ADVICE FOR PROFESSIONALS

Cancer Care has provided group counseling to cancer patients and their families for more than twenty years. We have found support groups to be a cost-effective method of service delivery for large numbers of patients and family members. Support groups are useful at all stages of the illness and can focus on coping with cancer diagnosis and treatment, adaptation to life after cancer or adjustment to loss and bereavement.

After reading this Professional Brief, you will be in a position to start a support group in your own setting. The section on "Nuts and Bolts" is specifically designed to assist you in planning and implementing such a group.

RATIONALE

Support groups offer people facing cancer many things: The ability to meet others in similar circumstances, to share methods of coping and develop new relationships at a time of isolation. Groups have also been shown to improve adjustment, mood, coping and quality of life for people dealing with cancer.

Other advantages of the group modality include an exchange of information about cancer and its treatment; mutual problem-solving especially in dealing with the health care system; support; encouragement; a sense of belonging and socialization.

NUTS AND BOLTS -- FOR GROUP PLANNING

Step 1 Identify a group of people who share similar concerns and screen them as potential group members. The screening interview can be used to develop a working alliance with each group member, discuss goals and expectations and rule out inappropriate people.

Step 2 Establish group goals that meet the expressed needs for mutual help, information or discussion of concerns. For example, newly diagnosed patients may need help in making treatment decisions and developing a good working alliance with their physician.

Step 3 Enlist the cooperation of administration and staff in planning for the new group. If other staff members are interested, invite their participation in this or future programs.

Step 4 Secure funding to sustain the group. This may include funding for refreshments, mail, phone calls, duplication of materials and transportation for group members.

Step 5 Contact the public relations and media staff in your setting to deal with publicity and recruitment. This can be used to build support among other departments and disciplines.

Step 6 Resolve logistical problems before the group begins. Where will the group meet? At what time will meetings take place? How often will the group meet? How long will each group session last? For how many weeks will the group meet in total? How will people travel to and from the group?

Step 7 Decide on an orientation for the group. Will the group be psychoeducational, social supportive, open- or closed- ended in nature?

Step 8 Implement the group as planned.

Step 9 Build in an evaluation process for the group experience. Include a pre- and post-test as well as a participant feedback form for use in fine-tuning and replicating the group.

NUTS AND BOLTS -- FOR THE GROUP LEADER

The group leader plays a vital role in guiding the group, setting the tone, creating an atmosphere of trust and providing support. These strategies are useful for the group leader:

1. Set the ground rules for attendance, confidentiality, mutual respect for group members, the cancellation policy and fee schedule (if any).

2. Begin where the group members are, rather than imposing your own preconceived agenda.

3. Initiate and stimulate discussion, and allow common themes to emerge.

4. Take an active part in the group process, especially in creating a safe atmosphere for participation.

5. Monitor the emotional pulse of the group. When painful topics are being avoided, you may have to introduce them.

6. Reinforce the predictability of feelings, placing problems in a universal context when possible.

7. Instill hope for change and improved quality of life for group members.

8. Encourage networking of group members outside the formal group for additional support and socialization.

9. Help members join in the group discussion and involve the more passive members as much as possible.

10. Leave sufficient time to summarize the process at the end of each group meeting.

11. Provide educational materials, articles and information on issues of concern to the group.

12. Prepare group members for termination ahead of time, and then terminate the group as planned.

DEALING WITH SETBACKS

It is important to acknowledge that all groups are not successful. Groups may fail to achieve cohesion as manifested by absenteeism, dropouts or internal division; personality types such as monopolizers or silent members may disrupt the flow of discussion; or groups may focus on "safe" topics such as treatment and anger at the medical system to avoid discussion about their feelings. No matter how difficult, each new group series should be seen as a learning experience. It's often helpful to discuss sessions with a colleague or a supervisor to keep things in perspective.