Circles of Care

Abstract

Peer support interventions extend care and health information to underserved populations yet rarely address serious illness. Investigators from a well-defined academic–community partnership developed and evaluated a peer support intervention for African Americans facing advanced cancer. Evaluation methods used the Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM) framework. Investigators initially recruited and trained 24 lay health advisors who shared information or support with 210 individuals. However, lay advisors reported barriers of medical privacy and lack of confidence working alone with people with cancer. Training was modified to match the support team model for peer support; training reached 193 volunteers, 104 of whom formed support teams for 47 persons with serious illness. Support teams were adopted by 23 community organizations, including 11 African American churches. Volunteers in teams felt prepared to implement many aspects of supportive care such as practical support (32%) or help with cancer or palliative care resources (43%). People with serious illness requested help with practical, emotional, spiritual, and quality of life needs; however, they rarely wanted advocacy (3%) or cancer or palliative care resources (5%) from support teams. Volunteers had difficulty limiting outreach to people with advanced cancer due to medical privacy concerns and awareness that others could benefit. Support teams are a promising model of peer support for African Americans facing advanced cancer and serious illness, with reach, adoption, and implementation superior to the lay advisor model. This formative initial evaluation provides evidence for feasibility and acceptance. Further research should examine the efficacy and potential for maintenance of this intervention.

Conceptualizing Native Identity with a Multidimensional Model

“…A special issue of American Indian and Alaska Native Mental Health Research presented several examples of needs assessments from Native communities around the country (Manson, 1999). The community needs assessment discussed here, which represents fi ndings from one site funded through the Circles of Care Initiative (Manson, 2004), complements this earlier work. We hope that this project might serve as a model for other AI community needs assessments and research partnerships, particularly in urban settings.…”

The effect of nurse-led group discussions by race on depressive symptoms in patients with heart failure

“…44 Peer support is known to be acceptable to African Americans. 45,46 Other clinical trial results of peer discussion groups reported improved self-care competence, social integration, greater use of community services, and lower depression levels. 47 Our previous research found “learning from other patients”, was highly rated by patients and family members in previous focus groups that included 50% African Americans.…”

Community-based participatory research: understanding a promising approach to addressing knowledge gaps in palliative care

“…For example, Hanson and colleagues (29) used this approach to develop and implement a peer support training intervention for African Americans living with advanced cancer. Throughout the project, community stakeholder groups provided recommendations about how best to recruit and train lay persons who received (and ultimately delivered) the support intervention.…”

“…Throughout the project, community stakeholder groups provided recommendations about how best to recruit and train lay persons who received (and ultimately delivered) the support intervention. The partnership was able to demonstrate broad reach of the intervention in the community, with 23 community organizations adopting its use (29). …”