Josée Savard1,2,3, Catherine Filion4,5, Marie-Pierre Gagnon6, Aude Caplette-Gingras5,7, Lynda Bélanger8, Charles M Morin9,10. 1. School of Psychology, Université Laval, 2325 Allée des Bibliothèques, Québec, QC, G1V 0A6, Canada. josee.savard@psy.ulaval.ca. 2. CHU de Québec-Université Laval Research Center, 11 Côte du Palais, Québec, QC, G1R 2J6, Canada. josee.savard@psy.ulaval.ca. 3. Université Laval Cancer Research Center, 11 Côte du Palais, Québec, QC, G1R 2J6, Canada. josee.savard@psy.ulaval.ca. 4. CHU de Québec-Université Laval Research Center, 11 Côte du Palais, Québec, QC, G1R 2J6, Canada. 5. Université Laval Cancer Research Center, 11 Côte du Palais, Québec, QC, G1R 2J6, Canada. 6. Faculté Des Sciences Infirmières, Université Laval, 1050 Avenue de la Médecine, Québec, QC, G1V 0A6, Canada. 7. Centre Des Maladies du Sein, CHU de Québec-Université Laval, 1050 ch Ste-Foy, Québec, QC, G1S 4L8, Canada. 8. CHU de Québec-Université Laval, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada. 9. School of Psychology, Université Laval, 2325 Allée des Bibliothèques, Québec, QC, G1V 0A6, Canada. 10. CERVO Brain Research Centre, 2301 avenue d'Estimauville, Québec, QC, G1E 1T2, Canada.
Abstract
PURPOSE: Insomnia affects 30-60% of cancer patients and tends to become chronic when left untreated. While cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment, this intervention is not readily accessible. This qualitative study investigated current practices in the assessment and management of insomnia in five hospitals offering cancer care and identified the barriers and facilitators to the implementation of a stepped care CBT-I (i.e., web-based CBT-I followed, if needed, by 1-3 booster sessions) in these settings. METHODS: Nine focus groups composed of a total of 43 clinicians (e.g., physicians, nurses, radiation therapists, psychologists), six administrators, and 10 cancer patients were held. The Consolidated Framework for Implementing Research (CFIR) was used to develop the semi-structured interview and analyze the data. RESULTS: Sleep difficulties are not systematically discussed in clinical practice and when a treatment is offered, most often, it is a pharmacological one. Barriers and facilitators to the implementation of a stepped care CBT-I included individual characteristics (e.g., lack of knowledge about CBT-I); intervention characteristics (e.g., increased accessibility offered by a web-based format); inner setting characteristics (e.g., resistance to change); and process factors (e.g., motivation to offer a new service). CONCLUSIONS: This qualitative study confirms the need to better address insomnia in routine cancer care and suggests that, while some barriers were mentioned, the implementation of a stepped care CBT-I is feasible. Keys to a successful implementation include accessibility, training, inclusion of stakeholders in the process, and ensuring that they are supported throughout the implementation.
PURPOSE: Insomnia affects 30-60% of cancer patients and tends to become chronic when left untreated. While cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment, this intervention is not readily accessible. This qualitative study investigated current practices in the assessment and management of insomnia in five hospitals offering cancer care and identified the barriers and facilitators to the implementation of a stepped care CBT-I (i.e., web-based CBT-I followed, if needed, by 1-3 booster sessions) in these settings. METHODS: Nine focus groups composed of a total of 43 clinicians (e.g., physicians, nurses, radiation therapists, psychologists), six administrators, and 10 cancer patients were held. The Consolidated Framework for Implementing Research (CFIR) was used to develop the semi-structured interview and analyze the data. RESULTS: Sleep difficulties are not systematically discussed in clinical practice and when a treatment is offered, most often, it is a pharmacological one. Barriers and facilitators to the implementation of a stepped care CBT-I included individual characteristics (e.g., lack of knowledge about CBT-I); intervention characteristics (e.g., increased accessibility offered by a web-based format); inner setting characteristics (e.g., resistance to change); and process factors (e.g., motivation to offer a new service). CONCLUSIONS: This qualitative study confirms the need to better address insomnia in routine cancer care and suggests that, while some barriers were mentioned, the implementation of a stepped care CBT-I is feasible. Keys to a successful implementation include accessibility, training, inclusion of stakeholders in the process, and ensuring that they are supported throughout the implementation.