Review ArticleSystematic review of peer-support programs for people with cancer
Introduction
A cancer diagnosis is a major stressor that can lead to physical, emotional and social crises [1], [2], [3]. As a result, many cancer patients experience a range of psychosocial difficulties following diagnosis, including depression, anxiety, loneliness, uncertainty and loss of control, decreased self-esteem, disruptions to relationships, and fears about cancer recurrence [4], [5], [6], [7], [8].
Social support has been identified as an important contributor to general well-being that buffers the impact of stressful experiences, including those related to physical illness [9], [10], [11]. It is a multidimensional construct that includes the provision of emotional, informational or instrumental support [10], [11]. In the cancer setting, it can be offered in a variety of forms, including psychotherapeutic programs such as supportive expressive group therapy [12], [13], [14], educational programs such as the Living With Cancer Education Program [15] and peer-support programs such as Reach to Recovery [16], [17] and Man to Man [18]. While each of these interventions provides support to cancer patients, they differ in some respects. In psychotherapeutic programs a trained therapist conducts therapy with patients (e.g., learning how to express and manage emotions), while in educational programs a health professional provides expert knowledge on cancer. While these approaches have gained support in the literature [8], [19], [20], [21], [22], the focus of this review is on peer support. Peer-support programs may adopt certain aspects of psychotherapeutic programs (e.g., discussing emotions) and educational programs (e.g., providing cancer information), but they differ in that no therapy is conducted and the focus is not on providing education to the patient.
Peer support refers to support offered to people with cancer by people who have also experienced cancer [23]. Sharing experiences is the essence of peer support and enables a peer to offer experiential empathy, something generally beyond the scope of health professionals [24]. Dennis [25] described emotional, informational and appraisal support as core attributes of peer support, with the mutual identification, shared experiences and sense of belonging developed through peer support thought to impact psychological outcomes positively. Two different theoretical models have been suggested to describe the mechanisms by which peer support may increase well-being. The direct effect model proposes that peer support directly affects health outcomes by decreasing feelings of isolation, encouraging health behaviours, promoting positive psychological states and providing information. The alternative model is guided by Lazarus and Folkman's theory [26] and suggests that peer support buffers the impact of stress on health by reframing threat appraisals and improving coping responses and behaviours.
Peer-support programs have been found to improve satisfaction with medical care; personal relationships and social support [27], increase a sense of belonging [28], [29] and improve mood [4], [25]. However, several studies have also found adverse outcomes, including failed social attempts, reinforcement of poor behaviours and diminished feelings of self-efficacy [25], [30]. Two recent reviews assessing the effectiveness of peer-support programs have concluded that participants benefit from these programs; however, both comment upon a paucity of well-designed studies [8], [20].
There are a number of different models for the delivery of peer support, including one-on-one, group, telephone and Internet services. Macvean et al. (2007) examined the literature describing one-to-one support programs for individuals with cancer; however, as the focus of that review was volunteer-based programs it included both peer and non-peer-support programs [31]. To date there has been no systematic review comparing the effectiveness of different peer-support models. The current systematic literature review aims to identify the different models of peer support described in the literature for people with cancer, and examine the research assessing their effectiveness.
Section snippets
Search protocol
An extensive search of the published literature was undertaken using electronic databases CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and PsychINFO, for the period 1980 to April 2007 with the search terms: cancer or neoplas$ or oncology$ and peer or peer support or peer and support or support group$ or support program$ or group psychosocial support or self-help or visitor$ or survivor support. Reference lists were searched and key researchers contacted to identify
Overview—paper selection and classification
A total of 2945 unique published papers were identified. An additional seven papers were recommended by key researchers in the field, producing a final count of 2952 papers reviewed at the title phase. Four hundred and thirty papers clearly irrelevant (for example, they focused on children or reported a cancer treatment trial) were eliminated. Abstracts for the remaining 2522 papers were examined and papers not meeting the inclusion criteria were eliminated (n = 2350). The remaining 172 papers
Discussion
This literature review identified five different models of peer-support delivery: one-on-one face-to-face, one-on-one telephone, group face-to-face, group telephone, and group Internet. The majority of the studies involved women with breast cancer. Most of the research was reported in descriptive studies, with only eight RCTs identified. Regardless of study type, the average program description rating was ‘fair’, indicating that many elements of the design and delivery of the peer-support
Disclosure statement
I confirm that all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.
Acknowledgements
This research was supported by the Department of Health and Ageing, Commonwealth of Australia, administered through Cancer Australia. We acknowledge the assistance of Joanna Tilkeridis in the planning of this research and Michelle Macvean for her advice on the systematic review processes.
References (74)
- et al.
Biopsychosocial aspects of prostate cancer
Psychosomatics
(2000) - et al.
Effects of contacts between cancer patients on their psychological problems
Patient Educ Couns
(1987) Peer support within a health care context: a concept analysis
Int J Nurs Stud
(2003)- et al.
The use and acceptability of a one-on-one peer support program for Australian women with early breast cancer
Patient Educ Couns
(2004) - et al.
What do cancer support groups provide which other supportive relationships do not? The experience of peer support groups for people with cancer
Soc Sci Med
(2006) - et al.
Psychosocial morbidity in prostate cancer. II. A comparison of patients and partners
Br J Urol Int
(2000) - et al.
Sense of coherence as a mediator of stress for cancer patients and spouses
J Psychosoc Oncol
(1993) - et al.
Evaluation of a peer support program for women with breast cancer—lessons for practitioners
J Community Appl Soc Psychol
(1999) - et al.
Experiences of women with breast cancer: exchanging social support over the CHESS computer network
J Health Commun
(2000) - et al.
The Young Women's Network: a case study in community development
J Community Appl Soc Psychol
(2001)
Review of peer support in the context of cancer
J Psychosoc Oncol
Stress, social support, and the buffering hypothesis
Psychol Bull
Stress and social support: in search of optimal matching
J Soc Clin Psychol
The health-related functions of social support
J Behav Med
Psychosocial interventions with cancer patients
J Psychosoc Oncol
A psychosocial intervention and survival time of patients with metastatic breast cancer
Adv: J Mind-Body Health
Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial
Cancer
The living with cancer education programme. I. Development of an Australian education and support programme for cancer patients and their family and friends
Eur J Cancer Care (Engl)
Effects of peer support: Reach to Recovery program and the mastectomy patient
Adv Cancer Contr: Epidemiol Res
An assessment of the Reach to Recovery program
CA Cancer J Clin
Man to Man prostate cancer support groups
Cancer Pract
Where are we now? Evaluating two decades of group interventions with adult cancer patients
J Psychiatr Ment Health Nurs
Cancer support programs—do they work?
Patient Educ Couns
Systematic review of psychological therapies for cancer patients: overview and recommendations for future research
J Natl Cancer Inst
Cancer support groups: a critical review of empirical studies
Psychooncology
A qualitative study of breast cancer self-help groups
Psychooncology
Self-help and mutual support programs
Stress, appraisal, and coping
One-on-one peer support and quality of life for breast cancer patients
Patient Educ Couns
Interviews with men with prostate cancer about their self-help group experience
J Palliat Care
Evaluation of a computer-based cancer support network
Cancer Pract
The effect of peer counseling on quality of life following diagnosis of breast cancer: an observational study
Psychooncology
One-to-one volunteer support programs for people with cancer: a review of the literature
Patient Educ Couns
The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials
Clin Oral Investig
The program evaluation standards: how to assess evaluations for educational, programs
Supporter or obstructer; experiences from contact person activities among Swedish women with breast cancer
BMC Health Serv Res
Cited by (306)
Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis
2023, International Journal of Drug PolicyIntegrating accompanying patients into clinical oncology teams: limiting and facilitating factors
2024, BMC Health Services Research