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| Name | Class |
|---|---|
| Canadian Institutes of Health Research (CIHR) | OTHER_GOV |
| Canadian Cancer Society (CCS) | OTHER |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stepped care CBT-I | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Web-based cognitive-behavioral therapy for insomnia (CBT-I) | Behavioral | 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 sleep diary, as well as quizzes with automated correction to reinforce patients' understanding of the content. |
| Measure | Description | Time Frame |
|---|---|---|
| Implementation (organizational) measures | Referral, enrolment and completion rates to the stepped care CBT-I in each clinical setting. | Passive phase (4 months) vs. active phase (20 months), through study completion, an average of 24 months |
| 1) Change in Insomnia Severity Index Scores | Change in Insomnia Severity Index Scores from pre- to post-intervention. The ISI is a 7-item questionnaire designed to evaluate insomnia severity. A score greater than or equal to 8 indicates the presence of insomnia symptoms. | Pre-treatment and post-treatment (6-8 weeks later) |
| 2) Change in sleep efficiency (SE) | Change in daily sleep diary parameters from pre- to post-intervention: Change in sleep efficiency (SE) index (%) = Total sleep time/total time spent in bed X 100. | Pre-treatment and post-treatment (6-8 weeks later) |
| 3) Change in sleep onset latency (SOL) | Change in daily sleep diary parameters from pre- to post-intervention: Change in sleep onset latency (SOL) = Time to sleep after lights out. | Pre-treatment and post-treatment (6-8 weeks later) |
| 4) Change in wake after sleep onset (WASO) | Change in daily sleep diary parameters from pre- to post-intervention: Change in wake after sleep onset (WASO) = Summation of nocturnal awakenings. | Pre-treatment and post-treatment (6-8 weeks later) |
| 5) Change in total wake time (TWT) | Change in daily sleep diary parameters from pre- to post-intervention: Change in total wake time (TWT) = Summation of SOL, WASO, and early morning awakening. |
| Measure | Description | Time Frame |
|---|---|---|
| 1) Demographic characteristics | Clinicians and patients' demographics (e.g., age, sex) | 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) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Josée Savard, Ph.D. | Contact | 418-525-4444 | 20622 | josee.savard@psy.ulaval.ca |
| Name | Affiliation | Role |
|---|---|---|
| Josée Savard, Ph.D. | Centre de recherche du CHU de Québec-Université Laval | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre de recherche de L'Hôtel-Dieu de Québec | Recruiting | Québec | G1R 2J6 | Canada |
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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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.
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| Professionally-administered booster face-to-face CBT-I sessions | Behavioral | 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. |
|
| Pre-treatment and post-treatment (6-8 weeks later) |
| 6) Change in total sleep time (TST) | Change in daily sleep diary parameters from pre- to post-intervention: Change in total sleep time (TST) = Time in bed minus total wake time. | Pre-treatment and post-treatment (6-8 weeks later) |
| 7) Hospital Anxiety and Depression Scale (HADS) | Change scores from pre to post-intervention: Hospital Anxiety and Depression Scale (HADS): A 14-item questionnaire comprising 7 items assessing depression and 7 items assessing anxiety. Scores obtained for each subscale range from 0 to 21. | Pre-treatment and post-treatment (6-8 weeks later) |
| 8) Fatigue Symptom Inventory (FSI) | Change scores from pre to post-intervention: Fatigue Symptom Inventory (FSI): A 14-item questionnaire measuring perceived fatigue. Each item is rated on an 11-point Likert scale, ranging from 0 to 10. A higher score indicates a higher level of fatigue or interference or a longer duration of fatigue. | 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) | Change scores from pre to post-intervention: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): A 30-item questionnaire. Scores are transformed to give a score ranging from 0 to 100. | Pre-treatment and post-treatment (6-8 weeks later) |
| 10) Satisfaction with Life Scale (SWLS) | Change scores from pre to post-intervention: Satisfaction with Life Scale (SWLS): A 5-item questionnaire (Likert scale from 1 to 7) designed to measure global cognitive judgments of satisfaction with one's life. | Pre-treatment and post-treatment (6-8 weeks later) |
| 1) Psychologists' adherence to the protocol | Psychologists' self-assessed adherence to the CBT-I protocol (%) | Throughout the active phase, up to 20 months |
| 2) Psychologists' perceived self-efficiency | Psychologists' perceived self-efficiency in using CBT-I protocol (%) | Throughout the active phase, up to 20 months |
Administrators' and clinicians' attitude towards empirically-based treatments (Evidence-Based Practice Attitudes Scale (EBPAS; 15 items)): Scores obtained range from 0 to 60. |
| Through study completion, an average of 24 months |
| 3) Workplace Stress Scale (WSS) | Stress at work (Workplace Stress Scale (WSS; 8 items)): Scores obtained range from 8 to 40. | Through study completion, an average of 24 months |
| 4) Organizational Readiness for Implementing Change (ORIC) | Attitude towards change (Organizational Readiness for Implementing Change (ORIC; 12 items)): Participants rated the hospital's readiness for implementation on 12 items using a 5-point ordinal scale that ranged from "disagree" (1) to "agree" (5). | Through study completion, an average of 24 months |
| 5) Clinicians expertise | Clinicians' CBT expertise (number of years of experience with CBT) | Through study completion, an average of 24 months |
| 6) Internet Evaluation and Utility Questionnaire (IEUQ) | Patients' familiarity with the Internet (Internet Evaluation and Utility Questionnaire (IEUQ; 15 items)): Patients respond to the questions on a 5-point likert scale from "not at all" (0) to "very" (4), with 2 open-ended items asking patients to identify "most helpful" and "least helpful" parts of the web program. | Pre-treatment and post-treatment (6-8 weeks later) |
| 7) Brief Health Literacy Screening Tool (BRIEF) | Health literacy (Brief Health Literacy Screening Tool (BRIEF; 4 items)): Each item ranges from 1 to 5 and total scores range from 4 to 20. | Pre-treatment and post-treatment (6-8 weeks later) |
| Possible moderating treatment effect | Possible moderating treatment effect by some of the participants' characteristics (e.g., age, sex, cancer site). | Pre-treatment (at recruitment) |
| D001523 |
| Mental Disorders |