Implementation of CBT-I in Cancer Clinics

Официальное название

Implementation of a Stepped Care Cognitive-Behavioral Therapy for Insomnia in Routine Cancer Care

Обзор

Insomnia affects 30-60% of cancer patients, thus making it one of the most common disturbances in this population. When untreated, which is the rule rather than the exception, insomnia often becomes chronic. Chronic insomnia is associated with numerous negative consequences (e.g., increased risk for psychological disorders, health care costs). A large body of evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in cancer patients, but CBT-I is still not offered routinely in cancer clinics. Self-administered CBT-I (e.g., video-based intervention) has been developed to increase patients' access to this treatment. However, results of clinical trials have suggested that these minimal treatments would be better used as a first step of a stepped care model. In stepped care, patients receive only the level of intervention they need. Generally, the entry level is a minimal, less costly, intervention (e.g., self-help intervention) followed by a more intensive form of treatment if needed (if the patient is still symptomatic). The investigators have recently assessed the efficacy of a stepped care model to administer CBT-I in cancer patients, which includes a web-based CBT-I (called Insomnet) followed by up to 3 sessions with a psychotherapist if the patient is still symptomatic. Results of this study suggest that this model of care is non-inferior to a standard face-to-face treatment (Savard, Ivers, et al., in revision), while being more cost-effective. A stepped care CBT-I could therefore be offered in routine cancer care clinics. This project will assess the feasibility and effectiveness of implementing a stepped care CBT-I in real-world cancer clinics, using a non-randomized stepped wedge design to compare the effects of our program (active phase) with a passive phase. The program is called Insomnia in Patients with Cancer - Personalized Treatment (IMPACT). The stepped care CBT-I (active intervention) is being implemented sequentially in the four participating hospitals over a number of equally spaced time periods of 4 months (wedges), for a total of 5 time points, over a period of 20 months.

Вмешательства

• Поведенческое Web-based cognitive-behavioral therapy for insomnia (CBT-I)
  Each week, the patients first have to read written information on the website (www.insomnet.ca), and then watch a video capsule (duration between 5 and 20 min each). Patients complete their daily sleep diary electronically on the website and the content is interactive. It includes the sending of automated emails to remind participants to complete the treatment tasks and encourage adherence, provision of tailored feedback (e.g., texts, charts) based on the information that they provide in their s
• Поведенческое Professionally-administered booster face-to-face CBT-I sessions
  Patients who obtain an ISI score of 8 and more after completing the web-based CBT-I are "stepped up" and offered to receive up to three 50-min booster sessions of CBT-I offered individually by a psychologist (if needed). Remitted patients (good sleepers; ISI score lower than 8) will receive no further treatment.

Первичные конечные точки

• Implementation (organizational) measures [Срок оценки: Passive phase (4 months) vs. active phase (20 months), through study completion, an average of 24 months]
• 1) Change in Insomnia Severity Index Scores [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 2) Change in sleep efficiency (SE) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 3) Change in sleep onset latency (SOL) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 4) Change in wake after sleep onset (WASO) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 5) Change in total wake time (TWT) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 6) Change in total sleep time (TST) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 7) Hospital Anxiety and Depression Scale (HADS) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 8) Fatigue Symptom Inventory (FSI) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 9) The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]

Вторичные конечные точки (8)

• 1) Demographic characteristics [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later) for patient; Through study completion (an average of 24 months) for clinicians]
• 2) Evidence-Based Practice Attitudes Scale (EBPAS) [Срок оценки: Through study completion, an average of 24 months]
• 3) Workplace Stress Scale (WSS) [Срок оценки: Through study completion, an average of 24 months]
• 4) Organizational Readiness for Implementing Change (ORIC) [Срок оценки: Through study completion, an average of 24 months]
• 5) Clinicians expertise [Срок оценки: Through study completion, an average of 24 months]
• 6) Internet Evaluation and Utility Questionnaire (IEUQ) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• 7) Brief Health Literacy Screening Tool (BRIEF) [Срок оценки: Pre-treatment and post-treatment (6-8 weeks later)]
• Possible moderating treatment effect [Срок оценки: Pre-treatment (at recruitment)]

Критерии участия

Критерии включения

• have received a diagnosis of non-metastatic cancer (any type)
• to be aged 18 years and older
• to be readily able to read and understand French or English
• having the minimum cognitive abilities to read, understand and memorize information
• having access to Internet

Критерии исключения

• having a psychological comorbidity needing clinical attention (e.g., major depressive disorder)
• having severe cognitive impairments (e.g., diagnosis of Parkinson's disease, dementia)
• having insomnia due to a temporary condition (e.g., acute pain, short-term medication side effects, environmental factors)

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Последовательный дизайн

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Канада · 1 центр

• Centre de recherche de L'Hôtel-Dieu de Québec — Québec

Идентификаторы

NCT: NCT04817163 · IC118713

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗