title: A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer.
abstract: OBJECTIVE
  Peer-to-peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer. Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships, usually without professional moderation. This paper reports findings from the first randomized, controlled study of the benefits of these types of Internet-based peer interactions.
  
  
  METHODS
  This pilot study involved seventy-eight women who were recently diagnosed with breast cancer. Participants were randomly assigned to either an Internet peer support condition or Internet-based educational control condition. Data were gathered at baseline and 4- and 12-months. Primary outcomes of interest were psychological distress and quality of life.
  
  
  RESULTS
  Contrary to hypotheses, participants in the Internet peer support condition tended to do worse over time on primary outcome measures. There were no differences between groups on secondary outcomes of perceived social support, self-efficacy, or hope. Paradoxically, many women in the Internet peer support condition actively participated and reported high levels of satisfaction, suggesting some self-perceived benefits.
  
  
  CONCLUSIONS
  These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants. Further research is needed to understand the magnitude of this effect with a larger sample. Moreover, these results raise questions about the need to understand the comparative effectiveness of Internet-based communications by group structure (i.e., unstructured/structured; unmoderated/moderated) and the effect of content (i.e., expression of fear/anxiety, insightful disclosures, etc.) on outcomes.
authors.affiliation: University of Pennsylvania, Philadelphia, PA 19104, USA. Mark.Salzer@uphs.upenn.edu
authors.forename: Mark S
authors.initials: MS
authors.lastname: Salzer
authors.forename: Steven C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Katy
authors.initials: K
authors.lastname: Kaplan
authors.forename: Eugene
authors.initials: E
authors.lastname: Brusilovskiy
authors.forename: Thomas
authors.initials: T
authors.lastname: Ten Have
authors.forename: Maggie
authors.initials: M
authors.lastname: Hampshire
authors.forename: James
authors.initials: J
authors.lastname: Metz
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
mesh_terms: D000223:Adaptation, Psychological; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D020407:Internet; D017063:Outcome Assessment, Health Care; D010379:Peer Group; D011581:Psychological Tests; D011788:Quality of Life / Q000523:psychology; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology