scholarly journals Barriers and Facilitators to Implementing a Stepped Care Cognitive-behavioral Therapy for Insomnia in Cancer Patients: a Qualitative Study.

2021 ◽  
Author(s):  
Josée Savard ◽  
Catherine Filion ◽  
Marie-Pierre Gagnon ◽  
Aude Caplette-Gingras ◽  
Lynda Bélanger ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Cancer Patients ◽  
Cancer Care ◽  
Behavioral Therapy ◽  
Stepped Care ◽  
Barriers And Facilitators ◽  
Cognitive Behavioral ◽  
Successful Implementation ◽  
Web Based

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, technologists, 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.

scholarly journals Barriers and Facilitators to Implementing a Stepped Care Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: A Qualitative Study.

2021 ◽  
Author(s):  
Josée Savard ◽  
Catherine Filion ◽  
Marie-Pierre Gagnon ◽  
Aude Caplette-Gingras ◽  
Lynda Bélanger ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Cancer Patients ◽  
Cancer Care ◽  
Behavioral Therapy ◽  
Individual Characteristics ◽  
Stepped Care ◽  
Prior Training ◽  
Web Based ◽  
Process Factors

Abstract BackgroundInsomnia affects between 30 to 60% of cancer patients and tends to become chronic when left untreated. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia. Yet, this treatment is not readily accessible. A stepped care intervention beginning with a self-administered (web-based) intervention appears to be a promising cost-effective approach to offer CBT-I in routine cancer care as compared to a standard face-to-face therapy. 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 in these clinical settings.MethodsNine focus groups composed of a total of 43 clinicians (e.g., physicians, nurses, nurse navigators, technologists, psychologists) and administrators, as well as 10 cancer patients were held. The Consolidated Framework for Implementing Research was used to develop the semi-structured interview and analyze the data.ResultsSleep difficulties are not systematically discussed in clinical practice and when a treatment is offered, most often, it is a pharmacological one. Based on the Consolidated Framework for Implementing Research, barriers to the implementation of a stepped care CBT-I included individual characteristics (e.g. lack of knowledge about CBT-I among cancer care providers, patients’ comorbidities and preferences); intervention characteristics (e.g., lack of internet access); inner setting characteristics (e.g., lack of time and resources, resistance to change); and process factors (e.g., need for prior training and engagement of all stakeholders). Facilitators were related to individual characteristics (e.g. strong beliefs in the efficacy of CBT-I); intervention characteristics (e.g. web-based format that increases accessibility at a lower cost, short- and long-term effects of CBT-I); and process factors (e.g. high motivation and commitment to offer a new service to patients).ConclusionsThis 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 provided that some conditions are met such as prior training and engagement of all stakeholders from the outset.

scholarly journals Barriers and Facilitators to Implementing a Stepped Care Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: A Qualitative Study.

2021 ◽  
Author(s):  
Josée Savard ◽  
Catherine Filion ◽  
Marie-Pierre Gagnon ◽  
Aude Caplette-Gingras ◽  
Lynda Bélanger ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Cancer Patients ◽  
Cancer Care ◽  
Behavioral Therapy ◽  
Individual Characteristics ◽  
Stepped Care ◽  
Prior Training ◽  
Web Based ◽  
Process Factors

Abstract BackgroundInsomnia affects between 30 to 60% of cancer patients and tends to become chronic when left untreated. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia. Yet, this treatment is not readily accessible. A stepped care intervention beginning with a self-administered (web-based) intervention appears to be a promising cost-effective approach to offer CBT-I in routine cancer care as compared to a standard face-to-face therapy. 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 in these clinical settings.MethodsNine focus groups composed of a total of 43 clinicians (e.g., physicians, nurses, nurse navigators, technologists, psychologists) and administrators, as well as 10 cancer patients were held. The Consolidated Framework for Implementing Research was used to develop the semi-structured interview and analyze the data.ResultsSleep difficulties are not systematically discussed in clinical practice and when a treatment is offered, most often, it is a pharmacological one. Based on the Consolidated Framework for Implementing Research, barriers to the implementation of a stepped care CBT-I included individual characteristics (e.g. lack of knowledge about CBT-I among cancer care providers, patients’ comorbidities and preferences); intervention characteristics (e.g., lack of internet access); inner setting characteristics (e.g., lack of time and resources, resistance to change); and process factors (e.g., need for prior training and engagement of all stakeholders). Facilitators were related to individual characteristics (e.g. strong beliefs in the efficacy of CBT-I); intervention characteristics (e.g. web-based format that increases accessibility at a lower cost, short- and long-term effects of CBT-I); and process factors (e.g. high motivation and commitment to offer a new service to patients).ConclusionsThis 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 provided that some conditions are met such as prior training and engagement of all stakeholders from the outset.

scholarly journals Barriers and Facilitators to Implementing a Stepped Care Cognitive-behavioral Therapy for Insomnia in Cancer Patients: a Qualitative Study.

2021 ◽  
Author(s):  
Josée Savard ◽  
Catherine Filion ◽  
Marie-Pierre Gagnon ◽  
Aude Caplette-Gingras ◽  
Lynda Bélanger ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Cancer Patients ◽  
Cancer Care ◽  
Behavioral Therapy ◽  
Individual Characteristics ◽  
Stepped Care ◽  
Prior Training ◽  
Web Based ◽  
Process Factors

Abstract Background: Insomnia affects between 30 to 60% of cancer patients and tends to become chronic when left untreated. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia. Yet, this treatment is not readily accessible. A stepped care intervention beginning with a self-administered (web-based) intervention appears to be a promising cost-effective approach to offer CBT-I in routine cancer care as compared to a standard face-to-face therapy. 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 in these clinical settings. Methods: Nine focus groups composed of a total of 43 clinicians (e.g., physicians, nurses, nurse navigators, technologists, psychologists) and administrators, as well as 10 cancer patients were held. The Consolidated Framework for Implementing Research 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. Based on the Consolidated Framework for Implementing Research, barriers to the implementation of a stepped care CBT-I included individual characteristics (e.g. lack of knowledge about CBT-I among cancer care providers, patients’ comorbidities and preferences); intervention characteristics (e.g., lack of internet access); inner setting characteristics (e.g., lack of time and resources, resistance to change); and process factors (e.g., need for prior training and engagement of all stakeholders). Facilitators were related to individual characteristics (e.g. strong beliefs in the efficacy of CBT-I); intervention characteristics (e.g. web-based format that increases accessibility at a lower cost, short- and long-term effects of CBT-I); and process factors (e.g. high motivation and commitment to offer a new service to patients). 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 provided that some conditions are met such as prior training and engagement of all stakeholders from the outset.

Efficacy of a stepped care approach to offer cognitive-behavioral therapy for insomnia in cancer patients

2019 ◽  
Vol 64 ◽  
pp. S337
Author(s):  
J. Savard ◽  
H. Ivers ◽  
A. Caplette-Gingras ◽  
C.M. Morin ◽  
S. Bouchard ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Cancer Patients ◽  
Behavioral Therapy ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Care Approach

scholarly journals Norwegian General Practitioners’ Perspectives on Implementation of a Guided Web-Based Cognitive Behavioral Therapy for Depression: A Qualitative Study

2014 ◽  
Vol 16 (9) ◽  
pp. e208 ◽  
Author(s):  
Maja Wilhelmsen ◽  
Ragnhild Sørensen Høifødt ◽  
Nils Kolstrup ◽  
Knut Waterloo ◽  
Martin Eisemann ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
General Practitioners ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Web Based

scholarly journals Patient Experiences of Web-Based Cognitive Behavioral Therapy for Heart Failure and Depression: Qualitative Study

10.2196/10302 ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. e10302 ◽  
Author(s):  
Johan Lundgren ◽  
Peter Johansson ◽  
Tiny Jaarsma ◽  
Gerhard Andersson ◽  
Anita Kärner Köhler
Keyword(s):  
Heart Failure ◽  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Patient Experiences ◽  
Cognitive Behavioral ◽  
Web Based

scholarly journals Patients’ Experiences of Telephone-Based and Web-Based Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Longitudinal Qualitative Study

10.2196/18691 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e18691
Author(s):  
Stephanie Hughes ◽  
Alice Sibelli ◽  
Hazel A Everitt ◽  
Rona Moss-Morris ◽  
Trudie Chalder ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Irritable Bowel Syndrome ◽  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Web Based ◽  
Randomized Controlled ◽  
Irritable Bowel

Background Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT. Objective Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results. Methods A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data. Results Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) included initial skepticism and concerns about the biopsychosocial nature of CBT, initial concerns about telephone-delivered talking therapy, challenges of maintaining motivation and self-discipline given already busy lives, and finding nothing new in the WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified. Conclusions Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants’ understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.

scholarly journals Patients’ Experiences of Telephone-Based and Web-Based Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Longitudinal Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Stephanie Hughes ◽  
Alice Sibelli ◽  
Hazel A Everitt ◽  
Rona Moss-Morris ◽  
Trudie Chalder ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Irritable Bowel Syndrome ◽  
Qualitative Study ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Web Based ◽  
Randomized Controlled ◽  
Irritable Bowel

BACKGROUND Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT. OBJECTIVE Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results. METHODS A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data. RESULTS Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) included initial skepticism and concerns about the biopsychosocial nature of CBT, initial concerns about telephone-delivered talking therapy, challenges of maintaining motivation and self-discipline given already busy lives, and finding nothing new in the WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified. CONCLUSIONS Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants’ understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.

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