Is Peer Education an Effective Method on Breast Cancers’ Patient?
A Systematic Review
Diana Pefbrianti
1
, Desak Gede Agung Suprabawati
2
and Esti Yunitasari
1
1
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
2
Specialist Oncologist, RSUD Dr. Soetomo Surabaya
Keywords: Peer-education, Breast-cancer, Qol, Knowledge
Abstract: There is increasing interest regarding peer education in healthcare. Peer education is a process of
communication, information and education conducted by peers are among groups, fellow colleagues
professions, gender. The purpose of this study was to determine the effect of peer education in improving
quality of life and knowledge among breast cancers’ patient. We identified articles through databases
searching: Sage, Proquest, Science Direct and EbscoHost, published between (2006-2016). The ten articles
were analyzed and selected from 1540: The studied evaluated that peer education is recomended for the
breast cancers’ patient to increase their quality of life and knowledge. peer education is suitable method to
increase quality of life and knowledge among breast cancers’ patient. However many of these studied still
lacked of method, so we suggest to the next research using more RCT to get better results.
1 BACKGROUND
Breast cancer is the most prevalent cancer in woman
(Stanton 2005). World Health Organization showed
that 12 million people around the world had breast
cancer and 7,6 million of them death. In Indonesia
the prevalence of breast cancer increase about 100
patients from 100.000 people each year. The data
from Sistem Informasi Rumah Sakit (SIRS), 2007
showed that breast cancer is the most disease in
inpatient ward in hospital (16,8%). Dharmais
hospital noted that breast cancer became the most
desease occur in 5 years late (32%). In Indonesia,
the most prevalence of breast cancer happen in west
java and east java.
Based on National Cancer Institute, physic and
psychology condition of patients examined at the
first diagnoses till the end of her life. Research by
(Heydarnejad 2009). This study evaluate 200 breast
cancers’ patients post chemotherapy, the data
showed that 11% patients had a good quality of life,
66% in a immidiate and 23% others in a less QOL
(Heydarnejad 2009). A research showed that breast
cancer and colorectal cancer survivors had limited
knowledge of their diagnosis and cancer treatment
(Malak, 2009).
A variety of interventions have been made to
increase the QOL and knowledge of the breast
cancers’ patients, pne of the intervention that has
been used is peer education. Peer education was
rated as one of the effective ways to increase QOL
and knowledge in breast cancer cases. The purpose
of this study was to determine the effect of peer
education in improving quality of life and knowledge
among breast cancers’ patient.
2 METHODS
We identified articles through databases searching:
Sage, Proquest, Science Direct and EbscoHost,
published between (2006-2016). Search terms
include “Peer education”, “Breast Cancer”, “Quality
of Life”, “Knowledge”. We found ten articles that
suitable with our Inclusion Criteria. Our inclusion
criteria are all of the study of peer education for
breast cancers’ patient that given an impact on QOL
and knowledge. We excluded the Articles if the
target population focused on other than breast
cancer.
280
Pefbrianti, D., Suprabawati, D. and Yunitasari, E.
Is Peer Education an Effective Method on Breast Cancers’ Patient?.
DOI: 10.5220/0008323902800286
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 280-286
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
Table 1: Table mapping (PICO).
N
o
Study
Design
Sample
Variable
Instrument
Result
1.
Long-Term
Effects of
Educational
and Peer
Discussion
Group
Intervention
s on
Adjustment
to Breast
Cancer
(Vicki S,
sheldon
cohen dan
Richard
Schul 2006)
Randomize
d
Controlled
trial
Sample:
312
respondent
s
(education
group
(n=79),
peer
education
group
(n=74),
kelompok
education
plus peer
education
group
(n=82) and
control
group
(n=77)
Independent
Variables :
Education &
peer education
Dependent
Variables
Quality of life
SF-36 Health
survey
The benefits
of educational
intervention
are
maintained
over a 3-year
period even
though the
effects
disappear
over time
2.
Exploring
The Effects
of Being A
Peer
Educator on
African
American
Breast
Cancer
survivors
(Melanie J,
2013)
Qualitative
research
design with
grounded
theory
design
Sample:
35
respondent
s (breast
cancer
patients)
Sampling
Purposive
Sampling
Independent
Variables:
Peer education
Dependent
Variables
1. Healthy
behaviour
2. Healthcare
utiliation
3. QOL
1. Demographi
c
questionare
2. The Quality
of Life of
Adult
Cancer
survivors
(QLACS)
The results
showed that
all
participants
had a positive
experience on
the role of
peer educator.
It found
positive
influence of
participants
in quality of
life, health
behavior,
utilization of
health
services
3
.
The Effect
of Peer-led
Education
on The Life
Quality of
Mastectomy
Patients
Referred to
Breast
Cancer-
Clinics in
Shira, Iran
2009
(Farkhonde
Pre post test
with control
design
Sample:
99
respondent
s
Sampling
Convenien
t sampling
Independent
Variables:
Peer-led
education
Dependent
Variables
QOL
1. Quality of
Life
Question
(QLQ-30)
2. QLQ-BR23
In the
intervention
group, there
was a
significant
increase in all
aspects of
quality of life
and decreased
symptoms (P
<0.001). while
the control
group there
was no
Is Peer Education an Effective Method on Breast Cancers’ Patient?
281
h Sharif,
Narjes
abshorshori,
Sedigheh
Tahmasebi,
Maryam
Harati,
Najaf are,
sarah
Masoumi,
2010)
significant
difference in
all aspects of
quality of life.
4
.
Belonging
to A Peer
Support
Group
Enhance
The Quality
of Life and
Adherence
Rate in
Patients
Affected by
Breast
Cancer: A
Non-
Randomized
Controlled
Clinical
Trial
(Afsaneh
Melekpour,
iba
Farajadegan
and Ahmad
Rea amani,
2011)
Clinical
Controlled
Trial
Sample:
68
respondent
s
Sampling
Purposive
sampling
Independent
Variables:
Peer support
group
Dependent
Variables
1. QOL
2. Adherance
SF 36
questionaire
Providing
support to
breast cancer
patients with
explanatory
sessions in
peer group
support
methods can
improve their
quality of life
(p <0.001).
5
.
Peer-Based
Models of
Supportive
Care: The
Impact of
Peer support
Groups in
African
American
Breast
Cancer
Survivors
(kimlin
ashing-
giwa,
Carolyn
Tapp,
Monica
rosales et al.
2012)
A
qualitative
research
study
Sample:
62
respondent
s
Independent
Variables:
Peer support
group
Dependent
Variables
1. Demographic
s
2. Medical
story
3. Support
group impact
4. Adherance
Questionaire
Survivors
recognize that
cultural-based
learning with
peers comes
from the
spiritual,
linguistic,
experiential
and historical
aspects. Peer-
based support
groups offer
many benefits
to emotional,
social,
spiritual,
information
and cultural
support.
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
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6
.
Group
Support
Intervention
s for
Women
with Breast
Cancer:
Who
Benefits
From What?
(Vicki S,
Sheldon
Cohen,
Richard
Schul, Joyce
Yasko,
2006)
Randomize
d
Controlled
trial
Sample:
230
respondent
s
Independent
Variables:
1. Peer
Education
2. Peer
discussion
group
Dependent
Variables
1. Emotional
support
2. Negative
interaction
3. Support
information
about cancer
4. Self
resources
SF-36
questionaire
Educational
groups show
better results
in terms of
physical
function, peer
discussion
groups are
helpful to
women who
lack support
from
colleagues or
psychologists
7.
The effect
of breast
cancer
educational
intervention
on
knowledge
and health
beliefs of
woman 40
years and
older,
Isfahan, Iran
(Mohsen
Rezaeian,
Gholamreza
Sharifirad,
Firoozeh
Mostafavi et
al, 2014)
Randomize
d controlled
trial
Sample:
290
respondent
s (145
interventio
n group
and 145
control
group)
Sampling
Simple
random
sampling
Independent
Variables:
Breast cancer
educational
intervention
Dependent
Variables
1. Knowledge
2. Health belief
Champion’s
health belief
model scale
(CHBMS)
The average
score of
perceived
vulnerability,
perceived
severity,
perceived
benefits,
obstacles and
benefits of
mammograph
y and
Health
motivation in
the
intervention
group had
significant
comparison
differences
with the
control group
after
educational
intervention
(P ≤ 0.001).
8.
Effectivenes
s of Peer
Education
for Breast
Cancer
Screening
and Health
Beliefs in
Eastern
Turkey
(Sebahat
Gozum,
Randomize
d controlled
trial
Sample:
5000
respondent
s
Sampling
Simple
random
sampling
Independent
Variables:
Peer education
Dependent
Variables
1. Knowledge
2. Health belief
3. Practice
Champion’s
health belief
model scale
(CHBMS) &
Cancer Early
Diagnosid ans
Screening
Centers Data for
Mammography
Practice
Peer
education is
effective to
increase
knowledge,
confidence
and practice
in breast
cancer
patients
Is Peer Education an Effective Method on Breast Cancers’ Patient?
283
Ozgul
Karayurt,
Sultan Kav,
2010)
9.
Effects of
Peer
Education
on The
Knowledge
of Breast
Cancer and
Practice of
Breast Self-
Examinatio
n Among
Mansoura
University
Female
Students
(Heba
Salama,
Nahed
Elsebai,
Fardos
Abdelfatah
et al, 2013)
Quasy
experimenta
l design
Sample:
150
respondent
s
Sampling
Simple
random
sampling
Independent
Variables:
Peer education
Dependent
Variables
Knowledge
Knowledge of
breast cancer
and BSE form
& Breast self
examination
performance
checklist
There was a
significant
increase in
female
students'
knowledge of
breast cancer
and BSE,
improved
practice in
BSE (p =
0.000)
10
.
Effects of
Peer
education,
Social
Support and
Self Esteem
on breast
Self
Examinatio
n
Performanc
e and
Knowledge
Level (Arzu
Tuna M,
Murat
Bektash,
Ayshe San
T et al,
2009)
Quasy
experimenta
l design
Sample:
65
respondent
s
Sampling
Simple
random
sampling
Independent
Variables:
Peer education,
social support
and self esteem
Dependent
Variables
Knowledge
Kuesioner for
the coopersmith
self-esteem
inventory and
scale of
perseivedsocial
support
The level of
knowledge
and practice
of BSE
increased in
peer support
intervention
(p <0.001)
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3 RESULTS
Articles reviewed include; 5 Randomized Controlled
Trial, 2 Qualitative research, 2 Quasy Experiment,
and 1 pre post with control design. According to the
level of evidence, 10 articles are in 1-6 levels from 7
level of evidence, level 1 (5 articles), level 3 (3
articles) & level 6 (2 articles). Study reviewed
deriving from 3 countries; USA (5 studies), Iran (4
studies), and Carolina (1 study). Spain (1 study).
Ten articles that have been collected, analyzed
and scored, obtained the following results. Research
conducted by (Helgeson, 2006) aimed to follow up
the effects of 8 week support group intervention on
the QOL of woman in early stage breast cancer. On
the results obtained that the benefits of this
intervention remained over a 3 year period
(Helgeson, 2006). In the meantime research
conducted by Boyd (2013) was to determine the
effects of being a peer educator, the results of the
research show that participants in the intervention
group had a positive influence of their quality of life,
health behaviours and healthcare utiliation.
A study found to evaluate the effect of peer-led
education on the QOL of mastectomy patients, the
research showed that statistically significant
increasing in all aspects of QOL and decrease the
symtom (p<0.001) (Sharif, 2010).
The study by Tehrani (2011) Aims to see the
effect of peer support and educational program on
QOL in breast cancer patients. The results showed
that intervention group was significantly higher than
that of the control group (p < 0.001). Research by
Ashing-giwa (2012) aims to evaluate the effect of
support group on African American breast cancer
survivors. The result showed that the survivors
underscored that cultural based groups are rooted in
the linguistic , spiritual, experiential, and historical.
The peer based support groups had many functions,
such as social, emotional, spiritual, informational,
and financial support.
Research conducted by Helgeson (2006) aimed
to evaluate the impact of an educational group and
peer discussion group on the physical and mental
functioning of breast cancers’ patients. The data
showed that peer discussion groups were helpful for
woman who lacked support from their partners or
physicians (p<0.001).
A research intended to know the effect of breast
cancer screening education using HBM on
knowledge and health beliefs. The results of the
research showed that a significant differences in
comparison between the experimental group with
the control group after intervention (p ≤ 0.001)
(Rezaeian, 2014).
Research by (Gozum, 2010) aimed to evaluate
the efficacy of peer education in breast cancer
screening and health beliefs. The results of the study
showed a significant increase of knowledge, beliefs
and practice on breast cancers’ patients (p < 0.001).
Research by Salama (2013) aimed to evaluate the
peer education for breast cancer patient’s knowledge
and practice of BSE. The data showed an increase in
knowledge about their ill and practice of BSE
(p=0.000).
Research of Nissen (2012) aims to know the
difference efficacy of peer education, social support
and self esteem on BSE and knowledge level. The
data showed that there is a significant increase in
knowledge level and BSE practice in peer support
group (p<0.001).
4 DISCUSSION
The studies examined in this systematic review were
about evaluation of the peer education on breast
cancers’ patient. Research by Heydarnejad (2009),
evaluate 200 breast cancers’ patients post
chemotherapy, the data showed that 11% patients
had a good quality of life, 66% in a immidiate and
23% others in a less QOL. A study showed that
breast and colorectal cancer survivors had limited
knowledge on the details of their diagnosis and
cancer treatment (Malak, 2009). In this case the role
of nurse is important in primary, secondary and
tertiary prevention to avoid complication. At the
level of primary care nurse can implement health
education intervention, one of them is peer
education.
Breast cancer patient need a forum that is
responsive to their physical, psychosocial, spiritual
and information (Coward, 2005). Therefore, peer
education can be attributed to the recognition of the
breast cancer need. The peer education group
member underscored that the groups were roted in
the essential experiential, linguistic, spiritual.
Peer support is important for the breast cancer
patient during the treatment, postdiagnostic,
emotional, and informational. Therefore, member
felt they were in a comfort zone by being able to
relate to other members with similar condition. A
study identified that breast cancer support group
members benefited from the therapeutic and were
able to articulate their breast cancer journey by
allowed an acceptance and strength in their goals.
Therefore, their experience, support and practices
are revealed in decreasing emotional and they have
Is Peer Education an Effective Method on Breast Cancers’ Patient?
285
given permission to share their cancer journey
(Ashida, 2008).
5 CONCLUSIONS
This study evaluated the peer education on Breast
Cancers’ Patient. The 10 studies reviewed, 5
indicates that the peer education effective to increase
the QOL among breast cancers’ patient. The five
other studies showed an increase in the knowledge.
Majority of ten studies showed significant
positive effects on quality of life and knowledge.
The journals research by Melanie (2013), showed
that the peer education had a positive influence of
quality of life, health behaviours and healthcare
utiliation. Future expected that RCT studies should
continue to be done to find out the actual effect and
to avoid bias.
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