Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors.

BACKGROUND: African American breast cancer survivors may be at high risk for reproductive health problems, including menopause symptoms, sexual dysfunction, and distress about cancer-related infertility. The authors partnered with Sisters Network Inc. to create the Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT) program, a culturally sensitive intervention program that combined a written workbook and peer counseling. METHODS: Three hundred women were randomized to receive either the workbook plus 3 in-person sessions with a trained peer counselor or the workbook plus ≤ 30 minutes of telephone counseling to be initiated by the participant. Questionnaires at baseline, post-treatment, and at 6-month and 12-month follow-up assessed emotional distress, sexual function, relationship satisfaction, spirituality, menopause symptoms, and knowledge. Satisfaction with the program and the use of medical care also were assessed. RESULTS: Both groups of women improved significantly in knowledge, decreased in distress, and had decreased hot flashes. Sexually active women had improved sexual function at 6-month follow-up but not at 1 year. However, peer counseling had little incremental benefit over the telephone counseling. CONCLUSIONS: The SPIRIT program was rated very useful by 66% of women. Outcomes justify continued use of the workbook and further research to optimize the impact of peer counseling.

Interrater reliability of scores derived from two methods for scoring the clock drawing test.

Scores on the Clock Drawing Test have long been considered a useful screening tool for neuropsychological dysfunction, and a number of scoring methods have been developed to evaluate various aspects of performance. This study compared quantitative and qualitative scoring by briefly trained students on 145 clock drawings produced by patients in a geriatric psychiatry outpatient clinic to estimate the interrater reliability of the methods, user's acceptance of the methods, and whether the methods provide differential diagnosis. Both systems showed acceptable interrater reliability. Using the quantitative method, raters scored drawings by patients with organic mental disease as more impaired than those patients diagnosed as depressed or schizophrenic. Results suggest that the Clock Drawing Test is a reliable screening tool for cognitive impairment in a geropsychiatric population, but the scoring methods examined do not yet appear psychometrically sound enough to provide a differential diagnosis.

Randomized trial of peer counseling on reproductive health in African American breast cancer survivors.

PURPOSE: We designed a peer counseling program to improve sexual function, increase knowledge about reproductive health, and decrease menopausal symptoms and infertility-related distress for African American breast cancer survivors. PATIENTS AND METHODS: Women were randomly assigned to immediate counseling or a 3-month waitlist. Three peer counselors conducted a 3-session intervention using a detailed workbook. Questionnaires at baseline, after the waitlist period, at posttreatment, and at 3-month follow-up assessed spirituality, sexual function, menopause symptoms, emotional distress, relationship satisfaction, fertility concerns, and knowledge about reproductive health and breast cancer. At the postcounseling assessment, women rated the workbook, their counselor, and the program. RESULTS: Of 93 women screened, 60 women (65%) enrolled in the study. Women who completed counseling (80%; N = 48) had a mean age of 49 years (standard deviation [SD], 8 years) and a mean follow-up of 4.5 years (SD, 3.8 years) since cancer diagnosis. Almost all rated the workbook as very easy to understand (94%) and their counselor as very knowledgeable (96%) and very skillful (98%). Eighty-one percent rated the program as "very useful to me." Immediate counseling and waitlist groups did not differ at baseline in psychologic adjustment, nor did scores change during the waitlist period. Therefore, the groups were combined in analyzing outcomes. Knowledge of reproductive issues improved significantly from baseline to 3-month follow-up (P < .0001), as did emotional distress (P = .0047) and menopause symptoms (P = .0128). Sexually dysfunctional women became less distressed (P = .0167). CONCLUSION: Women valued the Sisters Peer Intervention in Reproductive Issues After Treatment program highly and found it relevant. The program had positive effects on knowledge and target symptoms.