Peer support to maintain psychological wellbeing in people with advanced
cancer: A feasibility study for a Randomised Controlled Trial

Background
People with advanced cancer can struggle to cope with their diagnosis, and this causes stress, anxiety and depression. Our qualitative research with patients (and their carers) demonstrates that people can and do cope well at times, using a range of coping strategies to maintain and restore wellbeing. The challenge is to develop ways of supporting people to cope well early in their illness trajectory to promote patient benefit and costeffective use of NHS resources. Patients in our study felt that individual proactive peer support would be a valuable mechanism to learn about adaptive coping mechanisms. Learning from peers has substantive differences to learning from health professionals; it is perceived and valued differently and occurs under different
conditions. Most peer support initiatives are offered in group settings and evaluated with reference to satisfaction rather than outcomes such as psychological wellbeing. There is a need to evaluate whether peer support to
those with advanced cancer has an impact on psychological wellbeing.

Aims of research
To determine the feasibility of delivering and investigating a novel peer mentor intervention to promote and maintain psychological wellbeing in people with advanced cancer using a randomised controlled trial (RCT) design.

Plan of investigation
Design: This feasibility study will enable estimation of important parameters and design decisions for a full trial. Using a two armed RCT of a proactive peer mentor intervention vs. usual care (with qualitative process evaluation) for our feasibility study will enable the contextual estimation of parameters needed for a full trial: how to deliver a novel intervention in a trial context; and how to appropriately investigate this intervention.

Setting, sampling and recruitment: We will recruit adults with advanced cancer from two cancer centres, using quota sampling to maximise heterogeneity. Peer mentors (with experience of cancer) will be recruited via advertising. The intervention will be delivered in a range of participant/mentor determined informal settings.

Intervention: The intervention offers patient interaction with a peer mentor for a period of up to 12 weeks. Interaction between patient and mentor will be flexible, in a format and at a pace which suits the pairing including
telephone contact or informal face-to-face meetings. A co-ordinator will recruit, train, assess, monitor and match mentors (n=15) with patient participants.

Randomisation: Recruited patient participants will randomised to each arm by a clinical trials unit (n=33 per arm, with a nested qualitative sample of 10-15 across patient/mentor participants).

Data collection: Our data collection plan maps onto our feasibility objectives, with data collected to facilitate full trial planning. We will collect data to monitor a) mentor recruitment, training, work and attrition b) mentor/participant interaction c) mentor wellbeing d) perceptions of intervention. To estimate parameters needed to design a full study we will collect data on a) participant recruitment b) trial processes including outcome measure completion c) potential intervention contamination and d) health service usage. Data from measures for future primary and secondary trial outcomes will facilitate a power calculation. Data collection points are minimised to T=0 weeks, T=4 weeks and T=12 weeks or study exit using validated brief measures and sensitive
qualitative interviews to minimise participant burden.