Review Article
Systematic review of peer-support programs for people with cancer

https://doi.org/10.1016/j.pec.2007.11.016Get rights and content

Abstract

Objective

To identify models of peer support for cancer patients and systematically review evidence of their effectiveness in improving psychosocial adjustment.

Methods

CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and PsychINFO databases were used to identify relevant literature published from 1980 to April 2007. Data on characteristics of the peer-support program, sample size, design, measures, and findings were extracted and papers were also rated with respect to research quality (categories ‘poor’, ‘fair’ or ‘good’).

Results

Forty-three research papers that included data from at least 1 group were reviewed in detail, including 26 descriptive papers, 8 non-randomized comparative papers, and 10 papers reporting eight randomized controlled trials (RCTs). Five models of peer support were identified: one-on-one face-to-face, one-on-one telephone, group face-to-face, group telephone, and group Internet.

Conclusion

Papers indicated a high level of satisfaction with peer-support programs; however, evidence for psychosocial benefit was mixed.

Practice implications

One-on-one face-to-face and group Internet peer-support programs should be given priority when considering ways to offer peer support. Nevertheless, the other models discussed in this review should not be dismissed until further research is conducted with a wide range of cancer populations.

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.

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