Hobson's choice or a horned dilemma: a grounded theory on adherence to adjuvant endocrine therapy verified with breast cancer survivors

PURPOSE

A literature review and meta-synthesis of qualitative research had enabled us to develop a grounded theory explaining the difficulties breast cancer survivors face with the initial decision to accept long-term endocrine therapy, and the everyday challenges of continuing or deciding to stop treatment early. Our objective was to interview a cohort of women in a UK setting to corroborate and complete the grounded theory with the end users' primary involvement.

METHODS

A semi-structured interview schedule was written based on the existing grounded theory. Fourteen women with a history of hormone-positive breast cancer were recruited and interviewed. The audio-recorded interviews were transcribed and analysed against the existing grounded theory.

RESULTS

The findings were compatible with the core theory 'Hobson's choice or a horned dilemma' and its constituent categories previously developed, with additional concepts identified and added to our paradigm models. Importantly, we found that some women who started with a strong sense of commitment to their treatment changed their mind as they experienced the medication side effects over time, impacting on their persistence with long-term endocrine therapy.

CONCLUSION

The findings indicate an opportunity for health providers to intervene and influence women's waning perceptions of the necessity of their treatment, for example upon experiencing the side effects. Interventions could involve the provision of side effect management strategies via accessible resources.

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.

Reasons for not participating in scleroderma patient support groups: a comparison of results from the North American and European scleroderma support group surveys

PURPOSE

Many people with scleroderma rely on peer-led support groups as a coping resource. Reasons for not attending support groups in scleroderma have been investigated only in North American participants. This study assesses reasons for nonattendance in European countries and compares results with previously published North American findings.

MATERIALS AND METHODS

The same 21-item survey as used in the North American sample assessed possible reasons for not attending scleroderma support groups. Proportions of items rated Important or Very Important were compared between samples.

RESULTS

Consistent with the North American survey findings (N = 242), the two items most commonly rated as (Very) Important reasons for nonattendance among 228 European participants were (1) already having enough support (57%), and (2) not knowing of any local scleroderma support groups (58%). Compared to North American non-attenders, European patients were significantly more likely to rate not knowing enough about what happens at support groups (46% vs 19%), not having reliable ways to get to meetings (35% vs 17%), and being uncomfortable sharing experiences with a group (22% vs 11%) as (Very) Important reasons for nonattendance.

CONCLUSIONS

Improving access to European support groups, providing education about support groups and group leader training may encourage participation.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals might help develop local support groups for people with systemic sclerosis (scleroderma) to address the lack of access to these groups for many patients.The need for transportation and limited local accessibility may also be addressed by implementing online systemic sclerosis support groups.Professionals in the field of rehabilitation may work with people with systemic sclerosis and patient organizations to provide education about support groups to improve support group attendance in Europe.

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.

The difference is more than floating: factors affecting breast cancer survivors' decisions to join and maintain participation in dragon boat teams and support groups

Purpose: Peer support can be helpful in rehabilitation from breast cancer, but participation in peer support groups is low. Groups that provide support opportunities in physical activity contexts are an attractive alternative for some survivors. This study examined survivors' reasons for joining and maintaining participation on a dragon boat team, along with perceptions of barriers and attractions to traditional peer support groups. Materials and methods: Seventeen breast cancer survivors were interviewed on five occasions over their first two seasons of a newly formed dragon boating team to explore their perceptions of peer support groups and dragon boating. Data were inductively analyzed using thematic analysis. Results: Categories surrounding physical, psychological, social and community features were identified with several themes emerging within each. Advantages of dragon boating included opportunities to get a combination of physical, psychosocial and community benefits; health improvement and behavior change; and obtaining social support without the focus being on cancer. Peer support groups were identified as having advantages for forming relationships and avoiding barriers associated with physical activity. Conclusions: While neither type of program meets all needs, practical considerations are identified for incorporating advantages of both programs to improve participation. Implications for rehabilitation Further understanding of perceptions, and attractions and challenges to taking part in group programs will inform development of accessible programs that target multiple rehabilitation needs. Physical activity can provide a positive, alternative focus that takes the emphasis off of cancer, which is more accessible to some survivors. Physical activity also provides opportunities to build relationships around a common, positive goal, which can be a foundation for providing support for coping with cancer.

Reasons for Not Participating in Scleroderma Patient Support Groups: A Cross-Sectional Study

OBJECTIVE

Peer-led support groups are an important resource for many people with scleroderma (systemic sclerosis; SSc). Little is known, however, about barriers to participation. The objective of this study was to identify reasons why some people with SSc do not participate in SSc support groups.

METHODS

A 21-item survey was used to assess reasons for nonattendance among SSc patients in Canada and the US. Exploratory factor analysis (EFA) was conducted, using the software MPlus 7, to group reasons for nonattendance into themes.

RESULTS

A total of 242 people (202 women) with SSc completed the survey. EFA results indicated that a 3-factor model best described the data (χ² [150] = 302.7; P < 0.001; Comparative Fit Index = 0.91, Tucker-Lewis Index = 0.88, root mean square error of approximation = 0.07, factor intercorrelations 0.02-0.43). The 3 identified themes, reflecting reasons for not attending SSc support groups were personal reasons (9 items; e.g., already having enough support), practical reasons (7 items; e.g., no local support groups available), and beliefs about support groups (5 items; e.g., support groups are too negative). On average, respondents rated 4.9 items as important or very important reasons for nonattendance. The 2 items most commonly rated as important or very important were 1) already having enough support from family, friends, or others, and 2) not knowing of any SSc support groups offered in my area.

CONCLUSION

SSc organizations may be able to address limitations in accessibility and concerns about SSc support groups by implementing online support groups, better informing patients about support group activities, and training support group facilitators.

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.

My Road Ahead study protocol: a randomised controlled trial of an online psychological intervention for men following treatment for localised prostate cancer

Background

There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone.

Methods/design

This study utilises a RCT design with three groups receiving: 1) the 6-module My Road Ahead intervention alone; 2) the My Road Ahead intervention plus a moderated online forum; and 3) the moderated online forum alone. It is expected that 150 men with localised prostate cancer will be recruited into the RCT. Online measures will assess men’s psychological distress as well as sexual and relationship adjustment at baseline, post-intervention, 3 month follow-up and 6 month follow-up. The study is being conducted in Australia and participants will be recruited from April 2012 to Feb 2014. The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress.

Discussion

To our knowledge, My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer. The RCT will assess the efficacy of this intervention in improving psychological well-being, sexual satisfaction, relationship satisfaction and overall quality of life. If successful, this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner.

Trial registration

Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000278932

A biopsychosocial model of resilience for multiple sclerosis

The concept of resilience remains under-researched in the multiple sclerosis literature. Consequently, current understanding of the unique and joint contribution of disability-specific variables, cognitive-behavioural skills and social resources to this dynamic process is limited. A holistic model of resilience was therefore developed and tested. Results of an online survey completed by 196 adults with multiple sclerosis revealed both direct and indirect pathways to resilience, with positive affect and self-efficacy being the strongest predictors. The findings lend support to psychological interventions which focus on promoting the personal resources and assets needed to cope effectively with multiple sclerosis.

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.

Art groups for marginalized women with breast cancer

Professionally led support groups can significantly reduce distress, trauma symptoms, and pain for women with breast cancer. Despite the known benefits, women with breast cancer from marginalized groups tend not to participate in support groups. It is important to address barriers that prevent their participation and to identify types of support groups that appeal to as wide a range of women as possible. For this study, we interviewed women with breast cancer from marginalized groups in the San Francisco Bay Area (United States). We asked them about social, cultural, and psychological barriers that prevent participation in support groups, and about the potential of art groups to overcome these barriers. Our qualitative analysis of the interviews yielded findings that suggest a model for a type of support group that could make the benefits of support groups available to more women with breast cancer.

'All in the same boat'? Patient and carer attitudes to peer support and social comparison in Motor Neurone Disease (MND)

This paper explores attitudes to peer support among people with Motor Neurone Disease (MND) and their family carers. It reports findings from a secondary analysis of data from two UK interview studies conducted by the authors. The process of secondary analysis is reported in detail. 48 people with MND and 22 carers were interviewed in 2005-2007. The authors identified narrative extracts on peer support from their own datasets and exchanged them for independent thematic analysis. Subsequent discussion, drawing on literature on support groups and social comparison, led to an exploration of two overarching themes: valuing camaraderie and comparison, and choosing isolation. Findings suggest that social comparison theory is a useful framework for analysing attitudes to MND support groups, but that on its own it is insufficient. 'Valuing camaraderie and comparison' explains how support groups offer practical and social support, as well as beneficial opportunities for social comparison. Seeing others coping well with the condition can provide hope, while downward comparison with those worse off can also make people feel better about their own situation. However, most people are also shocked and saddened by seeing others with the condition. Tension of identity can occur when group membership starts to define the individual as 'a person with MND, rather than the person I am that happens to have MND'. Choosing isolation can be a deliberate defensive strategy, to protect oneself from witnessing one's possible future. Levels of involvement may change over time as people struggle with their changing needs and fears.

Health effects of ownership of and attachment to companion animals in an older population

BACKGROUND

Two reasons for the inconclusiveness of the literature on the health effects of pet ownership are (1) failure to control for other known influences on health, and (2) inadequate consideration of the nature of the emotional relationship between owners and their companion animals.

PURPOSE

The main aims were to develop a measure of pet attachment that reflects psychologists' use of the attachment concept, and to see if pet ownership or attachment added to the health variance explained by known predictors.

METHOD

Community-living older adults (n = 314) gave information by interview using structured questions and standardized scales. Multiple regressions were then conducted to examine the possible predictive role of health habits, human social supports, pet ownership, and owners' attachment to the pet, on health and well-being.

RESULTS

The pet attachment measure showed good internal reliability. After controlling for other variables, neither pet ownership nor pet attachment added significantly to explained variance in health and well-being.

CONCLUSIONS

The health of elderly people is related to their health habits and social supports but not to their ownership of, or attachment to, a companion animal.

Psychosocial intervention as a component of routine breast cancer care-who participates and does it help?

Women who participated in the hospital psychosocial support groups following breast cancer surgery were compared with non-participants. The Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire were used to measure emotional distress and quality of life at the time of diagnosis and after 12 months. The General Life Orientation Test-Revised was used to measure dispositional optimism. Of 165 women, 87% reported that they had been invited to participate, and 66% participated. The salient predictor for participating in support group was optimism (OR 0.89 CI: 95% 0.83-0.98, p=0.01). No significant difference was found between the prevalence of anxiety and depression caseness at the time of diagnosis, but after 12 months, the prevalence of anxiety caseness was significantly lower among the participants than that among the non-participants (19% vs 34%, p=0.04). In conclusion, psychosocial intervention as a component of routine breast cancer care appears to have a long-term clinical beneficial effect on anxiety. For depression and quality of life, the study is inconclusive. Self-selection may prevent patients at risk of adverse outcome to participate in support groups.

Change in Need for Psychosocial Support for Women with Early Stage Breast Cancer

To simulate the longitudinal needs of patients treated for breast cancer, 2 groups of women were recruited. Patients within 6 months of diagnosis were considered in the early group and those 6-12 months after diagnosis were categorized as the late group. Participants were asked to identify effective and ineffective methods of psychosocial support and how those needs changed. Thirty-one women participated in the focus groups. Women in the early group identified problems related to their surgery and chemotherapy; those in the late group focused on symptoms associated with menopause. An exaggerated fear of disease recurrence and death were common to both groups. Most women found it difficult to strike a balance between wanting emotional support and wanting to be treated as normal. The provision of concrete medical information in the form of pathology and laboratory reports and information from health care professionals provided comfort and control. Spouses and partners were helpful in providing tangible assistance with transportation and childcare while female friends were more likely to share emotions. Organized support groups were helpful to only 13%. Participants acknowledged a need to learn how to identify their psychosocial needs and to ask for support from friends and family. Medical information provided patients with a sense of control and comfort. Women with breast cancer need to identify effective sources of emotional support and should be taught how to communicate those needs to their families and friends.

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.

Cancer support groups: a critical review of empirical studies

Support groups for adults affected by cancer are widely offered by local community and national agencies in North America. This type of psychosocial intervention is defined in terms of its structure and functions, and its theoretical underpinnings and models of practice are described. Forty-four empirical studies of professionally led cancer support groups are summarized and critically reviewed. These studies include 32 outcome evaluations of randomized controlled trials, two process evaluations, and 10 consumer satisfaction studies. The findings reveal high levels of consumer satisfaction, and the outcome evaluations substantiate the morale and other quality of life benefits short of prolonging life. Discussion centers on priorities for future research and practice.

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.

Support provision and emotional work in an Internet support group for cancer patients

OBJECTIVE

The study examined the content and frequency of messages to an Internet support group, using a conceptual framework based on support-giving and emotional work. The main questions addressed concerned what correspondents seem to be gaining from their involvement and whether the high-frequency correspondents differ motivationally from the lower-frequency correspondents.

METHODS

Messages to an Internet support group for women with breast cancer were collected over 12 months. The number of contributions written by individual correspondents could be determined. Messages were reliably coded for their main themes in terms of seeking or providing support.

RESULTS

The majority of correspondents (94%) wrote fewer than 10 messages. Two high-frequency correspondents emerged whose messages significantly less often referred to seeking and more often to providing support than did the messages of the less-frequent correspondents. These volunteer emotion workers both reported gaining personal satisfaction from their role.

CONCLUSION

The high-frequency correspondents act as informal volunteer emotion workers for the other users, and valuably supplement the role of the group's initiators. Further research is needed on how to amplify the psychological rewards for volunteer emotion workers in online support groups for adults with cancer.

PRACTICE IMPLICATIONS

Volunteer assistants in electronic groups may be crucial to the sustainability of online support initiatives.

Distance art groups for women with breast cancer: guidelines and recommendations

To overcome barriers that prevent women with breast cancer from attending support groups, innovative formats and modes of delivery both need to be considered. The present study was part of an interdisciplinary program of research in which researchers from counseling psychology, psycho-oncology, nursing, computer science, and fine arts have explored art making as an innovative format and telehealth as a mode of delivery. For this study, we conducted focus groups and interviews with 25 people with expertise about breast cancer, art, art therapy, and distance delivery of mental health services to generate guidelines for distance art-based psychosocial support services to women with breast cancer. A qualitative analysis of the focus group and interview data yielded guidelines for developers and facilitators of distance art groups for women with breast cancer pertaining to (a) emotional expression, (b) emotional support, (c) emotional safety, and (d) accommodating individual differences, plus special considerations for art therapy groups. Further research is needed pertaining to the use of computers, involvement of art therapists, and screening out vulnerable clients.

How do patients who participate in cancer support groups differ from those who do not?

Research has shown that cancer patients in general benefit from support group participation. However, few patients attend such groups. This study investigated differences between participants of a community cancer support group and a random selection of non-participants from the Cancer Registry. Data were collected through mail survey, and included variables identified through past research and variables derived from Leventhal's self-regulatory model of illness representations and the theory of planned behaviour. Sixty-three support group participants and 44 comparison sample respondents were recruited. Support group participants were more likely to be female, without a partner, younger, and to have more education and formal support than non-participants. They held more favourable views of support groups, believed that significant others were favourable towards participation, and perceived less difficulty in joining a group. They furthermore used more active, adaptive coping strategies and felt more control over their cancer, but were more distressed and anxious. Non-participants reported more support from a special person. A multivariate logistic regression analysis showed only psychosocial variables to be independent predictors of participation. As psychological variables are amenable to change, increase of appropriate support group participation should be possible, for instance by addressing patients' beliefs about support groups.

Cognitive and affective determinants of decisions to attend a group psychosocial support program for women with breast cancer

OBJECTIVE

This prospective study assesses the roles of illness beliefs, emotion regulation factors, and sociodemographic characteristics in decisions to participate in a group support program for women recently diagnosed with breast cancer.

METHOD

Women recruited during clinic visits 2 to 4 weeks after diagnosis completed measures of affective and cognitive factors identified by Leventhal's Common-Sense Model of illness self-regulation: cancer-related distress, avoidance tendencies, beliefs that the breast cancer was caused by stress and altered immunity, and personal control beliefs. Measures of general anxiety and depression, social support, and demographic characteristics were also completed; prognostic status information was obtained from medical records. All women were encouraged to participate in a free, 12-week program offering coping skills training and group support. Participation was recorded by program staff.

RESULTS

Of the 110 women, 54 (49%) participated in the group support program and 56 (51%) did not. Logistic regression analyses revealed that participation was predicted by stronger beliefs that the cancer was caused by altered immunity, higher cancer-related distress, lower avoidance tendencies, and younger age.

CONCLUSIONS

Participation in the group psychosocial support program appeared to be guided by cognitive and affective factors identified by the Common-Sense Model. Psychosocial support programs and informational materials promoting their use may attract more participants if they are tailored to focus on resolving cancer-related distress rather than on general anxiety or depression, appeal to those with high avoidance tendencies, address the role of immune function in cancer progression, and meet the needs of older participants.

Setting up a health education website: practical advice for health professionals

Recently, both popular and professional publications about health care have begun to express enthusiasm for the Internet as a source of medical information and possibly of psychological support for those with serious illnesses. However, there are pitfalls for practitioners and researchers who seek to capitalise on these patient education possibilities. We describe here the process and mixed outcomes of the efforts of a multidisciplinary team to set up and evaluate a website for rural women with breast cancer. We provide recommendations for other health professionals contemplating similar ventures, and also identify some future steps to develop and research this potentially valuable form of patient education and support.