investigate this issue further. In such studies, efforts should be made to control
for sources of selection bias (such as the possibility that depressed persons turn
primarily to ESGs for support, while staying away from face-to-face groups).
A recent example of a well-designed study is the randomized controlled
trial (RCT) reported by Winzelberg et al.2 In this trial, a breast cancer ESG was
found to be an effective intervention for reducing participants' scores on
depression, perceived stress, and cancer-related trauma measures. The effect
size of the intervention was in the moderate range.
ESGs as navigation aids
If one accepts the notion that most of those who participate in ESGs may
benefit enormously from these interactions, then, how can the quality of ESGs
be assessed? I have argued3 that ESGs can be especially valuable as
navigation aids for those trying to find their way through the healthcare system. It
has been suggested by Farber et al.4 that navigation of the healthcare system
can be regarded as having four major components: coordination of care,
education/information, decision-making and self-care. These authors have also
proposed three types of outcome data as appropriate for an evaluation of the
navigator role: workload indicators, indicators of patient/client satisfaction, and
indicators of more systemic evaluation issues.4 It should be feasible to develop
indicators such as these that are suitable for use in the evaluation of ESGs.3
Because subscriptions to ESGs are usually free, the cost-effectiveness of such
ESGs as navigation aids is determined primarily by their effectiveness in this
role.
Of course, the needs of those dealing with breast cancer, for example,
depend on each person's particular situation or context:
! pre-diagnosis but high-risk;
! tentative diagnosis not yet confirmed;
! postdiagnosis but with therapeutic decisions yet to be made;
! postdiagnosis and postinitial treatment, but still recurrence free; and
! postrecurrence with metastases; etc.
So, the quality of navigation assistance provided for the various phases along
the trajectory of the cancer journey also needs to be taken into account in efforts
to evaluate the navigator role of ESGs.
Models of navigation
On the basis of their study, which addressed the status of the navigator
role for meeting the needs of women with breast cancer in Canada, Farber et al.4
identified three conceptual models. The first was the Active Coordination Model,
in which a navigator is actively involved in helping affected individuals. The
second was the Facilitating Navigator Model, in which the navigator provides