Skip to main content
Download PDF
Download ePub
  • Study Protocol
  • Open access
  • Published:

Using peer narrative support to promote return to work for cancer survivors: a protocol study of action research

Archives of Public Health volume 83, Article number: 21 (2025) Cite this article

Abstract

Background

Chinese cancer survivors are not doing well in returning to work. Peer support, as an external coping resource to help cancer survivors return to work, brings together members of the lay community with similar stressors or problems for mutual support. Peer volunteers have not received systematic training, so inappropriate language in the support process can often cause secondary damage to both the peer and the cancer survivor. High-quality narrative support can help both parties gain positive meaning in communication. Therefore, we draw on narrative-related theoretical techniques to construct a model of peer narrative support to facilitate cancer survivors’ return to work.

Methods

This study is a participatory action research, including three phases: (i) Construction: Construct a peer narrative support model through literature review, theoretical research, and expert meetings. A peer narrative competence training program and a peer narrative support implementation program are constructed on this basis. (ii) Intervention: Firstly, two rounds of training actions will be carried out for 8 weeks. Second, after the peers have passed the training assessment, cancer survivors will be recruited to carry out two rounds of peer narrative support for six months. The model framework will be revised in conjunction with observation and reflection during the action. (iii) Evaluation: A combination of quantitative and qualitative methods will be used to assess the feasibility and scientific validity of the peer narrative support model and to evaluate the effectiveness of the intervention. The research methods used include theoretical research, literature review, expert meeting method, participatory observation method, interview method, and questionnaire survey method.

Discussion

China currently has cancer rehabilitation associations in most provinces, cities, and counties, and peer volunteers in these organisations use their personal experience to help other cancer patients. Currently, the content of their help is mostly limited to disease recovery and financial condolences, and there is a lack of scientific training for peer volunteers. This study aims to help patients cope with their suffering and eventually return to work by narrating the stories of role models. The narrative support covers three aspects: focusing on recovery, rebuilding effectiveness, and adjusting planning. In addition, this study relies on the methodology of action research to develop a peer narrative support model, training program, and implementation plan, which are more applicable to the national context of peer support for cancer patients in China. This will provide scientific guidance for the Chinese Cancer Rehabilitation Association to develop peer narrative support and guide cancer survivors back to work.

Trial registration

This study has been registered at the Chinese Clinical Trial Registry (Registration number ChiCTR2300068403) on Feb 17, 2023. (Retrospectively registered) https://www.chictr.org.cn/bin/project/edit?pid=183766.

Peer Review reports

Text box 1. Contributions to the literature

• This study will evaluate whether the implementation of a peer narrative support model is effective in avoiding secondary victimisation during peer support, and in providing support for cancer survivors to return to work.

• This study utilises participatory action research and a mixed-methods research design to ensure the scientific validity and feasibility of the peer narrative support model.

• The results of this study will provide scientific guidance for China’s Cancer Rehabilitation Association to conduct peer narrative support and guide cancer survivors to return to work in the future.

Background

Returning to work for cancer survivors signals social reintegration, restoration of a sense of normalcy, being valued [1], resumption of normal life [2], and restoration of personal identity [3]. At the same time, returning to work has a positive impact on the health and well-being of cancer survivors [4].

However, currently, Chinese cancer survivors are poorly returning to work [5,6,7]. Cancer survivors face tremendous challenges in returning to work due to their reduced ability to work and higher financial and psychological burdens after receiving anti-cancer treatment [8]. As a result, cancer survivors need help to cope with physical, psychological, and occupational issues to facilitate their return to work. Research has shown that peer support is an important external coping resource to help cancer survivors return to work [9].

Peer Support as a form of social support refers to a diverse range of forms that enable patients with similar illnesses, medical conditions, or experiences to provide substantial help to each other, as well as practical, social, and emotional support in life [10]. Peer support has been widely used in various aspects, such as AIDS [11], education [12], and cancer [13]. Research studies have shown that peer support can improve cancer patients’ psychological pain [14], fear of cancer recurrence [15], quality of life [16], and psychosocial adaptability [17]. Peer support has now become an important part of China’s healthcare delivery system, which can alleviate the problem of workforce shortage in healthcare resources [18]. However, Kowitt et al. [19]found that of 100 articles on peer support research, only some (22%) described the impact of providing peer support on supporters. Based on similar experiences with patients, most peer supporters themselves experience similar afflictive dilemmas as patients, and they must be willing and able to help others. During peer support exchanges, when supporters are unable to meet the patient’s needs, their self-confidence is undermined, and they suffer a greater psychological burden [20]. When supporters are overwhelmed, it often leads to psychological disorders, including anxiety and depression, and impairs their physical health, work and family commitments, and economic well-being [21]. Meanwhile, Ohara [22] argued that existing research should train potential peer supporters to implement peer support.

At present, peer support training in Canada is involved in various health services areas such as oncology, screening and prevention of infectious diseases, and chronic disease management [23, 24]. The content, timing, methodology, and post-training certification standards of peer support training have been set up with corresponding accreditation and certification processes [25] and training guidelines [26]. However, peer support studies conducted in China for cancer patients are still limited to exploring their online or offline models [27], and the purpose of the studies is mostly focused on the intervention effects from the perspective of whether the patients benefit or not [28]. Kong [29] et al. have suggested the need for diverse, high-quality, well-designed peer support interventions to enhance patients’ self-management abilities. Han [27] et al. concluded that peer support interventions still have limitations, with a lack of standardised peer support and difficulties in recruiting and maintaining peer supporters. Zhang et al. [30]also suggested that existing peer support research lacks a theoretical framework to guide the study, which should promote the participation of multiple stakeholders, enrich the connotation of peer support, optimise the organizational process of peer support, and develop a standardised implementation plan. In addition, the researcher’s preliminary review of qualitative studies exploring the real experience of the support subject found that inappropriate support and negative remarks in the process of various types of peer support interventions caused secondary damage to cancer patients and peers [31]. Secondary victimisation refers to the fact that cancer peer supporters and patients who have developed cancer are re-victimized due to a variety of factors during their participation in peer support programs [31]. These deficiencies mostly occurred during peer-patient narrative exchanges.

Narrative, meaning the description of a story, emphasises personal experiences and feelings and is the basic way in which people organize their experiences into realistic events that can have corresponding meanings for both the narrator and the listener [32, 33]. Currently, the healing power of narrative has been repeatedly demonstrated [34,35,36]. However, the development of narratives in China has mostly focused on medical humanistic care [32, 33, 37], and the imbalance of the doctor-patient ratio in China has resulted in patients’ narrative needs not being met [38, 39]. A combination of narrative and peer education has been studied with satisfactory results in reducing cancer survivors’ fear of recurrence [40] and disease stigma [41]. However, the combination of narrative and peer support has not been studied in depth in the area of returning cancer patients to work.

Therefore, we saw a need to develop a peer narrative support model to meet the future requirements of patients better. Based on the research team’s previous research foundation in the area of cancer patients’ return to work adaptation [9, 42, 43], this study formed a program to implement a peer narrative support model exemplified by cancer survivors’ return to work. Aim to cultivate high-quality peers with narrative ability, to provide peer narrative support for cancer survivors, to improve their adaptability to return to work, and to help support both parties to achieve full recovery.

This study needs to address the following questions: How do we avoid secondary victimisation on both sides of peer narrative support? How do we translate theoretical findings related to peer support and narrative into practice? How do we train peers to empower their narratives? How do we develop peer narrative support practices? In this context, Participatory Action Research has emerged as a methodological strategy to transform specific situations better, bridge the gap between research and training, and facilitate the implementation of new theories [44,45,46]. Action research is not limited to methods of data collection. It can be conducted using a combination of qualitative and quantitative methods, going deeper into the context to interpret, reflect on, and analyse specific issues [46]. Thus, using action research, we will be able to reflect on and revise the model in response to particular problems during implementation and construct a scientifically viable model of peer narrative support.

Methods/design

Aim and objectives

The study aims to construct a peer narrative support model, train peers’ narrative abilities, and provide peer narrative support for cancer survivors returning to work. It will also observe the support process to understand the real experiences of both sides of the peer narrative support, modify and adjust the model, and evaluate its effectiveness.

Design

This study adopts a participatory action research methodology. Participatory action research is a systematic and rigorous approach in which project stakeholders, such as researchers, peers, and patients, are involved throughout the model-building process, enabling exploration and discovery of effective solutions to problems. In this study, the researcher (WQ), who was certified as a teacher of narrative medicine in China, will be responsible for training peers in narrative competence and organising narrative support interventions for peers. At the same time, other members of the multidisciplinary team (oncologists, nurses, psychologists) will also provide back-up support for cancer survivors’ peers. The study started on July 1, 2022, and ended on October 31, 2023.

Fig. 1
figure 1

An action research flowchart for constructing peer narrative support model

Full size image

The study consisted of three phases: (Fig. 1 shows the whole process of the study)

  • The construction phase delved into theories and research related to peer support, narratives, and return-to-work for cancer survivors, and it constructed a peer narrative support model. Based on this, a peer narrative competence training program (training objectives, content, methods, assessment methods) and a peer narrative support implementation program (objectives, process, targets, methods, and effect evaluation) will be constructed. To ensure its scientific validity and feasibility, four experts in narrative medicine and oncology psychosocial care will be invited to convene an expert meeting to discuss the model and plan and revise the model in light of the meeting.

  • The intervention phase consists of a peer narrative skills training intervention and a peer narrative support intervention. Each intervention consists of two action cycles, each including a period of planning, action, observation, and reflection.

The 12 peers recruited by the Cancer Rehabilitation Association will be first trained through a combination of WeChat online training and offline training, and the training interventions consist of two action cycles (each cycle lasts 4 weeks, with 2–3 trainings per week). The theoretical training includes ①Hello Peer (concepts and behavioural guidelines related to peer narrative support), ②Peer Narrative Support Skills, ③Appropriate Support Role, ④Appropriate Language, ⑤How to Handle Difficult Cases, ⑥Balancing Work and Life as a Volunteer, ⑦Health Management during Return to Work, ⑧Focus on Rehabilitation, ⑨Restoring Efficacy, and ⑩Adjustment Planning. (⑧, ⑨, and ⑩ are the main points of describing the experiences related to successful return to work. Situational exercise training includes ①Reflective observation: peer review, reflecting on inappropriate support, and narrative turning points. ②Abstract generalization: Narrative support exchange process, role model stories. ③Action application: again peer-to-peer mutual narrative support. Peers who passed the theoretical and situational training assessments will be invited to participate in the following peer narrative support intervention.

To ensure the m0atching of peers with cancer survivors, the researcher recruited 18 cancer survivors from the chemotherapy ward of a tertiary care hospital in a city in Jiangsu Province, China, using purposive sampling based on general information about the peers (cancer type, gender, age, etc.). Secondly, the peer narrative support intervention will be carried out by combining WeChat online video or voice phone calls and offline, which consisted of two rounds of supportive actions (each round lasts 12 weeks, and patients receive peer narrative support from their peers once a week as needed). The narrative support process includes five steps: understanding needs, creating context, self-expression, focusing on understanding, and reflecting on responses. Peers and cancer survivors will be invited to interview at the end of each cycle to understand their satisfaction with the intervention, their experience of participation, and whether they have any relevant suggestions. Most importantly, all data from the intervention will provide the evidence base for improving the peer narrative support model, the training program, and the implementation of the program.

  • In the evaluation phase, the research team developed an effective evaluation program. Presently, there are few studies related to the evaluation indicators of peer narrative support and peer narrative support competency training. Research [47] pointed out that action research does not apply the traditional “reliability” and “validity” to test and measure its effectiveness. Consideration should be given to whether the research is conducive to the development or improvement of the current social reality. Whether it solves practical problems. Whether it deepens practitioners’ understanding of practice or develops their professional knowledge. During the construction phase of this study, the expert meeting suggested that the evaluation of the effects of this study could focus on assessing the personal feelings and experiences of peers and cancer survivors. Therefore, this study uses a mixed research approach combining qualitative and quantitative methods to understand and evaluate the effectiveness of the implementation of the Peer Narrative Support Model from the perspectives of peers and cancer survivors. Quantitative data of cancer survivors and peers will be investigated before and after the peer narrative support. Cancer survivors and peers will be invited to conduct focus group interviews to collect qualitative data after the supportive action to evaluate the effectiveness of the implementation of the peer narrative support model.

Setting of the study

The project will be carried out in the Cancer Rehabilitation Association and the chemotherapy ward of a tertiary hospital in a city in Jiangsu Province, China. The researcher lives and studies in the city, volunteers at the Cancer Rehabilitation Association, and runs a peer narrative support program at the hospital. There are many benefits to conducting the project here, including an in-depth knowledge of the hospital’s environment and culture, as well as having a wealth of medical resources that allow the researcher the opportunity to gather a greater amount and depth of data from medical practitioners.

The Cancer Survivors Rehabilitation Association has not trained volunteer cancer volunteers in peer narratives, except for routine membership card processing and association activities. In addition, the chemotherapy ward of this tertiary care hospital does not provide peer narrative services to cancer survivors beyond the daily treatment of the disease. Considering the needs and schedules of peers returning to work and recovering patients under the influence of the epidemic era, we carried out the program with microblogging online support and offline support.

Participants in this study are cancer survivors with a social interest in potentially returning to work. Cancer survivors’ participation ensured that the model and any interventions are friendly and appropriate for them, and reflected the true needs of cancer survivors.

Sample

The sample includes 4 experts, 12 peers and 18 cancer survivors who meet the inclusion and exclusion criteria.

Expert inclusion criteria: ①with background in oncology nursing research or cancer survivor return to work research; ②with certain narrative related knowledge background; ③with at least 10 years of work in the above mentioned professional fields; ④with the title of associate senior or above.

Peer inclusion criteria: ①diagnosed with cancer; ②volunteer workers of Nantong Cancer Survivors Rehabilitation Association; ③age 18 years or older; ④informed consent and voluntary participation in the study; ⑤high school education or above; ⑥intact cognitive function and ability to use intelligent software such as WeChat.

Cancer survivors inclusion criteria: ① pathological diagnosis of cancer; ② survivors who are receiving treatment in hospital and have no disease progression or are in the rehabilitation waiting period; ③ working before treatment; ④ aged 18 years or older and less than 60 years; ⑤ informed consent and voluntary participation in the study; ⑥ intact cognitive function and can use intelligent software such as WeChat.

Exclusion criteria for peers and cancer survivors: ① presence of a psychiatric disorder or history of the psychiatric disease; ② combination of serious complications of other systems; ③ advanced cancer.

Data collection

Data will be collected throughout the action research. The expert meeting will be held in January 2023. 12 peers were recruited during February, and two rounds of the Peer Narrative Support Competency Training intervention took place between March and April. In addition, 18 cancer survivors were recruited during March through April, and two rounds of peer narrative support interventions will be conducted between May and October.

Phase of construction

This phase provides a solid theoretical foundation for the peer narrative support model. The researcher searched keywords such as “narrative/narrative medicine/narrative nursing”, “peer/peer support/peer education/peer narrative”, “cancer survivor/cancer patient/tumor”, “peer narrative”, “return to work”, reviewed related literature and theories, and constructed a preliminary framework for the peer narrative support model, a training program for peer narrative competence, and a peer narrative support implementation program to help cancer survivors return to work.

Fig. 2
figure 2

Theoretical foundations of the peer narrative support model framework

Full size image

The Peer Narrative Support Model seeks to develop a narrative-based model of peer support with the cancer survivor themselves as the peer and in the lead role. As shown in Fig. 2, the model refered to the Narrative Care Model Framework [48], Peer Support Accreditation and Certification (Cannada) (PSACC) National Certification Handbooks [49], Narrative Medicine and Narrative Care Theory [37, 50], Positive Psychology Theory and Feedback Intervention Theory [51, 52] to construct framework for the foundational model and to identify the framework (support elements, support modalities, support processes, professional support), peer narrative literacy, skills, and routes for the peer narrative support model.

In addition, peers are often non-healthcare professionals, and it becomes a challenge to develop their narrative skills considering compliance and actionability. This study takes into account the real needs of peers and patients and refers to the contents of Narrative-Based Primary Care [53] to design a simple and easy-to-understand Peer Narrative Support Tool (Table 1). The Narrative Tool consists of three parts: the Peer Narrative Support Process, Narrative Purpose, and Narrative Conversation Skills. Narrative conversation skills are presented in short sentences for peers to understand easily. Peers can choose their narrative conversation skills and use the support process to carry out narrative support and achieve the purpose of the narrative. This tool will be used in training as an aid to help peers understand the purpose of narrative support and to enhance their narrative support skills. The narrative support process is as follows. ①Understand the needs: Peers ask questions to understand the urgent needs of the patient and clarify the theme of the peer narrative. ②Create a context: Peers ask questions in a dispersive manner, inducing the patient to recall the complex context in which the problem occurred. Let the patient describe their troubles and find an entry point for the peer to express their own experience. ③Express oneself: On the one hand, the peer reveals their own similar experience and describes their past problems to win the patient’s consensus and empathy; on the other hand, the peer turns and explains how they overcame the difficulties to solve the problem, thus setting a positive role model for the patient. ④Pay attention and Understand: The peer expresses attention and understanding to the patient by referring to the key elements of the patient’s narrative (people, events, objects or statements) again through eyes, gestures or words in a timely response. ⑤Reflective response: the peer thinks deeply about the patient’s stated distress and its causes and encourages the patient to express their feelings and opinions by asking the details of the patient’s problems in a cyclical manner, guiding the patient to analyse the root causes of the issues spontaneously. Finally, on the premise of respecting the patient’s ideas, the patient’s original negative perceptions can be changed. Peers work together with the patient to think of effective treatment measures and act as witnesses to help the patient positively reshape their story for the future.

Table 1 Peer narrative support tool
Full size table

The expert meeting will be conducted online through Tencent Meetings, an online video conferencing software. The researcher will record the experts’ recommendations.

Phase of intervention and evaluation

Quantitative data include training assessment scores, scale questionnaire data, closed-ended questions from focus group interviews, and other observed quantitative data (peer and patient participation during the intervention). These data will be used to assess the feasibility and effectiveness of the model, training program, and implementation program. The training examination papers and scale questionnaires will be collected online through offline face-to-face or questionnaire star (an online questionnaire distribution and collection platform), pre-and post-training, and pre-and post-peer narrative support intervention, respectively. The content of the training assessment test papers will be designed by the research team based on the theoretical content of the training. To measure the level of relevant theoretical knowledge acquired by peers before and after the training, including peer narrative support behavioural guidelines & skills, appropriate supportive language & roles, balancing volunteer work and life & coping with difficult cases, health management during return to work & narrative structure of return to work role model experiences. The questionnaire covers Return to Work adaptability [42], Return to Work Self-Efficacy [54], The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 [55], Connor-Davidson Resilience Scale [56], social support [57], Self-Rating Depression Scale [58] and Self-Rating Anxiety Scale [59].

Qualitative data included open-ended questions from the focus group interviews, the content of the narrative communication supported by the peer narrative support, and some observational data (behavioural changes after peer and patient participation in the intervention). Peer interview contents: ①What changes do you think you have made after the training? Talk about your experience and gains. ② What was your impression of the peer narrative support provided in relation to returning to work? Did the peer narrative support help you personally? Talk about your experience and gains. Cancer Survivor Interviews: ① What is your impression of the peer narrative support related to returning to work? ② Do you think the peer narrative support related to returning to work has helped you? Or talk about your experiences and gains. A combination of qualitative and quantitative research methods will be used to evaluate the effectiveness. These data will be used to analyse the current Peer Narrative Support model, the training program, and the implementation of the program to identify gaps in outcomes and deficiencies in goals. All qualitative data will be documented in the form of audio recordings and notes. Additionally, the researcher will use an observational method to participate in each peer narrative support session by observing and recording the entire process and completing a brief written report at the end. This report will document the topics discussed, the level of peer and cancer survivor participation, the role of the peer in the narrative support activity, problems that arose during the activity, and eventual solutions.

Data analysis

The source of quantitative data for this study will be the results of a questionnaire survey. Two researchers worked together to enter the raw data into SPSS 22.0 statistical software, and a third researcher performed the checks. Means, standard deviations, and percentages will be calculated for statistical analysis.

With the consent of the participants, all support activities will be recorded, and all interviews will be audio-recorded and transcribed. Qualitative data will be analysed using thematic framework analysis, aided by the use of NVivo11 software. Thematic framework analysis is a qualitative method that aims to identify commonalities and differences in qualitative data by drawing descriptive and explanatory conclusions around themes [60]. In practice, the researcher will identify, synthesise and analyse the research data according to core themes, key concepts and emergent categories. The framework consists of a series of stem themes, each of which contains a series of interrelated sub-themes. Once the scope of analysis is defined, each theme is presented in a complete matrix or table, where the rows and columns of the matrix or table represent each subtheme. In the analysis, we will apply analyst triangulation and membership checks. The research team will be involved in discussing and refining the analysis conducted. The results of each cycle of analysis will inform the next phase of the research process.

Rigour

Some measures will be used to increase the rigour of this study.

For quantitative data, the scales used to measure the outcome indicators in the questionnaires of this study will be scientifically validated, and the data will be entered by two statistically trained investigators and checked by a third investigator.

For qualitative data, to minimise personal bias, the researcher will collect and code data with the research team at regular intervals. Documenting potential sources of personal bias over time and regularly examining the raw data, analyses, and reports will enhance the credibility of the study. In addition, participants may be re-interviewed if necessary to clarify the data further.

Discussion

In the course of our study, we found that Chinese organisations of cancer patients’ rehabilitation associations can currently provide peer support in the form of accompaniment to medical appointments, rehabilitation tours, condolences, financial support, and other aspects. However, there is little training in narrative communication for volunteer peers and little peer support to help cancer patients return to work. In the current social context, research on narrative services and the return to work of cancer patients has been primarily driven by healthcare professionals [61]. However, as reported in earlier studies, researchers [62] have suggested that the unequal ratio of doctors to patients is an important factor hindering the implementation and application of narrative healthcare services in China. The search for new subjects for narrative services should be focused on the public. Significantly, when facing very distressing events [63], patients inwardly tend to distance themselves from the outside world. Compared to medical workers under the strong pressure of medical work, patients’ peers who have experienced similar disease situations are more able to understand the suffering situation of the person concerned deeply and, on this basis, guide the patient out of the painful situation. Therefore, this project is based on an action research approach, which combines peer support [25, 26] and narrative theory [48, 53, 64, 65] to construct a peer narrative support model through practice and to use peer narrative support to help cancer survivors return to work.

In addition, good peer narrative support necessarily requires that peers have good narrative skills. The narrative has been widely studied in the medical field, and many researchers [41] have proposed narrative therapies such as “problem externalisation and deconstruction,” which are difficult for peers to understand in technical terms. Researchers [66] have shown that practising language skills have a significant impact on improving narrative skills. Launer J [53]. uses short sentences to illustrate practical narrative communication methods that are easier for patients to understand in primary care narratives. Therefore, we expected to design a narrative tool consisting of short verbal communication sentences as a training tool to train peers in narrative skills.

How peers narrate their return-to-work experiences is also a critical step in the narrative process. Xu et al. [9] found that the adaptation stages of cancer patients’ return to work included three levels of focusing on recovery, rebuilding efficacy, and adjusting planning. This finding provides a scientific narrative route for peers to tell their stories. We anticipate that this study will increase communication among cancer survivors about return-to-work topics and facilitate their return to work.

Participatory action research has the advantage that its “plan-act-observe-reflect” spiral process allows peers, patients, and researchers to participate in the design and revision of the model and implementation plan [67]. Consistent with previous action research [68, 69], all participants in this study were able to self-reflect on their behaviours and select context-appropriate strategies that ultimately led to modifications and adjustments to the model. For example, for the narrative support process, peers argued that the process should not be limited to a fixed sequence. This will restrict their ideas for providing support, leaving the support process trapped within a framework and lacking a natural narrative flow. The beauty of narrative is that it is the natural flow that is appropriate and moving. Therefore, we modified the narrative process by stating that peers were free to choose the proper process and narrative conversational techniques for support as needed, in no particular order. In addition, we found that peers from different occupations and cancer survivors had diverse suggestions for cancer rehabilitation organisations in China. Peer volunteers with rich experience in helping people felt the need to promote such systematic training. Especially for novice volunteers, it can effectively avoid some detours. Cancer survivors who are engaged in community work believe that in the future, such narrative support service points can be set up in residential communities so that cancer survivors can receive support easily. Reflections, corrections, and suggestions will help promote the success of follow-up interventions and provide new ideas for the development of cancer rehabilitation in China.

Ultimately, feasible models and programs are developed through practice. Action research allows for a combination of quantitative and qualitative research methods, allowing us to obtain both quantitative objective data on “how” peer narrative support affects outcome variables and qualitative, subjective data that are descriptive and provide insight into “why” the intervention did or did not work. By combining these two research methods, we can more fully analyse the effects of the peer narrative support model from both subjective and objective perspectives.

Participatory action research approaches promote stakeholder consensus on scientifically feasible action strategies through practical activities. Therefore, if the peer narrative support model is successful, he seems to be able to train peers in narrative skills in an easy-to-understand way to help peers better carry out peer narrative support and have a positive experience in the support process. If the model is effective, it could serve as a reference for cancer rehabilitation associations across China to train peers and conduct divisional peer narrative support activities to facilitate cancer survivors’ return to work.

Limitations

The process of peer narrative support is a slow process that requires a conscious use of narrative techniques based on mutual trust between the supporting subject and object. Professional narrative skills must be translated into ways that are easy for peers to understand and use. This study constructed narrative discourse books for use with peers to enhance their narrative literacy. Considering the qualitative nature of the study, the conclusions cannot be generalised. Still, this study developed appropriate questionnaires supported by objective data, and they can provide guidance and insight for such studies.

Data availability

No datasets were generated or analysed during the current study.

References

  1. Sheppard DM, Frost D, Jefford M, O’Connor M, Halkett G. Beyond Cancer’: a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work. BMJ open. 2019;9(12):e032505.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fitch MI, Nicoll I. Returning to work after cancer: survivors’, caregivers’, and employers’ perspectives. Psychooncology. 2019;28(4):792–8.

    Article  PubMed  Google Scholar 

  3. Lilliehorn S, Hamberg K, Kero A, Salander P. Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women. Scand J Caring Sci. 2013;27(2):267–74.

    Article  PubMed  Google Scholar 

  4. Palmadottir G. The role of occupational participation and environment among Icelandic women with breast cancer: a qualitative study. Scand J Occup Ther. 2010;17(4):299–307.

    Article  PubMed  Google Scholar 

  5. Wang ML, Liu JE, Wang HY, Chen J, Li YY. Posttraumatic growth and associated socio-demographic and clinical factors in Chinese breast cancer survivors. Eur J Oncol Nursing: Official J Eur Oncol Nurs Soc. 2014;18(5):478–83.

    Article  Google Scholar 

  6. Cai YC, Wang JL, Zhang J, Yao NL, Sun XJ. Working status and influencing factors of cancer survivors in 5 counties of Shandong Province. Ournal Shandong Univ. 2017;55(04):96–100.

    Google Scholar 

  7. Yang SS, Lu JE, Su YL, Zhao Y, Liu YF. Analysis of the status quo of breast cancer patients returning to work and its influencing factors. Chin Nurs Manage. 2020;20(06):821–5.

    Google Scholar 

  8. Petersen KS, Momsen AH, Stapelfeldt CM, Olsen PR, Nielsen CV. Return-to-work intervention during cancer treatment - The providers’ experiences. Eur J Cancer Care. 2018;27(2).

  9. Xu JZY, Li J, Tang J, Hu X, Chen Y, Guo Y. Cancer patients’ return-to-work adaptation experience and coping resources: a grounded theory study. BMC Nurs. Mar 2023;10(1):66.

    Article  Google Scholar 

  10. Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud. 2003;40(3):321–32.

    Article  PubMed  Google Scholar 

  11. Marino P, Simoni JM, Silverstein LB. Peer support to promote medication adherence among people living with HIV/AIDS: the benefits to peers. Soc Work Health Care. 2007;45(1):67–80.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kesici S, Bayrakci Z, Birbilen AZ, Hanalioglu D, Öztürk Z, Teksam Ö, et al. Peer Education Model for Basic Life Support Training among High School children: a Randomized Trial. Prehosp Disaster Med. 2021;36(5):553–60.

    Article  PubMed  Google Scholar 

  13. Sansom-Daly UM, Wakefield CE, Bryant RA, Butow P, Sawyer S, Patterson P, et al. Online group-based cognitive-behavioural therapy for adolescents and young adults after cancer treatment: a multicenter randomised controlled trial of recapture Life-AYA. BMC Cancer. 2012;12:339.

    Article  PubMed  PubMed Central  Google Scholar 

  14. L L. A study of the effects of peer support intervention on psychological distress in young cancer patients: South Central University; 2022.

  15. Xiaoxuan HCX, Chao Zhang et al. Research progress on the effect of peer support on the fear of recurrence in cancer patients. Journal of Nursing. 2023:116 – 20.

  16. X C. A study on the impact of peer support on the quality of survival of peritoneal dialysis patients. Suzhou University; 2016.

  17. L J. Study on the effect of peer support on psychosocial adaptation of breast cancer patients: Nanchang University; 2020.

  18. T L. Research on the application of peer support education in gestational diabetes mellitus patients based on internet platform: Nanhua University; 2020.

  19. Kowitt EK SD et al. Carlisle V 2019 Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature. Support Care Cancer 27 1 97–108 Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature. Support Care Cancer 2019;27(1):97–108.

  20. Hanson LC, Armstrong TD, Green MA, Hayes M, Peacock S, Elliot-Bynum S, et al. Circles of care: development and initial evaluation of a peer support model for African americans with advanced cancer. Health Educ Behavior: Official Publication Soc Public Health Educ. 2013;40(5):536–43.

    Article  Google Scholar 

  21. Kim Y, Given BA. Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer. 2008;112(11 Suppl):2556–68.

    Article  PubMed  Google Scholar 

  22. Ohara C, Nishizono-Maher A, Sekiguchi A, Sugawara A, Morino Y, Kawakami J, et al. Individualized peer support needs assessment for families with eating disorders. Biopsychosoc Med. 2023;17(1):11.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Schippke J, Provvidenza C, Townley A. al. e. Peer support best practice.toolkit. http://www.hollandbloorview.ca/Assets/Evidence%20to%20Care/Peer%20support%20toolkit/Etc_Peer_Support_Section1_FA.pdf.2019.

  24. Additions&Mental Health Ontar io.Best practices in peer support. 2017f final report. http://www.mississaugahaltonlhin.on.ca/-media/sites/mh/Primary%20Navigation/Goals_Achievement/Program%20Area%20and%20lnitiatives/Mental_Health_and_Addictions/Peer_Support/Best%20Practices%20in%20Peer%20Support%20Final%20Report%202017.pdf?la=en.2019.

  25. Peer support. (Accreditation and Certification)Canada.National certification handbook version3 https://peersforprogress.org/wp-content/uploads/2017/03/170324-psacc-certification-handbook-2016.pdf2016.

  26. Sunderland K. W. M. Guildlines for the practice and training of peer support. http://www.mentalhealthcommision.ca.2019.

  27. Han LLJ, Xiao Y et al. Peer support in breast cancer patients with fertility concerns. China Nurs Manage. 2023:1564–8.

  28. Hu JWX, Guo S et al. Peer support interventions for breast cancer patients: a systematic review. Breast cancer research and treatment. 2019:325 – 41.

  29. Kong LN, Hu P, Zhao QH, Yao HY, Chen SZ. Effect of peer support intervention on diabetes distress in people with type 2 diabetes: a systematic review and meta-analysis. Int J Nurs Pract. 2020;26(5):e12830.

    Article  PubMed  Google Scholar 

  30. Zhang JZQ, Zhou J et al. Advances in peer support among parents of preterm infants. Chin J Nurs. 2022:245–51.

  31. Que WQ, Zhao JY, Tang J, Su XQ, Li JM, Gu CH et al. Peer Supporters’ Experience of Supporting Cancer Patients: A Meta-synthesis. Cancer Nurs 2023; Mar 3.

  32. Cunliffe A, Coupland C. From hero to villain to hero: making experience sensible through embodied narrative sensemaking. Hum Relat. 2012;65(1):63–88.

    Article  Google Scholar 

  33. Lewis B. Narrative and psychiatry. Curr Opin Psychiatry. 2011;24(6):489–94.

    Article  PubMed  Google Scholar 

  34. Iannello P, Biassoni F, Bertola L, Antonietti A, Caserta VA, Panella L. The role of Autobiographical Story-Telling during Rehabilitation among hip-fracture geriatric patients. Europe’s J Psychol. 2018;14(2):424–43.

    Article  Google Scholar 

  35. Wise M, Marchand LR, Roberts LJ, Chih MY. Suffering in Advanced Cancer: a Randomized Control Trial of a narrative intervention. J Palliat Med. 2018;21(2):200–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cleary EH, Stanton AL. Mediators of an internet-based psychosocial intervention for women with breast cancer. Health Psychology: Official J Div Health Psychol Am Psychol Association. 2015;34(5):477–85.

    Article  Google Scholar 

  37. Chen H, Xu J. Narrative and the Shaping of Doctor-Patient Community: a review of Narrative Medicine: A Story of respecting Disease. Cult J. 2022(03):39–42.

  38. Han QD. The temperature of Medicine. Decision. 2021;01:1005–5940.

    Google Scholar 

  39. Xiao SY, Jiang CQ. Clinical practice of narrative medicine in China: current situation, problems and countermeasures. Chin Med Ethics. 2022;35(04):362–7.

    Google Scholar 

  40. Li XZ, Cao ME, Deng JY, Cao MP, Ou LF. Effect of narrative therapy on the level of fear and hope for cancer recurrence in patients with nasopharyngeal carcinoma]. J Nurs. 2020;27(11):71–4.

    Google Scholar 

  41. Sun XY, Xu J, Jiang Y, Yang F, Hu JQ. Effects of peer narrative education on postoperative self-image and stigma in patients with head and neck cancer. Chin J Practical Nurs. 2022;38(16):1201–6.

    Google Scholar 

  42. Li JMGY, Gu LP, Zhou XY et al. The preparation and validity of the ready-to-work adjustment scale for cancer patients. PLA Nurs J. 2021;(08):1–4.

  43. Tang JGY, Que W et al. Construction of an adaptive return-to-work intervention program for cancer patients with the goal of rebuilding the self. Military Nursing. 2022:18–21.

  44. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet (London England). 2003;362(9391):1225–30.

    Article  PubMed  Google Scholar 

  45. Booth J, Tolson D, Hotchkiss R, Schofield I. Using action research to construct national evidence-based nursing care guidance for gerontological nursing. J Clin Nurs. 2007;16(5):945–53.

    Article  PubMed  Google Scholar 

  46. Williams AM, Dawson SS, Kristjanson LJ. Translating theory into practice: using Action Research to introduce a coordinated approach to emotional care. Patient Educ Couns. 2008;73(1):82–90.

    Article  CAS  PubMed  Google Scholar 

  47. M Q. Educational Action Research and its Determination Criteria Based on Scientific Norms. Modern Education Series. 2014:6–12.

  48. Yang Y. Construction and implementation of narrative nursing practice model. People’s Liberation Army Navy Medical University; 2020.

  49. Peer Support Accreditation and Certification (Cannada) (PSACC) National Certification Handbooks. 2016; Version 3.

  50. Zaharias G. What is narrative-based medicine? Narrative-based medicine 1. Can Family Physician Medecin De Famille Canadien. 2018;64:3:176–80.

    Google Scholar 

  51. Galanakis MDTE. Positive psychology in the working environment. Job demands-resources theory, work engagement and burnout: a systematic literature review. Front Psychol. 2022;13:1022102.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Cunningham JAHK, Kypri K, van Mierlo T. Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers. J Med Internet Res. 2006;8(2):e5.

    Article  PubMed  PubMed Central  Google Scholar 

  53. J L. Narrative-based primary care. A practical guide: Abington, UK: Radcliffe Medical; 2002.

  54. Ravinskaya M, Verbeek JH, Langendam MW, Madan I, Verstappen SMM, Kunz R, Hulshof CTJ, Hoving JL. A general framework for selecting work participation outcomes in intervention studies among persons with health problems: a concept paper. BMC Public Health. 2022;22(1):2189.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Efficace F, Boccadoro M, Palumbo A, Petrucci MT, Cottone F, Cannella L, Zamagni E, Niscola P, Kyriakou C, Caravita T, Offidani M, Mandelli F, Cavo M. A prospective observational study to assess clinical decision-making, prognosis, quality of life and satisfaction with care in patients with relapsed/refractory multiple myeloma: the CLARITY study protocol. Health Qual Life Outcomes. 2018;16(1):127.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Velickovic K, Rahm Hallberg I, Axelsson U, Borrebaeck C, A. K., Rydén L, Johnsson P, Månsson J. Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a non-clinical population in Sweden. Health Qual Life Outcomes. 2020;18(1):132.

  57. Riccetti N, Hempler I, Hermes-Moll K, Heidt V, Walawgo T, Singer S. Experience of office-based haematologists and oncologists with outpatient psycho-social support services for cancer patients with and without migration background in Germany. Journal of Cancer Research and Clinical Oncology.

  58. M-Y G. Application of the Zung Depression Self-Rating Scale in the care of cancer patients. Journal of Nursing. 1997.

  59. An Introduction to the Anxiety Self-Rating Scale. A clinical meta-analysis. 2010;25(04):304.

  60. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.

    Article  PubMed  PubMed Central  Google Scholar 

  61. C W. Progress of research on the clinical application of narrative nursing practice. Heilongjiang Med Sci. 2022:2941–4.

  62. D. W. Humanities in clinical medicine: dilemma and way out. Clinical medical humanities: dilemma and way out–and the significance of narrative medicine for clinical medical humanities. Chinese Journal of Orthopaedic Surgery. 2014.

  63. X Y. Metaphorical wisdom and narrative empowerment in the philosophy of pain. Med Philos. 2021:15–20.

  64. Avrahami ESR. Narrative medicine. Isr Med Assoc J. 2009;11(6):335–8.

    PubMed  Google Scholar 

  65. RM P. Narrative medicine. Ann Intern Med. 2001;135(10):929–30.

    Article  Google Scholar 

  66. Khan KS, Logan J, Justice LM, Bowles RP, Piasta SB. The contribution of Vocabulary, Grammar, and phonological awareness across a Continuum of Narrative ability levels in Young Children. Journal of speech, language, and hearing research. JSLHR. 2021;64(9):3489–503.

    PubMed  PubMed Central  Google Scholar 

  67. Reid-Searl K, DT, Happell B, Moxham L, Kahl J, Morris J, Wheatland N. Caring for children with complex emotional & psychological disorders: experiences of nurses in a rural paediatric unit. J Clin Nurs. 2009;18(24):3441–9.

    Article  PubMed  Google Scholar 

  68. Li PL, BL, Schwager G, Spain R, Ryan H, Oakman M, Firth J, Lockyer M, Harper D. Higgins I. Clinicians’ experiences of participating in an action research study. Contemp Nurse. 2010;35(2):147–56.

    Article  PubMed  Google Scholar 

  69. Garcı´a MA, SnRnF, Amoro´ s Cerda´ SM, Balaguer Albarracı´n F, Dı´ez Alcalde M, Dura´n Torres MT, Gonzalez Gascue M, Lastra Cubel P, Sanchez Calvin C, Zaforteza Lallemand C. Development of an attention guideline for the critical patient’s family. Enferm Intensiva. 2010;21(1):20–7.

    Google Scholar 

Download references

Acknowledgements

The authors wish to thank Nantong University for supporting this research.

Funding

This study was supported by the National Office for Philosophy and Social Sciences (Grant Number: 21BSH007).

Author information

Author notes

  1. Wenqian Que and XiaoYun Hu contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, 226001, China

    Wenqian Que, Tingting Wu, Yue Shi, Jingyi Zhao, Xiaoqin Su, Benxin Kuai & Yujie Guo

  2. Qidong People’s Hospital/Affliated Qidong Hospital of Nantong University, Nantong, Jiangsu, 226001, China

    Wenqian Que

  3. School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 210000, China

    Xiaoyun Hu

  4. Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, 226006, China

    Haiyin Zhang

Authors
  1. Wenqian Que
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Xiaoyun Hu
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Tingting Wu
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Haiyin Zhang
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Yue Shi
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Jingyi Zhao
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Xiaoqin Su
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Benxin Kuai
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Yujie Guo
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

All authors made significant contributions to the study design. YG, WQ designed the study. WQ, TW, XH, HZ, YS, JZ, XS, and BK prepared the first draft of the manuscript. WQ will conduct the statistical analysis of the data. YG provided participatory action research methodological expertise and will oversee the process evaluation. All authors commented on previous versions of the manuscript. All authors have read and approved the final draft.

Corresponding author

Correspondence to Yujie Guo.

Ethics declarations

Ethics approval and consent to participate

The Clinical Research Ethics Committee of Taizhou No. 2 People’s Hospital in Jiangsu Province, China, has approved this project (KY 2022-006-001). All methods will be conducted in accordance with the ethical standards of the Helsinki Declaration and the guidelines and regulations related to action research. All participants will sign an informed consent form, which will describe the objectives and characteristics of this study, as well as the confidentiality of relevant data. All participants have the autonomy to choose whether to participate in this study or to withdraw at any time during the study. Interview and observation data will be managed confidentially. Recordings will be deleted after transcription. Each interview and observation will be marked with a code and a list matching the individual’s identity, and the research team will securely store the code. This is a strictly supervised master’s research project, and the researcher will use the data from this research project to obtain a master’s degree in Emergency Critical Care Nursing. Several papers related to the results of the project will be published during the project. In order to protect participant information during the analysis and presentation of the data, data that may reveal the identity of the participant will be excluded or treated with special symbols such as “I work at…”.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Que, W., Hu, X., Wu, T. et al. Using peer narrative support to promote return to work for cancer survivors: a protocol study of action research. Arch Public Health 83, 21 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-024-01498-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-024-01498-9

Keywords

Archives of Public Health

ISSN: 2049-3258