Peer support to maintain psychological wellbeing in people with advanced cancer: findings from a feasibility study for a randomised controlled trial

Abstract

Background: Advanced cancer affects people's lives, often causing stress, anxiety and depression. Peer mentor interventions are used to address psychosocial concerns, but their outcomes and effect are not known. Our objective was to determine the feasibility of delivering and investigating a novel peer mentor intervention to promote and maintain psychological wellbeing in people with advanced cancer. Methods: A mixed methods design incorporating a two-armed controlled trial (random allocation ratio 1:1) of a proactive peer mentor intervention plus usual care, vs. usual care alone, and a qualitative process evaluation. Peer mentors were recruited, trained, and matched with people with advanced cancer. Quantitative data assessed quality of life, coping styles, depression, social support and use of healthcare and other supports. Qualitative interviews probed experiences of the study and intervention. Results: Peer mentor training and numbers (n = 12) met feasibility targets. Patient participants (n = 12, from 181 eligible who received an information pack) were not recruited to feasibility targets. Those who entered the study demonstrated that intervention delivery and data collection were feasible. Outcome data must be treated with extreme caution due to small numbers, but indicate that the intervention may have a positive effect on quality of life. Conclusions: Peer mentor interventions are worthy of further study and researchers can learn from these feasibility data in planning participant recruitment and data collection strategies. Pragmatic trials, where the effectiveness of an intervention is tested in real-world routine practice, may be most appropriate. Peer mentor interventions may have merit in enabling survivors with advanced cancer cope with their disease.

Empowerment in cancer patients: Does peer support make a difference? A systematic review

“…The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP) 46 as it applies to a wide range of quantitative 50,52,53,58,60,64,65,71,[74][75][76] The peer support interventions were mainly held in group settings (17 studies), of which 11 were face-to-face group interventions 48,51,54,55,58,59,61,63,67,68,72 and seven were delivered online. [56][57][58]66,69,70,73 Twelve peer interventions were one-on-one, mostly conducted face-to-face, but also by telephone, or-in two cases-via e-mail.…”

“…[56][57][58]66,69,70,73 Twelve peer interventions were one-on-one, mostly conducted face-to-face, but also by telephone, or-in two cases-via e-mail. 49,50,52,53,60,62,64,65,71,[74][75][76] If provided, duration of counselling varied from at least one session to several sessions within 12 months. The frequency of interactions was weekly in at least three studies, while most others had different intervals.…”

“…The included studies used diverse instruments to measure different dimensions of empowerment (Table 1). Twelve assessed coping (using mini-Mental Adjustment to Cancer (mini-MAC) scale, Brief Coping Orientation to Problems Experienced (COPE), Dealing with Illness Inventory-German Revised (DWI-GR), Functional Assessment of Cancer Therapy (FACT), Electronic Cancer Coping Scale (ECCS)), 49,51,54,56,57,[60][61][62]67,69,70,74 nine assessed self-efficacy (Cancer Behavior Inventory (CBI), Stanford Inventory of Cancer Patient Adjustment (SICPA), General Self-Efficacy Scale (GSE), Stanford Emotional Self-Efficacy Scale-Cancer (SESES-C), Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B), Selbstwirksamkeitserwartung (SWE) scale, Cancer Management Self-Efficacy Scale)), 48,52,53,60,[64][65][66]75,76 nine assessed knowledge (Breast Cancer Resources Questionnaire (BCRQ) and newly developed questionnaires), 52,53,55,58,59,[61][62][63]71 two assessed empowerment (Cancer Empowerment Questionnaire (CEQ) and modified own items), 72,73 four assessed self-management skills, 55,58,64,71 two assessed health behaviour outcomes 50,68 and one assessed control. 58 No study assessed health literacy explicitly.…”

“…Study quality was deemed as 'weak' for nine studies, 54,58,59,61,63,69,70,72,73 moderate for 11 studies, 48,50,55,56,62,[64][65][66]68,71,74 and 'strong' for nine studies 49,[51][52][53]57,60,67,75,76 (Table S2).…”

“…57 Lastly, in a pilot RCT, the authors found a decrease in problem-focused coping for participants of the dyadic peer intervention and an increase in emotion-focused and dysfunctional coping after 12 months, but did not indicate whether these effects were significant. 74…”