning) among coaches. They reported gains that were not reflected in standardized psychosocial assessments. These data support further implementation of peer-delivered PA programs to enhance the reach of interventions.

Exchanging narratives-A qualitative study of peer support among surgical lung cancer patients

AIM AND OBJECTIVE

The aim of this study was to examine how hospitalised, surgical lung cancer patients experience talking to a former patient, and how the former patient experiences the role as supportive.

BACKGROUND

During hospitalisation, patients often create a community in which they can engage with fellow patients. The exchange of experiences with others in a similar situation might increase opportunities for support and complement nursing care, but there is a need for more evidence and understanding on the topic.

DESIGN

The methodological framework is based on the French philosopher Paul Ricoeur's text interpretation theory. Qualitative interviews were conducted with nine patients, including a peer informant, using a narrative structure. The analysis was conducted on three levels: (i) naïve reading, (ii) structural analysis and (iii) critical interpretation .

RESULTS

Four themes were developed from the analysis of the interviews: Exchanging emotional thoughts is easier with a peer; Talking to a peer reduces loneliness; Being ambiguous about a relationship with fellow patients; and Being the main person in the conversation with a peer. Sharing stories about having similar symptoms and undergoing similar journeys predominated, and the key feature of the contact between patients was the commonality of their stories.

CRITICAL INTERPRETATION AND CONCLUSION

Telling one's story to a former patient, and thereby creating a joint, common story, is the essence of this study. The support received in this process can be empowering because knowledge of the illness experience is shared and increased. This can help create new coping strategies. The contact with a former patient offered a way to confirm one's thoughts and to find a way out of the illness perspective, by seeing how the former patient had recovered.

RELEVANCE TO CLINICAL PRACTICE

The nursing field faces challenges in the relational aspect of caring because of ever greater efficient and shortened hospital stays; therefore, the peer support concept is becoming increasingly relevant. Patient peers offer each other their own perspectives, and it is important to raise awareness of the value of this and incorporate it into patient stays in hospital.

Breast Cancer Survivors' Contribution to Psychosocial Adjustment of Newly Diagnosed Breast Cancer Patients in a Computer-Mediated Social Support Group

This study investigated the role of breast cancer survivors in a computer-mediated social support (CMSS) group for women with breast cancer. Applying a computer-aided content analytic method, the present study examined the differences in support provision between survivors and newly diagnosed patients. This study further investigated the impacts of survivor-provided social support on psychosocial adjustment of newly diagnosed patients. The results revealed that, compared with newly diagnosed patients, breast cancer survivors provided more emotional and informational support. Receiving emotional support from survivors contributed to an improvement in the quality of life and the depression of patients. The effects of survivor-provided informational support were not significant.