Formal Peer Support Research Articles

Peer support in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT): a qualitative study.

Peer support, a distinctive form of social support in which patients share emotional, social, and practical help based on their own lived experience of illness and treatment, positively impacts patient-reported outcomes in cancer populations. However, data on peer support experiences among hematopoietic stem cell transplant (HSCT) recipients are limited. We conducted semi-structured qualitative interviews among 12 allogeneic HSCT recipients who were ≤6 months post transplant without any complications and 13 allogeneic HSCT recipients >6 months post transplant and living with chronic graft-versus-host disease. Interviews explored patients’ experiences with peer support and their preferences for a peer support intervention tailored to the needs of HSCT recipients. While the majority (70%) of participants reported no formal experience with peer support, most (83%) articulated themes of potential benefits of peer support (e.g., managing expectations and uncertainty that accompany HSCT). Most participants (60%) reported a preference for a peer support intervention prior to the HSCT hospitalization. Despite the limited data on peer support interventions among HSCT recipients and lack of formal peer support experience in most of our cohort, our study shows that HSCT recipients clearly acknowledge the potential benefits of a peer support intervention, and they prefer that it start prior to transplantation.

Healthcare provider perspectives on integrating peer support in non-dialysis-dependent chronic kidney disease care: a mixed methods study

BackgroundPeer support complements traditional models of chronic kidney disease (CKD) care through sharing of peer experiences, pragmatic advice, and resources to enhance chronic kidney disease self-management and decision-making. As peer support is variably offered and integrated into multi-disciplinary CKD care, we aimed to characterize healthcare providers’ experiences and views on peer support provision for people with non-dialysis-dependent CKD within Canada.MethodsIn this concurrent mixed methods study, we used a self-administered online survey to collect information from multi-disciplinary CKD clinic providers (e.g., nurses, nephrologists, allied health professionals) on peer support awareness, program characteristics and processes, perceived value, and barriers and facilitators to offering peer support in CKD clinics. Results were analyzed descriptively. We undertook semi-structured interviews with a sample of survey respondents to elaborate on perspectives about peer support in CKD care, which we analyzed using inductive, content analysis.ResultsWe surveyed 113 providers from 49 clinics. Two thirds (66%) were aware of formal peer support programs, of whom 19% offered in-house peer support through their clinic. Peer support awareness differed by role and region, and most referrals were made by social workers. Likert scale responses suggested a high perceived need of peer support for people with CKD. Top cited barriers to offering peer support included lack of peer support access and workload demands, while facilitators included systematic clinic processes for peer support integration and alignment with external programs. Across 18 interviews, we identified themes related to peer support awareness, logistics, and accessibility and highlighted a need for integrated support pathways.ConclusionsOur findings suggest variability in awareness and availability of peer support among Canadian multi-disciplinary CKD clinics. An understanding of the factors influencing peer support delivery will inform strategies to optimize its uptake for people with advanced CKD.

Peer support for people with chronic conditions: a systematic review of reviews

BackgroundPeople with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions.MethodsA systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis.ResultsThe search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects.ConclusionsThe effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need.

Peer support facilitates post-traumatic growth in first responders: A literature review

Introduction First responders are routinely exposed to traumatic workplace incidents that can result in post-traumatic stress disorder (PTSD). First responder organizations utilize different types of peer led programs to support first responders following a critical incident including the Critical Incident Stress Management Program (CISM) and stand-alone peer support programs. Little research has been done to determine the benefits or limitations of stand-alone peer support programs on the mental health of first responders. The aim of this project was to understand what characteristics of peer support facilitate post-traumatic growth (PTG) in first responders. Methods A literature search was completed using the City University of Seattle library database, ResearchGate and Google Scholar. The studies used in this review were found on EBCSOhost, ProQuest, PubMed and Wiley Online. This review includes literature published since 2006 that references post-traumatic growth in first responders, and/or their preferences for support, their coping styles and organizational impacts on growth. Thematic analysis was conducted to identify the themes and patterns in the final 10 research papers. Results This literature review identified five themes of formal and informal peer interactions that support PTG in first responders. (1) Peer support assists first responders with the processing of traumatic events and (2) managing organizational stressors. (3) Peer support alone may not lead to PTG and requires the use of adaptive coping behaviours. (4) First responders who actively engage with peer support experience increased well-being and (5) relational safety with peers encourages disclosure that leads to post-traumatic growth. Conclusion Formal and informal peer support contribute to post-traumatic growth (PTG) in first responders. Further research needs to be done to differentiate between the effects of trained peer support and support from colleagues.

The impact of peer support on testing, linkage to and engagement in HIV care for people who inject drugs in Indonesia: qualitative perspectives from a community-led study

IntroductionPeople who use, including those who inject, drugs in Indonesia are disproportionately affected by HIV, but tend to be diagnosed at a late stage of infection, delay initiation to and have poor rates of retention in antiretroviral treatment, resulting in high rates of morbidity and mortality. In addition to legal, policy and health system barriers, PWID may be hesitant to engage in HIV, treatment and care due to lack of knowledge, distrust of the health care system, and stigma related to their dual drug use and HIV status. Implementation of formal peer support initiatives may reduce provider- and individual-level barriers and increase testing, linkage to, and engagement in HIV care among people who use drugs.MethodsWe conducted a community-led qualitative study to explore the impacts of peer support for people who inject drugs on HIV care access and engagement in Indonesia. Semi-structured, in-depth interviews were conducted with 20 participants in Jakarta and Bandung. Thematic analysis was used to explore how people who inject drugs living with HIV (PWID LHIV) (n = 8), peer support workers (n = 6), and service providers (n = 6) perceived peer support provision by non-governmental organisations.ResultsParticipants unanimously described peer support as beneficial. Peer support workers were widely credited with facilitating access to HIV testing, referral to care, uptake of and adherence to antiretroviral treatment, as well as sustaining engagement in care for PWID. Support mechanisms that facilitated positive peer experiences included provision of HIV knowledge and awareness, emotional support, help with navigating complex bureaucracy, developing trust in health care services, enhancing confidence and motivation, and supporting peers to navigate a wide range of health and social welfare services beyond HIV-related care.ConclusionsFindings indicate that peer support can enhance access to testing, linkage to, and engagement in HIV care for people who use drugs living with HIV in Indonesia. In a context of an ongoing HIV epidemic among people who use drugs, reduced funding and policy attention to HIV and harm reduction, there is an urgent need to prioritize peer support interventions to identify people who use drugs facing health risks and link them to appropriate services.

Opportunities and challenges: a case for formal peer support work in mental health in a South African context

ABSTRACT Objective Peer support in mental health has gained much attention especially in high income countries (HICs). Peer support can be delivered informally or formally. Both informal peer support and formal peer support work in mental health (PSW-MH) hold promise for service users’ recovery and increasingly delivered in low- and middle-income countries (LMICs) too, to overcome large treatment gaps between mental health care needs and limitations in services. Method 37 semi-structured interviews and 3 focus groups with 14 service users, 12 service providers and 12 carers of service users at three tertiary psychiatric hospitals in the Western Cape, South Africa, were conducted. Data were analysed using reflexive thematic analysis. Results Support as facilitator to recovery was generated as a theme, including peer support; described as beneficial for both service users and peer support workers. Discussion The benefits lead to the exploration of the opportunities and challenges for PSW-MH in the study context. While there is still a long way to go to the successful inclusion of formal peer support within health care services in South African contexts, we have discussed the possible ways in which such inclusion can be beneficial on various levels, if the challenges to PSW-MH are heeded.

Supplemental Material for Formal Peer-Support Services That Address Priorities of People With Psychiatric Disabilities: A Systematic Review

Supplemental Material for Formal Peer-Support Services That Address Priorities of People With Psychiatric Disabilities: A Systematic Review

Coping and Managing of Health and Functioning for People with Spinal Cord Injury: A Scoping Review

<h3>Objective(s)</h3> The objective of this scoping review was to explore how community-dwelling people with spinal cord injury (SCI) cope and manage their health and functioning. <h3>Data Sources</h3> Peer-reviewed journal articles were selected using the following academic databases: CINAHL Complete, Medline with Full Text, and PsycINFO. <h3>Study Selection</h3> Full-text journal articles included if they were published after 2000, included participants with traumatic or non-traumatic etiology and who were over the age 18 without cognitive impairments, focused on coping and managing of health and functioning, and were conducted in either Australia, Europe, New Zealand, and North America. <h3>Data Extraction</h3> Using the methodological process of Levac, Colquhoun & O'Brien (2010), article information was extracted and collated into a data chart with the following headings: authors & year of publication, country, purpose/objectives, design and methods, findings, limitations, and synthesis. Major findings were then extracted and categorized via inductive content analysis using qualitative software. <h3>Data Synthesis</h3> 35 peer-reviewed articles consisting of quantitative, qualitative, mixed-methods, and non-empirical study design were included. Personal strategies include cognitive behaviors, autonomy, hope, religion, spiritualty, health behaviors, and leisure, whereas external resources consist of formal healthcare support, peer support, informal support, and technology. <h3>Conclusions</h3> Community-dwelling people with SCI cope and manage their health and functioning using a wide variety of personal strategies and external resources. Future empirical research should focus on the lived experience of coping and managing of health and functioning in the community setting. <h3>Author(s) Disclosures</h3> N/A

10 Facilitated Peer Support Model Offers Promising Mental Health Intervention for Emergency Physicians During the Post-Pandemic Period

The COVID-19 pandemic has placed an unprecedented psychological burden on emergency medicine (EM) providers who have experienced anxiety, depression, isolation, burnout, and poor self-care. ACEP along with 44 medical organizations issued a statement in support of clinician health in the post-pandemic period calling for the removal of barriers to mental health care and using non-clinical mental health support, specifically peer support, to foster resilience and recovery. While physicians prefer to seek support from colleagues, formal peer support interventions are not well studied. The objectives of the study were to determine feasibility, receptivity, and effect of physician peer support groups on symptoms of acute distress, anxiety, depression, and burnout. A quasi-experimental design was used to determine pre-post intervention changes in anxiety and depression (primary outcomes) using the Patient Health Questionnaire (PHQ-4); provider burnout using the Maslach Burnout Inventory; and distress symptoms (fatigue, trouble sleeping, nervousness, feeling down, anger, helplessness, guilt, difficulty concentrating) using the SPADE Symptom Screener and PROMIS measure. The Participant-rated Global Impression of Change was used to monitor whether feeling better at the end of each session compared to the beginning. Receptivity was assessed using a net promoter score question. The study population was emergency physicians serving 10 academic and community hospitals who self-identified as having any mental health challenge during the pandemic. Three groups of 8 providers were recruited via departmental email listservs to participate in eight 1-hour virtual, peer support group sessions via Zoom Health. The visit structure was based on the National Alliance of Mental Illness (NAMI) peer support model and adapted for use in the clinician population. Three physicians were trained to cofacilitate with a NAMI support group leader. Data were collected using the Zoom polling function. Change analysis was conducted using dependent t-tests in SPSS. A sample size of 16 clinicians was needed to provide 80% power for two-sided tests at an alpha of 0.05 to detect a large effect size of 1.0 (3-point absolute change) for the PHQ-4. Of the 24 participating physicians, the majority were faculty physicians, white, female, and in practice 5 years or less. Average attendance was 6.5 sessions with 83% of physicians reaching the attendance goal of 6 out of 8 sessions. On average, participants reported feeling better at the end compared to the beginning of each session. Eighty six percent of physicians reported they would recommend peer support groups to a friend or colleague. Positive effect sizes showed improvement in 8 of 11 distress symptoms, and marginal significance (p<.10) for guilt and anxiety. High levels of attendance, feeling better at the end of sessions, and willingness to recommend peer support groups to friends or colleagues demonstrate high physician receptivity to peer support and feasibility of implementation. Positive effect sizes show promising signs of improvement in the majority of anxiety, depression, distress, and burn out symptoms in this pilot study. Attention is needed to tailor strategies to male providers who may be hesitant to participate. Further research of this model with a larger samples and more robust design is planned.

Extracorporeal Membrane Oxygenation for Adults and Children With Severe Respiratory Failure

&#x0D; This review used a framework analysis to synthesize 9 included studies on the perspectives and experiences of patients, family members, and providers on extracorporeal membrane oxygenation (ECMO).&#x0D; Patients’ perspectives on their experiences are limited due to their sedated status when treated with ECMO.&#x0D; Supporting a relative treated with ECMO is stressful for family members. They feel anxious and worried about their relative because of the patient’s critical condition, and they struggle to juggle multiple roles at work and home while supporting their relative receiving ECMO.&#x0D; Family members often have to travel to see their critically ill relative. Financial and logistical support for temporary relocation near the ECMO centre may ease the burden of travel.&#x0D; Family members benefit from clear and frequent communication from health care providers as a source of support and reassurance while their loved ones are being treated with ECMO. There may be a role for informal or formal peer support for family members of patients receiving ECMO.&#x0D; Clinicians’ decisions to offer, continue, and withdraw ECMO are based on their assessments of prognostic factors from patients’ medical histories and clinical conditions. Additional clinical research and/or refinements of prognostic guidance for ECMO may further support evidence-informed decision-making around ECMO.&#x0D; Patients, family members, and clinical team members may differ in their assessment of the limits of ECMO treatment and the decision to transition from active treatment to the withdrawal of life support. These findings point to the role of ethical considerations and processes when engaging in transitioning to end-of-life support in the provision of ECMO.&#x0D; After discharge, patients who had received ECMO and their family members continued to have feelings of anxiety, intrusive thoughts, and a need to process the event. ECMO programs that can offer continued or ongoing support or referral for patients and their family members’ mental health may help address these needs.&#x0D;

Peer Support as a Tool for Community Care: “Nothing About Us, Without Us”

In the face of socio-political marginalization, frontline communities reclaim power by harnessing peer wisdom and resilience. The year 2020 marked the confluence of a global pandemic and widespread resistance against anti-Black racism and police violence, highlighting the value of peer voices and community perspectives. To dismantle and transcend carceral approaches to community care, the field of social work is invited to join a larger anti-carceral mental health movement that honors lived experience and works alongside peers to build identity-affirming structures of mental health care. This article examines the ways in which frontline communities benefit from expanded access to anti-carceral formal and informal peer support as a mental health safety net that interrupts harm and prioritizes agency, consent, and self-determination. This paper broadens social work’s conceptualization of peer support through theoretical frameworks of anti-carceral social work, abolition, and intersectionality. Social work and its adjacent fields are called to urgently center Black liberation, collective healing, and community care by advocating for the integration of formal and informal peer support into mental health policy and practice. This paper strategically leans into a lineage of critical peer thought scholarship by utilizing footnotes and citations to model the ethical acknowledgment of peer labor within human rights movements. This intentional structure promotes radical solidarity that resists the exploitation of people with lived experience.

Perspectives of oncology nurses on peer support for patients with cancer.

To understand the perspectives of oncology nurses on peer support for patients with cancer and the role of oncology nurses in its provision. Thematic semi-structured interviews of 10 oncology nurses working in a single university hospital were conducted. The data were analysed using content analysis. Oncology nurses thought that peer support promotes the psychosocial wellbeing of patients with cancer by increasing their social contact and strengthening their emotional resources. In their daily work, oncology nurses engaged in several activities that promote the interactions between patients with cancer and informal forms of peer support. However, directing patients with cancer to formal peer support services outside specialised health care was not an established practice. Oncology nurses expressed several concerns about the availability of support and the coping ability of peer supporters and expressed scepticism about the reliability of information shared in peer support groups. The awareness of oncology nurses regarding formal peer support services appears rather limited. This knowledge gap should be reduced, such as through closer collaboration between hospitals and third sector cancer organisations, which does not appear effective at present based on the results. In addition, patients with cancer should be systematically informed about peer support.

Services needed and received when moving on from permanent supportive housing

ABSTRACT Moving On initiatives present opportunities for stable individuals to move from permanent supportive housing (PSH) into mainstream affordable housing. However, there is a dearth of research on how best to support individuals during this critical transition. This mixed-methods study examines transitional and aftercare services needed and received by individuals moving on through an MOI. Descriptive statistics quantified frequency of services needed and received as reported by movers (n = 43) in a post-move survey. Movers (n = 25) also completed pre- and post-move qualitative interviews regarding the transition and thematic analysis was used to elucidate how and why various supports were helpful to movers. During the pre-move transition, housing navigation and help obtaining financial assistance were the most frequently needed services. Movers relied on informal family and peer support to supplement provider assistance in these areas. Case manager visits were the most frequently needed aftercare service and financial assistance was the greatest unmet post-move need. In both periods, formal peer support was an identified service gap. This MOI generally met the self-identified needs of movers. However, MOIs may benefit from better targeting and more robust services specific to housing discrimination, tenants’ rights, formal peer support, and financial assistance.

Learning from each other in the context of personalisation and self-build social care

UK policy for adults with intellectual disabilities no longer supports state-provided building-based day care but promotes personalised care and support under individuals’ control with choice of community-based opportunities. The research explored experiences of this new terrain and the informal learning involved. An initial scoping review was followed by interviews with key service providers in one urban and one rural area in England and one of each in Scotland. Next, ethnographic fieldwork with people with intellectual disabilities involved a flexible mix of observations, interviews, focus groups, and participant-generated visual data. Thematic analysis involved an iterative mix of deductive and inductive coding. Findings showed informal peer learning ranged from ad hoc to structurally supported. Though learning was often tacit, support was valued and agency developed. The availability of local supportive people and schemes and time spent in them to develop new skills and identities was vital to people self-building community lives. Points of interest This research looked at the experiences of people with intellectual disabilities, as they and their friends and family respond to policy change bringing in more personalisation and individual choice. Often people with intellectual disabilities and those supporting them do not recognise their everyday learning. Learning outside schools/colleges gets little research attention. We looked at the learning involved in people managing their own daily lives in their communities. Staff and volunteers are helping people to learn from each other in organisations, and this can become more formal peer learning, peer mentoring and peer support programmes. Advocacy groups create a sense of belonging and shared purpose, encouraging peer learning through the sharing of knowledge, experiences and problem solving. When new projects start up or traditional day services change, the staff or volunteers may not involve people with intellectual disabilities in the planning. This means people with intellectual disabilities miss opportunities to learn.

Web Exclusive. Annals for Hospitalists Inpatient Notes - Preparing for Battle: How Hospitalists Can Manage the Stress of COVID-19.

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Peer support for frequent users of inpatient mental health care in Uganda: protocol of a quasi-experimental study

BackgroundReducing readmissions among frequent users of psychiatric inpatient care could result in substantial cost savings to under-resourced mental health systems. Studies from high-income countries indicate that formal peer support can be an effective intervention for the reduction of readmissions among frequent users. Although in recent years formal peer support programmes have been established in mental health services in a few low- and middle-income countries (LMICs), they have not been rigorously evaluated.MethodsThis protocol describes a quasi-experimental difference-in-differences study conducted as part of a broader evaluation of the Brain Gain II peer support programme based at Butabika National Referral Hospital in Kampala, Uganda. The primary objective is to investigate whether frequent users of psychiatric inpatient care who have access to a peer support worker (PSW+) experience a greater reduction in rehospitalisation rates and number of days spent in hospital compared to those who do not have access to a peer support worker (PSW-). Frequent users, defined as adults diagnosed with either a mental disorder or epilepsy who have had three or more inpatient stays at Butabika over the previous 24 months, are referred to Brain Gain II by hospital staff on five inpatient wards. Frequent users who normally reside in a district where peer support workers currently operate (Kampala, Jinja, Wakiso and Mukono) are eligible for formal peer support and enter the PSW+ group. Participants in the PSW+ group are expected to receive at least one inpatient visit by a trained peer support worker before hospital discharge and three to six additional visits after discharge. Frequent users from other districts enter the PSW- group and receive standard care. Participants’ admissions data are extracted from hospital records at point of referral and six months following referral.DiscussionTo the best of our knowledge, this will be the first quasi-experimental study of formal peer support in a LMIC and the first to assess change in readmissions, an outcome of particular relevance to policy-makers seeking cost-effective alternatives to institutionalised mental health care.

The changing nature of social support for adolescents and young adults with cancer.

The aim of this study was to explore adolescent and young adult (AYA) experiences and preferences for social support early within the continuum of cancer treatment. AYAs aged 15-25 years old at diagnosis were recruited from 6 clinical services that were purposively selected for providing specialist cancer care to AYAs across 3 Australian states and within paediatric and adult services. In-depth, semi-structured interviews were conducted by telephone 6-24 months from diagnosis. The narrative-based interviews included preferences for psychosocial support. Interviews were transcribed and thematic analysis was undertaken using grounded theory methodology. 60 AYAs were interviewed (mean age 20.52 [SD 2.97] years; 58% male; 72% adult settings). Analysis revealed that parents provided the foundation of emotional, informational and instrumental social support, even for older AYAs and those with partners and children. Informal emotional engagement with cancer peers was strongly appreciated during hospital treatment, while healthy peers provided welcome diversion at this time and during the transition towards their usual life. Nurses and allied health staff provided informational support to hospitalised AYAs and also provided a strong source of emotional support. Formal peer support programs were not endorsed by AYAs early in treatment but appreciated to be of greater interest to some following treatment completion. Social support was predominantly provided by family, peers and health professionals. The sources and types of support most welcomed by AYAs varied according to the intensity and phase of cancer treatment and where the young person was in their cancer trajectory.

The transcendent voice of recovery mentors in mental health: a philosophical reflection.

In a globalized world health and illness know no frontiers. Pandemics have never been limited to political borders and the contemporary campaigns to prevent them can be effective only when addressed not only internationally but also with the application of integrated disease management in order to respond to problems caused by the silo approach. In any case, it appears that global health has been constantly in redefinition. With this commentary a phenomenological redefinition of global health is proposed as an integrative strategy. Phenomenology prioritizes and investigates from the first-person point of view how the human being experiences the world, as it explores the unique meaning of the lived experience of being human. We are particularly interested in verifying if and how, from a first-person point of view, the lived experience of mental illness and of recovery can contribute to a more integrated definition of global health. In the field of mental health, formal peer support is a mentor/mentee relationship, and as such it is an emotional and practical support between two people who share a common experience of a mental health challenge or illness. Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. It is about understanding another's situation empathically through the shared experience of emotional and psychological pain. And when speaking in public, a recovery mentor accepts to disclose and to be recognized as a (former) mental health service user. That person knows that there is a possibility of being stigmatized, but yet remains courageously engaged towards the promotion of change and in solidarity with people who are suffering worldwide and who may not have this opportunity to speak freely.

Providing mental health peer support 1: A Delphi study to develop consensus on the essential components, costs, benefits, barriers and facilitators

Background: While formalised mental health peer support is on the increase, there continues to be a lack of consensus regarding the peer supporter role. Aim: The aim was to develop consensus on the essential components, personal costs, personal benefits, barriers and facilitators involved in providing mental health peer support. Methods: The Delphi method was used. In the first round, an exhaustive list of statements pertaining to peer support was generated from literature review and consultation with experienced peer supporters. In the second round, 147 UK peer supporters rated statements online or via post, and completed a questionnaire about experiences of providing peer support. Criteria for consensus were applied. Where there was uncertainty, statements were re-rated. Descriptive statistics and group comparisons were calculated. The final statements were grouped thematically. Results: Consensus was reached on statements pertaining to essential components ( n = 67), personal benefits ( n = 21), barriers ( n = 1) and facilitators ( n = 35). Formal peer support involves many skills and competencies. Most participants agreed that a wide range of personal benefits come with the role. Organisations may facilitate peer support through their values, actions and oversight. Approximately half of the sample worked in public services and were more likely to have concerns regarding pay and career progression. Conclusion and Implications for Practice: Results define the peer supporter role and add to the knowledge base about optimal conditions for it to thrive. Recommendations are made regarding role development and career progression, and future research to better understand personal costs and benefits.

The chaos of hospitalisation for patients with critical limb ischaemia approaching major amputation.

To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia. While a wealth of clinical outcome data on CLI and amputation exists internationally, little is known about the patient/family-centred experience of hospitalisation to inform preservation of personhood and patient-centred care planning. Longitudinal qualitative study using Heideggerian phenomenology. Fourteen patients and 13 family carers provided a semistructured interview after advice for major amputation. Where amputation followed, a second interview (6months postprocedure) was provided by eight patients and seven family carers. Forty-two semistructured interviews were audio-recorded and transcribed verbatim. Hermeneutic phenomenological analysis followed. Hospitalisation for CLI, with or without amputation, created a sense of chaos, characterised by being fragile and needing more time for care (fragile body and fragile mind, nurse busyness and carer hypervigilance), being adrift within uncontrollable spaces (noise, unreliable space, precarious accommodation and unpredictable scheduling) and being confused by missed and mixed messages (multiple stakeholders, information overload and cultural/linguistic diversity). Patients and families need a range of strategies to assist mindful decision-making in preparation for amputation in what for them is a chaotic process occurring within a chaotic environment. Cognitive deficits increase the care complexity and burden of family advocacy. A coordinated, interprofessional response should improve systems for communication, family engagement, operation scheduling and discharge planning to support preparation, adjustment and allow a sense of safety to develop. Formal peer support for patients and caregivers should be actively facilitated.