Grant: Canada Postdoctoral Research Award (CPRA) program

Insomnia Disorder is a serious issue for patients with cancer, affecting up to 60% of people and leading to worse mental health, quality of life, and cancer prognoses. Guidelines from authorities in cancer care like the National Cancer Institute recommend Cognitive-Behavioural Therapy for Insomnia (CBT-I) as the #1 treatment over prescribed medications and these recommendations have become "Quality Standards" in Ontario that outline what is considered acceptable care for insomnia. Healthcare providers within cancer centres ("HCPs," like doctors and nurses) unfortunately do not regularly ask patients about their sleep or treat insomnia according to clinical guidelines. CBT-I is still not a part of routine care in Canadian cancer centres so most patients cannot access it, and they are instead given a prescription. Barriers exist that make it hard to access CBT-I: patients and HCPs do not know about CBT-I; patients may not be motivated or able to afford treatment; cancer treatments can be demanding; and HCPs often lack the time to ask about sleep. Our study will assess the barriers among patients and HCPs and test different strategies to overcome them to improve access to CBT-I in a large cancer centre. We will educate patients about insomnia treatments; ask them their preferences at different points in the cancer journey; and use their feedback to create a virtual "insomnia treatment hub" to connect patients to recommended treatments in line with their preferences. We will also ask HCPs about what they see as barriers; survey how they currently assess/treat insomnia; introduce the Quality Standards; develop solutions to overcome barriers to following them; and see if those solutions lead to real behaviour changes (like more sleep assessments, CBT-I referrals, and fewer prescriptions). By changing how insomnia is assessed and treated, we can improve the lives of cancer patients with insomnia by not only increasing their quality of life, but also by improving survival.