The evidence and experience of support group leaders indicate that support groups ìwork bestî and are most effective when they:

1. Are established in response to, and adaptive to, community or member needs Successful groups evolve in response to an identified need and respond to membersí needs, in terms of structure and content.

2. Provide information, emotional support and socialisation Effective support groups provide a range of activities to meet the diverse needs of individual members for information, socialisation, reduction of isolation and emotional support, and improved coping skills.

3. Have skilled leadership and/or facilitation. Recent research has suggested that the group leader has a crucial role in determining the success or otherwise of cancer support groups. Group participants have highlighted the importance of the leadersí personality, empathy or understanding, and capacity to ensure everyone has an opportunity to participate. There is some evidence and a common belief that specific group leadership training for support group leaders is crucial to achieving best outcomes.

4. Maintain adequate number of, and recruit new, members A peer support group needs an adequate number of people to attend meetings to keep it

operational, and recruitment of new members to ensure it remains active and validates the group and the contribution of other members.

5. Involve a health professional or at least establish good links with one Having a link with a health professional may support group functions and effectiveness by providing resources, practical and informational support, and helping to promote the group to specialists and/or enhance referrals to the group, and also may lend credibility to the group.

6. Are well-organised, structured and supported Structured peer support groups are more popular with cancer patients and may be more effective. Some of the difficulties in running groups and potential burnout could be alleviated by sharing responsibilities and tasks with group members and/or having a co-facilitator

. 7. Have an appropriate ìpersonalityî and level of humour Group participants identify humour in the group and the group facilitatorís personality as important features that contribute to effectiveness.

It was agreed that the five key outcomes by which support group effectiveness should be assessed were health-related quality of life, cancerrelated

empowerment, anxiety, depression and satisfaction with the group.

Fawzy (1995) summarised the types of interventions that had been proved helpful for patients with cancer according to phase of disease or prognosis:

Diagnosis, initial treatment (good prognosis) Short-term, structured, psycho-educational. Usually last 6 to 10 weeks and are institution based.

Recurrence/retreatment (ongoing disease but longer-term prognosis) Ongoing, less structured, supportive in nature, patient issues-driven, perhaps less frequent, perhaps monthly rather than weekly.

Terminal/palliative (short prognosis) Long-term or ongoing, structured and goal-oriented (eg symptom management, dealing with end of life issues), supportive. Usually weekly or more often and are institution based.

Educational programs are superior. Educational programs are more effective in improving quality of life in adult cancer patients than social support, coping skills training or psychotherapy (Rehse and Pukropís metaanalysis, 2003; Fawzy et al, 1995; Helgeson et al, 1999); but interventions that include components designed to enhance self-regulation and increase self-efficacy with regard to cancer-related issues (such as improving coping skills and teaching how to recognise and restructure negative expectations) produce larger effect sizes than do interventions with few or no such components

Structured groups are better

Longer interventions may be more beneficial than short programs.

Durations of more than 12 weeks were significantly more effective than shorter interventions (Rehse and Pukropís meta-analysis, 2003). Quality-of-life improvement appeared to be greater for a standard 6-week support group program than a ìweekend intensiveî intervention (Cunningham

The researchers concluded that:

People who attended support groups in a community setting had better mental quality of life, were less depressed, found the group more helpful and were more satisfied with the groupís activities than those who attended support groups in a hospital.

People who attended a group led by health professionals were more anxious than those attending a group led by non health professionals.

People in general cancer support groups were more satisfied with the activities of their group than those attending groups targeting a specific cancer.