"There's somebody like me": perspectives of a peer-to-peer gynecologic cancer mentorship program

Implementation and Evaluation of Peer Ambassador Support to Patients Newly Diagnosed With Hematological Cancer and Their Caregivers

Aims and Objectives: To provide a comprehensive report on the development and implementation of peer ambassador support to patients newly diagnosed with hematological malignant disease and their caregivers within a clinical setting. Methods: The continued development and implementation of the peer ambassador support program took place between October 2022 and January 2024 at the Department of Hematology, Copenhagen University Hospital, Rigshospitalet. Grol and Wensing's 5-step model of implementation guided the process. Results: This paper demonstrates the successful adaptation and implementation of the peer ambassador program and provides valuable insights into the enabling factors and obstacles encountered. In total, 48 peer ambassadors were recruited, and 27 patients and seven caregivers received support. Over 90% of patients and caregivers reported high satisfaction with the support, and the majority (70%) noted that the support improved their understanding and provided new insights into their disease and treatment journey. Conclusion: The development and implementation of the intervention are complex and demanding long-term processes that require applying theoretical knowledge, understanding patient and caregiver's experiences, and collaboration with the interdisciplinary team in clinical practice. Implications: This paper provides knowledge for implementing future peer ambassador support initiatives. It has potential transferability and value in a broader context for patients with life-threatening illnesses and their caregivers. Impact: It contributes to research and transparency in the development and implementation of evidence-based nursing interventions. It confirms that implementation of a peer support intervention is complex and requires theoretical knowledge, application of that knowledge, and interdisciplinary collaboration in clinical practice. Finally, it provides evidence-based knowledge applicable to the implementation of future peer support initiatives. Patient Contribution: Patients and their caregivers have been actively involved throughout the development and implementation of the peer ambassador support program. Trial Registration: ClinicalTrials.gov identifier: NCT03493906 and NCT04039100.

A Structured Peer Support Intervention for Patients With Hematologic Malignancies Undergoing Hematopoietic Stem Cell Transplantation: Peer Support Interventionists' Perspectives

BACKGROUND

Peer support is emerging as an important component of supportive care for patients with hematologic malignancies, but it has not been robustly implemented in patients undergoing hematopoietic stem cell transplantation (HSCT).

OBJECTIVES

This qualitative study aimed to explore the experiences of peer support interventionists (participants) delivering a structured, 5-session, phone-delivered peer support intervention, the Supporting Transplant Experiences with Peer Program (STEPP) for patients undergoing HSCT.

METHODS

Adult patients who underwent allogeneic or autologous HSCT for the treatment of a hematologic malignancy within the past 3 years were eligible to volunteer in this study as trained STEPP interventionists. Semi-structured qualitative interviews were conducted to explore participants' experiences, including their motivations for volunteering, reflections on intervention delivery and on the impact of peer support, and challenges faced while serving in this role. Interviews were deductively analyzed by 2 coders using framework-guided rapid analysis.

RESULTS

Twenty STEPP interventionists participated in this study. Participants were 65% men, with a median age of 63.5 years. Most (75%) had undergone allogeneic HSCT. Emerging themes from the qualitative interviews highlighted that participants were motivated to serve as interventionists by a sense of gratitude for their transplant care and a desire to share their transplant experiences with others. The impact of the STEPP intervention on interventionists included opportunities to process their transplant journey while also providing support to their peers. Interventionists reported a preference for free-flowing conversations, which were still guided by the structured manual. Challenges included terminating the interventionist-patient relationship at the conclusion of STEPP.

CONCLUSION

Peer support interventions for patients undergoing HSCT have the potential to enhance well-being and provide meaning for both patients preparing to undergo HSCT and HSCT survivors who serve as interventionists. Large-scale randomized clinical trials are needed to test the efficacy of peer support interventions for improving health-related outcomes among patients undergoing HSCT and HSCT survivors serving as interventionists for these interventions.

"A Mission and Purpose to Make Some Sense out of Everything That Was Happening to Me": A Qualitative Assessment of Mentorship in a Peer-to-Peer Gynecologic Cancer Program

This study aimed to elucidate the relationship between mentorship, survivorship, and identity construction in people who have had gynecologic cancer and participated as mentors in a peer mentorship program. A qualitative descriptive study was designed, and hour-long semi-structured interviews with peer mentors were conducted. Interviews investigated how serving as a peer mentor influenced understanding of mentors' own cancer experiences. Thematic analysis was then conducted. All authors open-coded a subset of interviews to develop a codebook, which was then used to code the remaining transcripts. This qualitative inductive analysis of over 7 h of data was managed with NVivo 12. Seven peer mentor participants (N = 7) were interviewed. Four main themes emerged: serving in the social role of mentor gave participants (i) a sense of daily direction in their lives, (ii) an opportunity to give back to others in the cancer community, (iii) an explanatory reason for their cancer journey, and (iv) the ability to reify their own status as survivor. Providing support through a peer mentorship program helped our participants make meaning in their own cancer experience.

A Peer Support Intervention in Patients With Hematologic Malignancies Undergoing Hematopoietic Stem Cell Transplantation (HSCT): The STEPP Proof-of-Concept Trial

Although peer support interventions are associated with improved patient-reported outcomes in diverse cancer populations, structured peer support programs tailored to the needs of patients undergoing hematopoietic stem cell transplantation (HSCT) are lacking. This single-arm, proof-of-concept trial aimed to refine the Supporting Transplant Experiences with Peer Program (STEPP), a structured, five-session, manualized, phone-delivered peer support intervention for patients undergoing HSCT, informed by qualitative feedback from patients. Adult patients with hematologic malignancies scheduled to undergo allogeneic or autologous HSCT were eligible to participate in the study approximately two weeks prior to their HSCT hospitalization. Participants received the STEPP intervention, which focused on providing informational, emotional, and practical support. To refine the intervention, we conducted semi-structured qualitative exit interviews to gather feedback on the content of STEPP and to identify facilitators and barriers to engagement. Transcribed interviews were analyzed using rapid analytic methods by two coders. Of the 37 eligible patients, 25 enrolled in the study, 20 completed all intervention sessions and 20 completed exit interviews. Participants highlighted that discussions with peer mentors/STEPP interventionists about the transplant journey and processing information provided by the clinical team were the most valuable aspects of STEPP. Positive experiences during the first intervention session facilitated patient engagement with the program. Potential barriers to engagement included logistical challenges in connecting with interventionists while experiencing physical symptoms during inpatient hospitalization and being paired with an interventionist who had a different cancer diagnosis and/or type of transplant. Patients undergoing HSCT reported positive experiences with the structured five-session, phone-delivered peer support intervention administered before and during the HSCT hospitalization. Patients' descriptions of barriers and facilitators to engagement with the STEPP intervention underscore the importance of patient input and programmatic structure in peer support interventions for this population. Insights from this proof-of-concept trial will be incorporated into future trials of STEPP to improve outcomes in HSCT recipients.

Peer Supporters' Experience of Supporting Cancer Patients: A Meta-synthesis

BACKGROUND

With the widespread use of peer support in the cancer field, more and more cancer survivors are becoming supporters. However, they may bear a huge psychological burden in the peer support project. There has been little effort to analyze supporters' experiences from a meta-perspective.

OBJECTIVE

The aims of this study were to review the literature on the experience of patients serving as peer supporters, integrate qualitative data to explore the experiences of supporters participating in peer support programs, and provide suggestions for future researchers.

INTERVENTIONS/METHODS

China Knowledge Network, Wanfang Database, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, CINAHL, and PsycINFO were searched. Titles, abstracts, and full texts were screened. Included articles (n = 10) underwent data extraction, the Joanna Briggs Institute Critical Appraisal Tool for qualitative researches (2016) quality evaluation, and thematic synthesis.

RESULTS

The literature ultimately included 10 studies from which 29 themes were distilled and grouped into 2 main categories: benefits and challenges of peer support for supporters.

CONCLUSIONS

Peer supporters will not only gain social support, growth, and recovery but also experience various challenges when providing peer support. Both supporters' and patients' experiences of participating in peer support programs deserve the attention of researchers. Researchers need to be rigorous in controlling the implementation of peer support programs to help supporters gain and overcome challenges.

IMPLICATIONS FOR PRACTICE

Future researchers can use study findings to better develop peer support programs. More peer support projects are needed to explore a standardized peer support training guide.

"It just made me feel better": qualitative examination of the implementation of a novel virtual psychosocial support program for adolescents with cancer

PURPOSE

Adolescents with cancer routinely report feelings of isolation and exclusion, including from medical decision-making. To address this problem and support adolescents, we designed and implemented the novel, virtual, weekly Teens4Teens peer support group and patient education program. We examined the views of participating adolescents, program guest speakers, and program moderators as they pertained to the need for the program, its feasibility, acceptability, and perceived impact.

METHODS

We recruited all available adolescents, moderators, and guest speakers who participated in Teens4Teens to take part in audio-recorded, semi-structured interviews. Interviews were transcribed, coded, and analyzed using thematic analysis.

RESULTS

We conducted 21 interviews across participant groups. We identified four broad themes: pathways into the Teen4Teens program, Teens4Teens implementation capacity, perspectives of the positive impact of Teens4Teens, and suggestions to improve Teens4Teens. These themes described a perceived need for adolescent-centered psychosocial programming in pediatric cancer care, provided lessons on how best to build and apply such a program, and highlighted the value of the program for both adolescents' and clinicians' acceptability, feasibility, and perceived utility.

CONCLUSION

Adolescents, guest speakers, and moderators valued Teens4Teens and made suggestions to improve capacity to routinely implement the program. Adolescent-tailored psychosocial programming, such as Teens4Teens, is positioned to be integrated into clinical care with relative ease and may serve to improve the cancer care experience of adolescents and their families. This study has potential to provide researchers and clinicians with valuable information about the content, design, and delivery of virtual peer support programming for adolescents with cancer.

Family caregiver ambassador support for caregivers of patients with newly diagnosed hematological cancer: a feasibility study

PURPOSE

This study investigated the feasibility of a one-on-one peer support intervention in family caregivers of newly diagnosed patients with a hematological cancer during initial treatment.

METHODS

The study was a one-arm feasibility study including family caregivers of newly diagnosed patients with hematological cancer (n = 26) and caregiver ambassadors who were family caregivers of previously treated patients as peer supporters (n = 17). The one-on-one peer support intervention consisted of three components: a caregiver ambassador preparatory course; 12 weeks of one-on-one peer support, and caregiver ambassador network meetings.

RESULTS

Family caregivers reported high satisfaction with the delivery and flexibility of one-on-one peer support and improved in most psychosocial outcomes over time. Telephone and text messages were the most used form of contact between the peers. Caregiver ambassadors reported high satisfaction with the preparatory course and used the available support from the network meetings. No adverse events were reported.

CONCLUSION

One-on-one peer support provided by a caregiver ambassador is feasible and safe in family caregivers of newly diagnosed hematological cancer patients during their initial treatment. Utilizing volunteer caregiver ambassadors has the potential to be a new support model in family caregivers of hematological cancer patients across diagnostic groups within a clinical setting.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04039100, July 29, 2019.

Paths to Motherhood for Women with Cystic Fibrosis

PURPOSE

Cystic fibrosis (CF) is no longer a disease limited to childhood. With medical advancements, many of those with CF live into adulthood and have similar life goals as their non-CF peers. Most women with CF want to become mothers. However, available options and the related decision-making process is not well understood. The purpose of this study was to explore the decision-making framework of women with CF to better understand the factors they consider when deciding on a path to motherhood.

STUDY DESIGN AND METHODS

Qualitative interviews were performed using a grounded theory approach. Inclusion criteria were women with CF who became mothers through biological pregnancy, adoption, or gestational surrogacy. Results: Twenty-five mothers with CF were interviewed. A distinct decision-making process was identified through which women started with a desire for motherhood, assessed several factors, then eventually took the path they felt was right for them and their family.

CLINICAL IMPLICATIONS

Our findings provide women with CF a framework that other women with CF have used to assist in making decisions about their reproductive options. Conversations about family planning should occur early and regularly between women with CF and their health care providers. The decision-making process to achieve motherhood for women with a chronic illness, such as CF, includes consideration of unique factors that should be included in clinical conversations.