Pay It Forward: Analysis of a novel peer-to-peer support initiative for individuals receiving treatment for head and neck cancer

PURPOSE: 'Pay It Forward' is a voluntary, anonymous peer-to-peer support initiative. During chemoradiotherapy (CRT) treatment for head and neck cancer, participants receive a handwritten card of support from someone who has completed the same treatment. After recovery, individuals write their own card to assist a future person undergoing CRT. This study examined participants' experience of the initiative and explored potential psychological benefits. METHODS: This single-centre prospective study used convenience sampling and mixed methods. Structured questionnaires were completed after receiving and writing cards. Semi-structured interviews were conducted at 12 weeks following completion of CRT. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. RESULTS: Thirteen individuals were recruited (12 male, median age 66 years). Twelve reported it was positive to receive support from another patient. From thirteen interviews (mean 15 min), two main themes encapsulating the core aspects of participants' perspectives were identified. Firstly, the therapeutic benefit and value of the card including subthemes of: instillment of hope and encouragement, personal reflection, and keeping the card safe and rereading it. The second theme described the perception that the card gave a sense of connectivity with subthemes about camaraderie, sharing with family and duty of care to future peers. CONCLUSION: Preliminary analysis indicates that this initiative supports patients when receiving a card during CRT, offering hope and solidarity, and when writing a card after treatment with benefits of reflection and altruism. Further research will evaluate the effectiveness and scalability of Pay It Forward across different clinical settings.