Facilitated Peer Support in Breast Cancer

Transcription

1 Copyright B 2010 Wolters Kluwer Health Lippicott Williams & Wilkis Siead Power, MSc, BSc, RGN, PGCertTLHE, PGDipTLHE Josephie Hegarty, PhD, MSc, RNT, BSc, RGN Facilitated Peer Support i Breast Cacer A Pre- ad Post-Program Evaluatio of Wome s Expectatios ad Experieces of a Facilitated Peer Support Program K E Y W O R D S Breast cacer Facilitated face-to-face peer support programs Peer support Preprogram ad postprogram evaluatio Backgroud: Peer support programs are associated with the provisio of emotioal, iformatioal, ad appraisal support. The beefits of peer support for wome with breast cacer iclude reduced social isolatio, ehaced copig, ad access to iformatio. Objective: The aim of this study was to coduct a pre- ad post-program evaluatio of a 7-week facilitated breast cacer peer support program i a cacer support house. Methods: Wome with primary breast cacer ( = 8) participated i pre- ad post-program focus groups. The iterviews were recorded ad were trascribed verbatim by the researcher. The data were aalyzed usig cotet aalysis. Eight themes were idetified. Results: The key themes emergig from the pre ad post programme focus groups icluded: The eed for mutual idetificatio; Post-treatmet isolatio; Help with movig o; The impact of hair loss; Cosolidatio of iformatio; Eablemet/empowermet; The importace of the cacer survivor; Mutual sharig. Coclusio: It is essetial that facilitated peer support programs are tailored to meet the support eeds of wome with breast cacer. There is a particular eed to facilitate mutual sharig ad support for hair loss withi these programs. Implicatios for Practice: Implicatios for practice emergig from this study iclude the importace of pre- ad post-program evaluatios i idetifyig whether peer support programs meet the expectatios of wome with breast cacer, the eed for peer/professioal programs to support wome with treatmet-iduced hair loss, the importace of icludig cacer survivors i support programs, ad the eed to allow more iformal sharig to occur i facilitated peer support programs. Authors Affiliatio: Catherie McCauley School of Nursig ad Midwifery Uiversity College, Cork, Irelad. Correspodig author: Siead Power, MSc, BSc, RGN, PGCertTLHE, PGDipTLHE, Catherie McCauley School of Nursig ad Midwifery Uiversity College Cork, Brookfield Health Scieces Complex, College Road Cork, Republic of Irelad (siead.power@ucc.ie). Accepted for publicatio August 2, Facilitated Peer Support i Breast Cacer Cacer Nursig TM, Vol. 33, No. 2, 2010 E9

2 Breast cacer ow affects 1 i 16 wome i Europe. Patiets with breast cacer experiece physical, psychological, ad social effects. These iclude ausea ad vomitig, fatigue, altered body image, social isolatio, depressio, ad disruptio to family relatioships. 2Y6 Sice their iceptio i the 1940s, 7 peer support programs i cacer have bee effective i alleviatig may of the physical ad psychosocial effects of breast cacer. 8,9 I a effort to idetify the support eeds of patiets with cacer, atioal ad iteratioal cacer agecies ad those ivolved i the day-to-day care of idividuals with cacer have idetified research ito the psychosocial well-beig ad supports for patiets with cacer as priority areas. 10Y15 The purpose of this study was to explore wome s expectatios, motivatios, ad experieces of participatig i a facilitated face-to-face breast cacer peer support program. Review of the Literature Peer support programs costitute the provisio of emotioal, iformatioal, ad appraisal support to idividuals. 16,17 Fidigs from empirical studies withi the literature suggest that wome who have a strog support etwork cope better with a diagosis of breast cacer ad have better psychological adjustmet. 18Y20 I the cotext of breast cacer, peer support programs have iheret beefits for patiets. These beefits iclude ehaced emotioal well-beig, self-efficacy, feeligs of empowermet, ad ehaced kowledge. 21Y23 Peer support programs i breast cacer may be delivered i umerous differet formats. These may be oe-to-oe or facilitated face-toface group programs. 9,21 Furthermore, these programs may be delivered olie or via the telephoe ad may be facilitated by peers ad/or healthcare professioals. 20Y24 The provisio of peer support to idividuals by cacer survivors i group or oe-to-oe format is of particular beefit to patiets with breast cacer. 21,25Y28 The literature demostrates the positive beefits of peer support programs for wome with breast cacer regardless of how they are delivered. Despite the positive beefits of peer support programs for wome with breast cacer, more formal evaluatios of commuity-based peer support programs are required to assess their effectiveess i meetig the support eeds of those who avail of them. 9 While umerous studies have verified the positive beefits of peer support for wome with breast cacer, relatively few researchers have coducted pre-evaluatio ad postevaluatio of such programs to assess whether these programs are effective i meetig the support eeds of participats. 28 Methods This study used a qualitative descriptive desig. The data were collected through focus groups. Focus groups ivolve a discussio betwee a small group of people uder the guidace of a facilitator. 29,30 This method of data collectio was chose as the most effective, efficiet, ad oitrusive way of allowig ad ecouragig participats to express their 1 views o the facilitated peer support program. This method of data collectio was also similar i format to the facilitated peer support program. The preprogram focus group i particular also allowed participats to get to kow each other prior to attedig the first day of the peer support program. Participats ad Procedure Permissio to coduct the study was grated by the local ethics committee. Wome with breast cacer ( = 8) who had agreed to take part i a face-to-face peer support program i a local cacer support house were ivited to participate i preprogram ad postprogram focus group iterviews. Writte ad verbal iformatio o the study was provided by the researcher ad the breast urse couselor i a local cacer support house. Recruitmet of participats took place i the first 2 weeks of Jauary Havig agreed to participate i the study, participats siged a coset form. Participats were assured that their aoymity would be maitaied throughout the course of the study ad for subsequet publicatios by the use of code umbers. All of those ivited agreed to participate i the study. Participats raged i age from 30 to 60 years. We cosidered participat s age to be importat, as wome of differet ages may have had differet support eeds to each other. All participats had completed active treatmet for primary breast cacer. The legth of time that treatmet had bee completed raged from 1 week to 14 moths. We ackowledge that wome may have differet support eeds at differet stages posttreatmet. However, the sample for this study was obtaied usig coveiece samplig. Eight wome who had agreed to participate i a facilitated peer support program were ivited to participate i the study. Therefore, we had o cotrol over the legth of time that participats had fiished treatmet. The preprogram iterview took place 2 weeks prior to the commecemet of the facilitated peer support program. The postprogram iterview took place 2 weeks followig completio of the program. Peer Support Program Details The facilitated peer support program i this study was of 7-week duratio. The program is ru i a local cacer support house, which has bee i operatio sice The day-to-day ruig of the house is depedet o volutary cotributios ad fud-raisig activities. The breast cacer support program is ru 3 times per year ad is offered to wome with primary breast cacer who have completed active treatmet. The overall aim of the program is to help wome adjust to livig with the physical ad psychological effects associated with a diagosis of breast cacer. The program i questio was led by a breast cacer urse couselor, a voluteer retired couselor, a traiee couselor, ad a Reach to Recovery voluteer (a breast cacer survivor who has received traiig i providig peer support to idividuals from the Irish Cacer Society). Two of the participats missed 1 week of the program, each due to family commitmets. The objectives E10 Cacer Nursig TM, Vol. 33, No. 2, 2010 Power ad Hegarty

3 of the program are to provide iformatio o the effects of surgery, radiotherapy, ad hormoe treatmet; to dispel the myths ad miscoceptios associated with breast cacer; ad to offer a forum for wome to recheck the iformatio they have already received i hospital. Program participats met oce weekly over the 7-week period for a 2.5-hour sessio. The program ivolved a combiatio of iformatio sessios o practical issues such as hormoe therapy ad lymphedema. Iformal sharig of experieces betwee participats was ecouraged by the lead facilitator. There was also a opportuity for iformal sharig betwee participats. This allowed them the opportuity to share their experieces of breast cacer with other participats. All of these sessios were facilitated by the breast cacer urse couselor. Data Collectio Preprogram ad postprogram focus groups were the chose method of data collectio for this study. Each focus group meetig was recorded ad was of 1-hour duratio. The questios used i the preprogram ad postprogram iterviews are detailed i Table 1. A flip chart ad field otes were used to assist i summarizig key poits ad to recap o key themes from participats. The flip chart ad field otes were particularly useful i helpig the researcher to validate the resposes ad key themes with participats o completio of each focus group. Data Aalysis The focus group data were aalyzed through the use of cotet aalysis. Cotet aalysis is cocered with the aalysis of arratives ad the idetificatio of promiet themes. 31 There is evidece withi the literature to suggest that opiios vary i relatio to the meaig, procedure, ad iterpretatio of qualitative data through the use of cotet aalysis. 31 The iterviews were trascribed verbatim by the researcher (S.P.). The trascribed iterviews were read ad reread by the researcher (S.P.) ad the coresearcher (J.H.) to gai a uderstadig of the cotet. Secod, the text was divided ito codes, that is, a collectio of words or statemets relatig to the same cetral meaig. 32 Third, the codes were the divided ito subcategories ad categories. The formatio of categories is a core feature of qualitative cotet aalysis. 30 Fially, the categories emergig from the aalysis of the data were developed ito themes. Eight themes emerged followig the aalysis of the preprogram ad postprogram iterviews. Trustworthiess of the Study Three criteria were used to esure the trustworthiess of the qualitative data aalysis procedure ad resultat fidigs. These were credibility, depedability, ad trustworthiess. 33,34 Methods to esure credibility, depedability, ad trustworthiess i this study icluded the selectio of a homogeous group of patiets, that is, wome with primary breast cacer; a iterview guide was desiged by the researcher for both preprogram ad postprogram iterviews to esure cosistecy ad the stability of data over time; a flip chart was used to verify participat s resposes durig ad o completio of both focus group meetigs; the process of data collectio, data aalysis, ad a detailed presetatio of the fidigs supported by exemplars from the participats were provided. The researcher (S.P.) who collected the preprogram ad postprogram data was a idepedet perso ad did ot take part i the peer support program. Fidigs Eight themes ad 5 subthemes emerged followig aalysis of the preprogram ad postprogram data. These themes ad subthemes are provided i Table 2. Preprogram Iterview: Mai Themes THE NEED FOR MUTUAL IDENTIFICATION Whe asked about their motivatio for takig part i the program, all participats idetified the eed to idetify with others i a similar situatio. Table 1 & Preprogram ad Postprogram Focus Group Questios Preprogram How did you fid out about the support program? What was your motivatio for takig part i the support program? What are you expectatios of the program? How do you thik the support program will help you? Why did you choose face-to-face group support? Postprogram Was the support group what you expected it to be? How did the support group affect your life/lifestyle? Did you feel that the program was log eough? The format of the program (meetig o set dates ad facilitatio by a professioal)vdid this suit your eeds? Is there aythig you would like more of/less of i the program? Did you fid that that the cotet of the program was appropriate for your eeds? Would you recommed participatio i the support group to other wome with breast cacer? What does the word peer support mea to you havig bee through the program? Some of you metioed i the previous iterview the eed for support aroud hair loss. What are your views o this? That is, whe, how, ad by whom should this be delivered? Facilitated Peer Support i Breast Cacer Cacer Nursig TM, Vol. 33, No. 2, 2010 E11

4 Table 2 & Mai Themes Idetified i Preprogram ad Postprogram Evaluatio Preprogram Evaluatio The eed for mutual idetificatio Posttreatmet isolatio Help with movig o Support for hair loss To meet people that would have bee exactly the same as myselfi ad to see what they felt about iti I do t thik I ve met aybody my age yet who has had breast cacer or aythig like thati so I just wat to kow that their experieces were, so that I ca put my ow experieces ito some sort of order ad to fid out if they were differet or the samei how they felt. (P.3) This participat hoped that her attedace at the program would help her to reiterpret her breast cacer experiece based o listeig to the voices of other wome with breast cacer i the group. I thik there s o oe really who completely uderstads what you re goig through better tha someoe who has bee through it ad to get together with other people who have bee through the same experiecei although I ve got really good frieds who have bee very supportivei I thik it will be really goodi (P.5) For this participat, meetig wome who had bee through the same experiece as herself was importat, despite the fact that her frieds had bee very supportive of her. POSTTREATMENT ISOLATION Postprogram Evaluatio Cosolidatio of iformatio Empowermet The importace of the cacer survivor Mutual sharig Participats idetified the feeligs of isolatio associated with the completio of treatmet. All of the participats stated that support from healthcare professioals ad family members dimiished as soo as treatmet was completed. Participats felt that they cotiued to eed support eve followig completio of treatmet. They felt that the peer support program would help to address this void i the posttreatmet phase. I just felt that while I was havig the chemo, I was i cotact with people i the hospital the I had radiotherapy ad the suddelyi you re o your ow. You kow. I just felti there was o oe there. People were sayig to me, Oh you re lookig great, you re grad ow, it s all over, but I d say, Oh yeah it is. I d drive myself crazy the sayigi is it meat to be all over? II feel like it s oly startigi Fcos all the drama is over! You kow, so that s whyi (P.5) The exemplars above demostrate the fact that participats received ample support from healthcare professioals, family, ad frieds durig the active treatmet phase. However, it is clear that this support abates oce treatmet is completed. This suggests that patiets eed support i the posttreatmet phase. HELP WITH MOVING ON AND GETTING BACK TO NORMAL All of the participats i this study had completed active treatmet for primary breast cacer. The treatmet was idetified by all participats as a particular phase of their cacer jourey. Now that the treatmet was completed, participats were cocered with movig oto the ext stage ad gettig back to ormal life agai. All participats expressed their hopes that the peer support program would i some way assist them i movig o ad returig to ormality. I am hopig that it will give me stregth to just get back, I was good up to ow, up util the mammogram I am back ow to square oe, I wat to just get backi to where I was. (P.4) Just to be ormal agaii yeah, I suppose to feel the way I was before I got the breast cacer. (P.7) It is apparet from the exemplars above that ow that treatmet was completed, participats were hopig to retur to their ormal lives. They were hopeful that participatig i the peer support program would help them to achieve this retur to ormality. SUPPORT FOR HAIR LOSS While the questios i the preprogram iterview did ot focus o the effect of treatmet-iduced hair loss, the impact of hair loss ad the eed for support for treatmet-iduced hair loss emerged as a sigificat theme withi the preprogram focus group. Six of the 8 participats i the preprogram focus group had experieced chemotherapy-iduced hair loss. It is evidet from the followig exemplars that treatmetiduced hair loss had a sigificat impact o participats ad their loved oes: I ca t say that losig the breast affected mei because there were other issues goig o at the time. I thik my hair was worse. I thik that s more visible you kowi it s more i your face, ad you re just like Oh my GodIYEUCH! (laughs) (pause)...it s like, oh here comes the cacer patiet! (P.3) Ithe childre. I d say to them, If you re frieds are comig up, let me kow i advacei. I do t wat a house full of teeagers ad me with o hair o! IThey re very good like thati they d say, Get your hair o; my frieds are outside. I could have the dressig gow o me, but I d have to have the hairi. So for them as much as you to have it? (P.8) A discussio the esued regardig the way i which hair loss was addressed by healthcare professioals. It is apparet from the followig exemplars that hair loss was addressed briefly by healthcare professioals ad with little awareess of the potetial impact of treatmet-iduced hair loss o wome with breast cacer: Just a little bit more thought about it, I mea [referrig to healthcare professioal] said to me, You ll have to have chemo, ad you ll lose your hair. That was thati E12 Cacer Nursig TM, Vol. 33, No. 2, 2010 Power ad Hegarty

5 there was o more about iti util it started fallig out. I asked him whe, ad he just said, Just after your secod sessio. (P.3) There was a suggestio from the group that more support is eeded aroud the issue of treatmet-iduced hair loss. Participats suggested that a hospital-based support itervetio combiig support o hair loss from peers ad healthcare professioals would be beeficial. It was also suggested that this itervetio would be most effective prior to the oset of hair loss. I thik with the hair. YesI I thik there is really a eed for somebody to be ivolved whe you lose your hairi It [is] growig backi ad just dealig with it. At the hospital maybe, because at the time I feel. You kow, you re i shocki you do t feel up to goig placesi It should be somethig that s brought to you i the hospitali I feel that there is a big gap there you kowi for hair loss. (P.8) A voluteer would doi I d do it myselfi If a utritioist ca come to you while you are o your chemoi I ca t see why they ca t have someoe to come ad talk to you about how traumatic hair loss is for a womai (P.7) As support for hair loss emerged as a sigificat theme withi the preprogram iterview, participats were agai asked to clarify issues aroud this area i the postprogram iterview. It is apparet from their resposes that the practical ad emotioal support provided for hair loss is miimal ad that there is a immediate eed for a hospital-based peer/professioal support itervetio prior to the oset of hair loss. Oe of the first thig I would love to do is go to the hospitali talk to the wome who are havig treatmeti talk to them about hair lossi You kowi just do what we did i the groupi They gave you the leaflet ad that was it. (P.4) As well as the emotioal side, there are practical thigsi like how to tie the scarf o your headi there is othigi (P.2) There are lots of people i the hospital who come ad talk to youvchaplais, pastoral care, etci There eeds to be someoe who kows what you are goig throughi from the first time the drip goes ito youi that s whe it eeds to starti for womei the hair it s everythigi you are stripped without your hair. (P.3) The exemplar above from participat 3 demostrates the sigificace of treatmet-iduced hair loss for wome. The statemet, You are stripped without your hair, suggests that the loss of hair is i some way associated with a assault o oe s perso. Postprogram Iterview: Mai Themes CONSOLIDATION OF INFORMATION For all of the participats, the peer support program allowed them to cosolidate the iformatio that they had bee give o their cacer sice diagosis. The followig exemplars demostrate the fact that participats felt that the iformatio they received o their cacer was fragmeted: You kow I foud by beig i the group that there were major gaps i the iformatio people were givei you kow I was told oe thig, ad XXX would be told aotheri yeahi gaps i iformatio. The groupi it filled i a lot of the gaps. (P.2) It s like a jigsawi you kow you go to the support group ad everythig comes togetheri the pey drops! (P.4) While the structured format of the group served to fulfill participats eed to cosolidate the iformatio they had received regardig their cacer, the iformal sharig of iformatio betwee participats was also highly valued by all participats. A lot of thigs came together for mei ad a lot of it happeed whe we were just havig the coffee. (P.1) It is clear from the previous exemplars that participats valued the structured compoet of the program i helpig them to cosolidate the iformatio they had received o their breast cacer. However, the previous exemplar demostrates the fact that the iformal sharig of iformatio was also valued by participats. EMPOWERMENT All participats felt that havig atteded the group, they felt more capable of makig defiite decisios for themselves i relatio to issues such as returig to work, choosig what they wated, ad discussig their eeds aroud breast recostructio. These feeligs of empowermet are demostrated i the followig exemplars: Well, it took me 11 moths to get there! IIt took a lot of thought, but oce I got therei just talkig to the othersi I felt like a wimpi You kow 12 moths o ad ot beig with othersi But owi it s give me the couragei Now I am goig back i JueI It s doe that for me help me get back to where I felt ormal agai. (P.5) I have got great ecouragemet ad I have chagedi certai thigs that I wated to do ad ow I am goig to do them. I hate my scari I really wat to get somethig doe with iti up to ow I felt I could t go about iti but ow, after the groupi ad by talkig to others, I feel that I will go ad get is [it] sorted. I have a appoitmet with (plastic surgeo) o the 14th April. (P.2) It is clear from the previous exemplars that takig part i the program had a powerful effect o participats ability to make importat decisios i their lives. THE IMPORTANCE OF THE CANCER SURVIVOR Oe of the facilitators i the program was a Reach to Recovery voluteer (a breast cacer survivor who had the first diagosis of breast cacer 18 years ago). It is apparet from Facilitated Peer Support i Breast Cacer Cacer Nursig TM, Vol. 33, No. 2, 2010 E13

6 the followig exemplars that this idividual had a sigificat impact o participats. Her ivolvemet i the group helped participats to cope better with their diagosis o a daily basis: It was importat that she was therei you kowi eve what she said about keepig the bit of mystery there about yourselfi that for me was importati You kow she was t the ordiary Joe SoapI she just kew what we had bee throughi I ofte thik of her you kowi eve whe I meet someoe i towi I ll tell them oly what I wat to tell themi keep my busiess to myself you kow. (P.7) The previous exemplar demostrates that the presece of the Reach to Recovery voluteer i the group had a sigificat impact o participat 7. Whe I get these thoughts about it comig back, I thik of heri you kow I thik of her. (P.6) Participats felt that the cacer survivor provided them with a sese of hope regardig the future. The examples provided previously demostrate the beefits of icludig a cacer survivor i the program. Not oly did this idividual eable participats to cope with their diagosis o a daily basis, but she also provided them with hope regardig the future. MUTUAL SHARING The program i questio was a 7-week facilitated peer support program. All participats felt that they would have beefited if the program was of a loger duratio (approximately 10 weeks). Whe questioed o their reasos for watig a program of loger duratio, all participats idetified the fact that they would have liked more opportuities for mutual sharig of experieces betwee each other. I would have liked a sessio where we could just chati just chati you kow, over our coffee, we leart a loti We really leart a awful lot. (P.8) Defiitely 1 or 2 classes of ostructured stuffi We wated more time together. (P.5) The previous exemplars demostrate the fact that mutual sharig ad idetificatio were highly valued by all participats. While the participats cosidered the facilitatio of the program importat, all expressed the feelig that the provisio of more opportuities for mutual sharig ad chattig would have beefited them greatly, particularly as they got to kow each other better. Discussio I a cocept aalysis of peer support withi a healthcare cotext, 16 3 key attributes of peer support were idetified. These were emotioal, iformatioal, ad appraisal support. The fidigs of this study support the presece of these 3 attributes i facilitated face-to-face peer support programs for wome with breast cacer. I relatio to emotioal ad appraisal support, all of the participats i this study beefited from the mutual sharig of experieces, mutual idetificatio, ad uderstadig that occurred withi the program. All participats would have welcomed more time to egage i iformal chattig with each other. To further support this fidig, the values of mutual sharig, mutual idetificatio, ad uderstadig have bee idetified as key fidigs withi previous studies o peer support programs i breast cacer. 24,35 I relatio to iformatioal support, the iformatioal compoet of the program was highly valued by all participats ad played a importat role cosolidatig the iformatio participats had received sice diagosis. This fidig is supported withi the fidigs of previous studies. 9,36 It is also apparet that participatio i the program eabled wome to make defiite decisios regardig importat issues i their lives. This fidig cocurs with the fidigs of previous studies where participatio i peer support programs istilled cofidece i idividuals with cacer. 23,24 This study also demostrates the importace of icludig a cacer survivor (Reach to Recovery voluteer) i facilitated peer support programs for wome with breast cacer. The Reach to Recovery Program is a iteratioal oe-to-oe peer support program that was iitiated i the Uited States i the 1950s by Teresa Lasser. 37 There is evidece i the literature to support the value of icludig a idividual who has survived a diagosis of breast cacer i facilitated peer support programs for wome with breast cacer. 21,25Y27 The iclusio of the Reach to Recovery voluteer i the facilitated peer support program i this study was istrumetal i providig participats with the ecessary skills eeded to cope with the day-to-day problems associated with a diagosis of breast cacer. The voluteer also provided participats with hope for the future. Followig aalysis of the preprogram ad postprogram data, the eed for support i relatio to treatmet-iduced hair loss was idetified ad has emerged as a major theme withi the fidigs of this study. While chemotherapy-iduced alopecia is a sigificat cocer for wome with breast cacer, 6,38 we are uaware of the presece of this fidig withi previous studies o peer support programs for wome with breast cacer. This fidig suggests that support for treatmet-iduced hair loss is a umet eed for wome with breast cacer. The fidigs from our study also demostrate that little attetio ad sesitivity were paid to addressig the practical ad emotioal aspects of treatmet-iduced hair loss by healthcare professioals. This fidig cocurs with the fidigs of previous studies. 6,39,40 Participats believed that support for hair loss would be most appropriate if provided i the hospital settig prior to the oset of hair loss by both professioals ad peers. A search of the Iteret demostrated that there are umerous iformal systems of support available for all types of hair loss. 41Y44 The majority of these are locally ru groups facilitated by voluteers, ad there is also evidece of some olie support groups. 43,44 We are aware of a program facilitated E14 Cacer Nursig TM, Vol. 33, No. 2, 2010 Power ad Hegarty

7 by cacer survivors that provides practical ad iformatioal support to wome who have bee affected by chemotherapyiduced hair loss. 45 While this program is commedable, the fidigs from our study demostrate that programs focusig o the provisio of practical ad emotioal support eed to be made widely available to wome i a effort to address their umet support eeds pertaiig to treatmet-iduced hair loss. Cacer survivors ad professioals already ivolved i the provisio of services to idividuals with treatmet-iduced hair loss may be ideally positioed to become ivolved i providig the ecessary support for treatmet-iduced hair loss withi the hospital settig. Implicatios for Research ad Practice The fidigs of this study have may implicatios for healthcare professioals ad those ivolved i the plaig ad implemetatio of peer support programs. This study was cocered with the pre-evaluatio ad postevaluatio of a face-to-face peer support program for wome with breast cacer. The preprogram ad postprogram evaluatio compoet of this study was importat, as it helped to idetify the eeds of wome prior to their participatio i the program. It also served to assess whether the eeds of participats idetified i the preprogram focus group iterview were met by their participatio i the 7-week peer support program. I recet years, umerous studies have bee carried out explorig the beefits of participatig i peer support programs for wome with breast cacer. Few of these studies have focused o the pre-evaluatio ad postevaluatio of these programs. For example, i a systematic review of 43 peer support programs, 28 oly 11 of the studies icluded ivolved a preprogram ad postprogram evaluatio. There is a eed for future preprogram ad postprogram evaluatios to idetify whether peer support programs are adequate i meetig the specific eeds of wome with breast cacer. The mutual sharig ad idetificatio that aturally occurred withi the group were highly valued by all participats. This fidig suggests that those ivolved i the plaig ad implemetatio of peer support programs eed to structure programs so that there is adequate time for mutual sharig to occur betwee participats. All participats valued the iformatioal aspect of the program. This fidig suggests that program developers caot uderestimate the value of the iformatioal compoets of facilitated peer support programs i addressig the gaps that exist i health-related iformatio for wome with breast cacer. It is evidet from the fidigs of this study that participats believed that support for hair loss would be most effective if provided prior to the oset of hair loss. This fidig has implicatios for healthcare professioals ad suggests that itervetios to address the practical ad emotioal aspects of hair loss eed to be implemeted i the hospital settig prior to the oset of hair loss. I the postprogram focus group, all of the participats spoke of the importace of the cacer survivor (Reach to Recovery voluteer) withi the facilitated peer support program. Give the positive impact of the cacer survivor o participats i this study, those ivolved i the plaig of facilitated peer support programs should cosider the iclusio of a cacer survivor i such programs where possible. Limitatios of the Study This study ivolved the collectio of data by meas of preprogram ad postprogram focus groups. The focus groups were cofied to wome with breast cacer who had agreed to take part i a face-to-face facilitated peer support program i a local cacer support house. Because of the relatively small umber of participats ( = 8) ad the fact that the study was cofied to 1 cacer support house, the fidigs may ot be trasferable to other settigs or programs. The fact that participats had completed their treatmet at differet stages (1 week to 14 moths) is a limitatio of this study. We ackowledge that wome with breast cacer may have differet support eeds at differet stages followig treatmet. Coclusio I coclusio, the fidigs from this study demostrate the value of preprogram ad postprogram evaluatios i idetifyig whether facilitated peer support programs are effective i meetig the eeds of wome with breast cacer. The fidigs demostrate that facilitated face-to-face peer support programs icorporatig cacer survivors are effective i helpig patiets adjust to a diagosis of breast cacer. There is also a eed for more iformal sharig betwee participats i facilitated peer support programs. The fidigs also demostrate the fact that wome with breast cacer have umet eeds i relatio to treatmet-iduced hair loss. There is clearly a eed for practical ad emotioal support for wome with breast cacer prior to the oset of hair loss. ACKNOWLEDGMENTS The authors thak the followig people without whom this study would ot have bee possible: the 8 wome who gave freely of their time to take part i the prey ad postyfocus group iterviews; the staff ad voluteers ARC House Cork, Irelad, particularly, Elle, Fioa, Marie, ad A; Prof Joyce Fitzpatrick (Fulbright professor) at the Catherie McCauley School of Nursig ad Midwifery, Brookfield Health Scieces Complex, College Road, Cork, for her expert advice; ad fellow colleagues ad members of the Irish Cacer Society (Steerig Group Committee o buildig effective cacer support groups for Irelad) for their ecouragemet to date. Refereces 1. World Health Orgaizatio Regioal Office for Europe Reproductive Health ad Research areas/ _6. Accessed May 7, Facilitated Peer Support i Breast Cacer Cacer Nursig TM, Vol. 33, No. 2, 2010 E15

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