The Effect of Peer Support with Telecommunication on Subjective Well-being in Colorectal Patients: A Randomized Controlled Clinical Trial

Document Type: Original Article


1 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran;

2 Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran;

3 Department of Medical-Surgical Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Colorectal cancer has a widespread impact on the psychological and physical dimensions
of patients and threatens their subjective well-being. Peer support is an effective strategy to increase
subjective well-being in cancer patients. This study aims to evaluate the impact of peer support through
telecommunications on the subjective well-being of colorectal cancer patients.
Materials: This randomized clinical trial was conducted on 60 patients with colorectal cancer in
Mashhad, Iran from November 2018 to April 2019. Two educational hospitals were selected through
random sampling from four educational hospitals. Then, participants were randomly selected from the
list of patients in each group using a block randomization method. The intervention group received
the peer support program by using telephone and virtual social networks for a month. The data were
collected by the Warwick-Edinburgh Subjective Well-being Scale before and after the intervention and
were then analyzed through independent t-test, paired t-test, and chi-squared test using SPSS version
16. The level of significant was set at p <0.05.
Results: Before the intervention, the mean subjective well-being score of the patients did not show
significant difference in the intervention and control groups, respectively (27.8±5.4 vs. 27.6±6.3,
P=0.619). However, after the intervention, the mean subjective well-being score of the intervention
group showed a significant increase compared to the control group (49.16±3.3 vs. 26.6±6.1, p <0.001).
Conclusion: This randomized controlled trial shows that peer support interventions through
telecommunication can improve the subjective well-being of patients with colorectal cancer. Therefore,
this method can be used as an effective palliative approach to promote patients’ subjective well-being.


  1. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: Incidence, mortality, survival, and risk factors. Przegla̜d Gastroenterologiczny. 2019;14:89-103.
  2. Mello Mrspd, Moura SF, Muzi CD, Guimaraes RM. Clinical evaluation and pattern of symptoms in colorectal cancer patients. Arquivos de Gastroenterologia. 2020;57:131-6.
  3. Pourhoseingholi MA, Vahedi M, Baghestani AR. Burden of gastrointestinal cancer in Asia; an overview. Gastroenterology and Hepatology from Bed to Bench. 2015;8:19-27.
  4. Caruso R, Breitbart W. Mental health care in oncology, Contemporary perspective on the psychosocial burden of cancer and evidence-based interventions. Epidemiology and Psychiatric Sciences. 2020;29:e86.
  5. Jones JM, Olson K, Catton P, et al. Cancer-related fatigue and associated disability in post-treatment cancer survivors. Journal of Cancer Survivorship. 2016;10:51-61.
  6. Lu D, Andersson TML, Fall, et al. Clinical diagnosis of mental disorders immediately before and after cancer diagnosis: a nationwide matched cohort study in Sweden. JAMA Oncology. 2016;2:1188-96.
  7. Wang Y, Lin Y, Chen J, et al. Effects of Internet-based psycho-educational interventions on mental health and quality of life among cancer patients: a systematic review and meta-analysis. Supportive Care in Cancer. 2020;28:2541-52.
  8. Marziliano A, Tuman M, Moyer A. The relationship between post‐traumatic stress and post‐traumatic growth in cancer patients and survivors: A systematic review and meta‐analysis. Psycho‐Oncology. 2020;29:604-16.
  9. Ochoa C, Casellas-Grau A, Vives J, et al. Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress. International Journal of Clinical and Health Psychology. 2017;17:28-37.
  10. Bener A, Alsulaiman R, Doodson L, Agathangelou T. Depression, hopelessness and social support among breast cancer patients: in highly endogamous population. Asian Pacific Journal of Cancer Prevention. 2017;18:1889-96.
  11. Tessier P, Blanchin M, Sébille V. Does the relationship between health-related quality of life and subjective well-being change over time? An exploratory study among breast cancer patients. Social Science & Medicine. 2017;174:96-103.
  12. Haviland J, Sodergren S, Calman L, et al. Social support following diagnosis and treatment for colorectal cancer and associations with health‐related quality of life: Results from the UK Colorectal Wellbeing (CREW) cohort study. Psycho‐Oncology. 2017;26:2276-84.
  13. Fasihi Harandi T, Taghinasab MM, Dehghan Nayeri T. The correlation of social support with mental health: A meta-analysis. Electronic Physician. 2017;9:5212-22.
  14. Walshe C, Roberts D. Peer support for people with advanced cancer: a systematically constructed scoping review of quantitative and qualitative evidence. Current Opinion in Supportive and Palliative Care. 2018;12:308-22.
  15. Kowitt SD, Ellis KR, Carlisle V, et al. Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature. Supportive Care in Cancer. 2019;27:97-108.
  16. Doull M, O’Connor AM, Welch V, et al. Peer support strategies for improving the health and well‐being of individuals with chronic diseases. The Cochrane Database of Systematic Reviews. 2017;2017:CD005352.
  17. Dehghani A, Mohammad khan Kermanshahi S, Memarian R, et al. The effect of peer-led education on depression of multiple sclerosis patients. Iranian Journal of Psychiatric Nursing. 2013;1:63-71. [In Persian]
  18. Hu J, Wang X, Guo S, et al. Peer support interventions for breast cancer patients: a systematic review. Breast Cancer Research and Treatment. 2019;174:325-41.
  19. Vorderstrasse A, Lewinski A, Melkus GDE, Johnson C. Social support for diabetes self-management via eHealth interventions. Current Diabetes Reports. 2016;16:56.
  20. Shorey S, Ng ED. Evaluation of Mothers’ Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study. Journal of Medical Internet Research. 2019;21:e11065.
  21. Huber J, Muck T, Maatz P, et al. Face-to-face vs. online peer support groups for prostate cancer: a cross-sectional comparison study. Journal of Cancer Survivorship. 2018;12:1-9.
  22. Irajpour A, Hashemi MS, Abazari P, et al. The Effects of Peer Support on Depression, Anxiety, and Stress Among Patients Receiving Hemodialysis. Iran Red Crescent Medical Journal. 2018;20:e66321.
  23. Bartolo A, Pacheco E, Rodrigues F, et al. Effectiveness of psycho-educational interventions with telecommunication technologies on emotional distress and quality of life of adult cancer patients: a systematic review. Disability and Rehabilitation. 2019;41:870-8.
  24. Tennant R, Hiller L, Fishwick R, et al. The Warwick-Edinburgh mental well-being scale (WEMWBS): development and UK validation. Health and Quality of life Outcomes. 2007;5:63.
  25. Lang G, Bachinger A. Validation of the German Warwick-Edinburgh mental well-being scale (WEMWBS) in a community-based sample of adults in Austria: a bi-factor modelling approach. Journal of Public Health. 2017;25:135-46.
  26. Rajabi G. Validity and reability of the perstian version of Subjective well-being in cancer pationt. Health Psycology. 2013;1:30-41. [In Persian]
  27. El-Shami K, Oeffinger KC, Erb NL, et al. American Cancer Society colorectal cancer survivorship care guidelines. CA: A Cancer Journal for Clinicians. 2015;65:428-55.
  28. Butow P, Sharpe L, Thewes B, et al. Fear of cancer recurrence: a practical guide for clinicians. Oncology. 2018;32:32-8.
  29. Fabi A, Bhargava R, Fatigoni S, et al. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Annals of Oncology. 2020;31:713-23.
  30. White VM, Young M-A, Farrelly A, et al. Randomized controlled trial of a telephone-based peer-support program for women carrying a BRCA1 or BRCA2 mutation: Impact on psychological distress. Journal of Clinical Oncology. 2014;32:4073-80.
  31. Madani H, Pourmemari M, Moghimi M, Rashvand F. Hopelessness, perceived social support and their relationship in Iranian patients with cancer. Asia-Pacific Journal of Oncology Nursing. 2018;5:314-9.
  32. Fong AJ, Scarapicchia TMF, McDonough MH, et al. Changes in social support predict emotional well‐being in breast cancer survivors. Psycho‐Oncology. 2017;26.664-71.
  33. Solano JPC, da Silva AG, Soares IA, et al. Resilience and hope during advanced disease: a pilot study with metastatic colorectal cancer patients. BMC Palliative Care. 2016;15:70.
  34. Applebaum AJ, Stein EM, Lord-Bessen J, et al. Optimism, social support, and mental health outcomes in patients with advanced cancer. Psycho-Oncology. 2014;23:299-306.
  35. de Rooij BH, Thong MSY, van Roij J, et al. Optimistic, realistic, and pessimistic illness perceptions; quality of life; and survival among 2457 cancer survivors: the population-based PROFILES registry. Cancer. 2018;124:3609-17.
  36. Schofield PE, Stockler M, Zannino D, et al. Hope, optimism and survival in a randomised trial of chemotherapy for metastatic colorectal cancer. Supportive Care in Cancer. 2016;24:401-8.
  37. Lee R, Lee KS, Oh E-G, Kim SH. A randomized trial of dyadic peer support intervention for newly diagnosed breast cancer patients in Korea. Cancer Nursing. 2013;36:E15-22.
  38. Erfani SS, Abedin B, Blount Y. The effect of social network site use on the psychological well‐being of cancer patients. Journal of the Association for Information Science and Technology. 2017;68:1308-22.