Table 2.

Summary of Facilitator Skills

Revised	Explanation	Example
Provide leadership	The facilitator manages group membership. The facilitator monitors group rules. The facilitator establishes and maintains group norms.	“I’ll send you a link so you can join the group.” “Please remember that our group rules prohibit political discussions.” “We like to have everyone introduce themselves to the group, telling everyone as much or little about themselves as they would like.”
Create a welcoming and safe environment	The facilitator welcomes new members and encourages others to do the same. The facilitator fosters group safety.	“Please join me in welcoming Mary to our group. Mary, we’re glad to have you in our circle of support.” “Thank you for sharing how you are feeling. Feelings are neither right nor wrong, and no one is here to judge you.”
Validate members’ feelings	The facilitator engages in empathetic communication.	“It sounds like your family members are criticizing the decisions you are making while being pretty unwilling to help out. It makes perfect sense that you are feeling frustrated.”
Communicate effectively	The facilitator thoughtfully considers the balance of positive and negative group content. The facilitator models appropriate use of humor. The facilitator seeks feedback on issues raised by group members.	“We’ve has some heavy discussion this week. I want to make sure people also feel welcome to share positive experiences. For those who would like to share, what is bringing you joy this week? “ Periodically post humorous content or memes, avoiding humor at the expense of particular groups of people. “I know last week was rough for many of you. How are you all feeling this week?”
Educate group members to provide clarification and facilitate responses to questions and concerns with the support of the healthcare team	The facilitator ensures accurate and adequate information is available and shared among group members.	In response to a group member’s post on using essential oils to address dyspnea: “The physician on our team recommends this article, which provides many ideas on how to improve shortness of breath.”
Resolve conflicts and foster group cohesion	The facilitator assists group members in resolving disagreements and frames conflict as an opportunity for growth.	“James, you seemed to have had a really strong response when Mary said she was looking into nursing home care for her husband. And, Mary, you indicated that James’ response made you question whether you wanted to stay in the group. Can we discuss that a bit more?”
Manage boundaries and orient members to facilitator and peer roles	The facilitator limits self-disclosure to instances when it is beneficial to the group. The facilitator clearly communicates boundaries regarding the frequency with which they are actively present in the group. The facilitator refers problems outside the purpose of the group to other providers.	“I wonder if you’re feeling nervous about your discussion with the hospice nurse tomorrow. Sometimes when I’m nervous, I feel sick to my stomach.” “Please remember that I only check posts once per day. If you have an urgent need, please contact your hospice team.” “It sounds like your hospice agency might be able to provide you with additional resources. I would suggest you speak to your hospice social worker about that.”
Encourage group member introspection regarding their group participation	The facilitator reminds group members to reflect on their reactions to group content and processes.	“We’ve talked a lot lately about what happens during the dying process. Some people find talking about dying to be a relief. For others, it can be overwhelming. How are you feeling? For those of you who are feeling overwhelmed, how will you take care of yourself? Remember that your hospice team is available if you would like to individually discuss any of the information we share in this group.”
Encourage engagement	The facilitator monitors group members’ interaction with group content such as videos or articles, and uses data to guide group work. The facilitator uses group features such as “tagging” to invite specific members to engage in group discussions. The facilitator poses direct questions to solicit group participation.	“It looks like not many people have had a chance to watch this week’s video on pain management. It’s full of great information, so be sure to check it out.” “It sounds like you’re spending a lot of time and energy keeping all your family members informed about your husband’s condition. @Kathy and @Roger, you were talking a while back about a program you used to keep everyone in the loop. Do you have any ideas to share?” “Let’s take a quick poll. How many of you had thought much about spiritual pain before reading this week’s article?”