Experiential Support Across Breast Cancer Care and Familial Breast Cancer Genetic Risk Assessment in Quebec, Canada: A Comparative Study of Accompanying Patients’ Contributions

CONTEXT: The integration of peer support by accompanying peers (APs) into oncology care settings enhances the patient's experience through the contribution of their experiential knowledge. APs play a key role in providing emotional support, active listening, information, and shared lived experiences. However, little is known about how different clinical settings-such as a genetic risk assessment and oncological treatment-influence how these contributions are expressed and perceived. OBJECTIVE: This study assessed whether the perceived contributions of accompanying peers (APs) varied across three groups of women involved in breast-cancer-related clinical pathways: (1) unaffected women undergoing familial breast cancer genetic risk assessment; (2) affected women undergoing familial breast cancer genetic risk assessment; and (3) affected women receiving breast cancer oncological care. METHOD: Encounters with APs were organized in two hospital-based settings in Quebec, Canada participating in the same program: a hereditary cancer risk assessment setting and an oncology care setting. Women were classified into three groups according to clinical pathway: Group 1, unaffected women undergoing familial breast cancer genetic risk assessment; Group 2, affected women undergoing familial breast cancer genetic risk assessment; and Group 3, affected women receiving breast cancer oncological care. Peer support was offered by the clinical team as part of the clinical pathway. These encounters were conducted by telephone, videoconference or in person in the healthcare setting. An online questionnaire, completed by the women in the days following the peer support encounter, assessed sociodemographic and clinical characteristics, the support experience, psychological distress (K6), cancer coping skills (CASE-cancer) and the APs' contributions. Prevalence ratios (PRs) were calculated to compare the proportions of women reporting APs' contributions across clinical pathways. The analysis was adjusted for age, education, parental status, partner status and employment status. Both settings were part of the same PAROLE-Onco implementation and relied on the same overall process for integrating APs, although they corresponded to different points along the breast-cancer-related care pathway. RESULTS: 101 women completed the questionnaire. Each woman received a single peer support encounter. Across all clinical settings, many women reported that the AP contributes by sharing her experience, offering support, listening to the patient, and providing information. Unaffected women who received peer support as part of the genetic risk assessment process perceived greater contributions from APs in terms of system navigation-such as preparing for medical appointments (p < 0.05) and during appointments (p < 0.05)-as well as in informed decision-making, notably by providing new perspectives on decision-making (p < 0.05). CONCLUSIONS: This study confirms the value of peer support across breast cancer clinical settings, while highlighting variations in their perceived contributions according to the clinical pathway. Unaffected women in the genetic risk assessment process reported greater support in system navigation and decision-making. These findings suggest an emerging role for APs in preventive care, where their experiential knowledge and guidance can actively support patients facing complex and anticipatory health decisions.