Grant: Project Grant

An abundance of psychosocial interventions has been developed and found to be efficacious in clinical trials conducted in academic settings to reduce psychological symptoms and improve quality of life of cancer patients. However, these interventions are not typically integrated in routine care thus resulting in a huge gap between the massive research evidence supporting their usefulness and what is actually done in the real-world. The consequence is that cancer patients do not receive the best available psychological interventions. Our research team is an international leader in the psychological treatment of cancer-related insomnia. In 2005, we published the first clinical trial supporting the efficacy of cognitive-behavioural therapy for insomnia (CBT-I) in cancer patients, a finding that has repeatedly been replicated since then. Despite the available evidence showing several beneficial effects associated with CBT-I, this treatment remains rarely offered. Recently, we developed a stepped care model in order to increase the use of CBT-I in routine care. It begins with a web-based CBT-I followed if needed (only if the patient still suffers from insomnia) by up to 3 sessions with a psychotherapist. Our findings indicate that this stepped care approach is as efficacious as a more standard face-to-face CBT-I while being much less costly. It is now time to implement this approach widely in routine cancer care. The main goals of this study are to ascertain factors that make it easier/harder to implement our stepped care CBT-I in 5 hospitals providing care to cancer patients, to evaluate the extent to which health care providers use it and administer it competently after it has been implemented and to assess its effects on patients' well-being. A pre-implementation quality study (Phase 1), a clinical trial (Phase 2) and a post-implementation quality study (Phase 3) will be performed.