The use of motivational interviewing to promote peer-to-peer support for cancer survivors.

W ith continued improvements in early detection and treatment of cancer, an increasing number of patients survive cancer. More than 12 million cancer survivors are living five or more years beyond initial diagnosis in the United States (Horner et al., 2009), creating unanswered questions about long-term psychological well-being, as well as impact on families and support systems. Psychosocial problems related to cancer from diagnosis to post-treatment have been well documented. Studies have reported negative stressors to physical (Hewitt, Greenfield, & Stovall, 2006), psychological (Carlsen, Jensen, Jacobsen, Krasnik, & Johansen, 2005; Hegel et al., 2006; Hewitt et al., 2006; Spiegel & Giese-Davis, 2003), social, emotional, and spiritual or existential well-being (National Cancer Institute, 2004), as well as concerns about body image. In addition, management of treatment-associated long-term issues and late effects is required, along with ongoing surveillance and health promotion strategies (Hewitt et al., 2006). In contrast to the escalating number of cancer survivors, projected limits in the medical and healthcare oncology workforce will affect the industry’s ability to serve the sheer number of survivors (Oeffinger & McCabe, 2006; Shulman et al., 2009). Therefore, innovative solutions such as training laypeople to provide support should be explored. Peer support in this study is provided by survivors who have experienced cancer personally or have been caregivers. Lay support has been used with breast cancer survivors (Ashbury, Cameron, Mercer, Fitch, & Nielsen, 1998; Curran & Church, 1999; Dunn, Steginga, Occhipinti, & Wilson, 1999; Dunn, Steginga, Rosoman, & Millichap, 2003; Edgar, Remmer, Rosberger, & Rapkin, 2003; Gray, Fitch, Davis, & Phillips, 1997) and has been found to improve satisfaction with medical care, personal relationships, and social support (Ashbury et al., 1998); increase a sense of belonging (Fernsler & Manchester, 1997; Gray et al., 1997); and improve mood (Dennis, 2003; Dunn et al., 1999). Peer support can provide survivors with information, coping skills, a sense of normalcy, and diminished social Motivational interviewing (MI) as a counseling approach has gained empirical support for its use in a number of settings and for a variety of behaviors. However, the majority of practitioners trained to use MI have been professionals rather than laypeople. This article presents the rationale, design, and evaluation of an MI-based training for cancer survivors and caregivers to deliver peer support. The training and evaluation of the peers (“guides”) to encourage practice and increase research knowledge for using MI-based peer support models for cancer care are discussed. Thirteen cancer survivors and two caregivers received two-day DVD-based MI training, as well as supplemental monthly sessions for six months. The guides demonstrated MI proficiency as assessed by the MI Treatment Integrity scale and other process evaluation assessments. MI can be adapted to train laypeople to provide support for groups such as cancer survivors.