0388 Why do Patients Drop-out from Cognitive Behavioral Therapy for Insomnia (CBT-I)? A Qualitative Interview Study. (12th April 2019)

• Record Type: Journal Article
• Authors: Koffel, Erin; Wisdom, Jennifer
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A157
• Page End: A158
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz067.387
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Although CBT-I is the recommended treatment for insomnia, it can be challenging for patients. Poor adherence often limits treatment gains. Only half of patients consistently adhere to CBT-I treatment recommendations, and up to 40% prematurely drop out of treatment. Research has identified several factors related to adherence in patients with insomnia, including beliefs about the value of sleep treatment, medical and mental health comorbidities, and baseline symptom severity. Qualitative research is needed to provide CBT-I patient and provider perspectives to substantiate theories for treatment drop-out and to develop adherence promoting strategies. The current qualitative study sought to explore perspectives on adherence barriers (i.e., practical barriers, self-efficacy, maladaptive beliefs/cognitions, comorbidities and medication treatment side-effects like sleepiness, ) and suggestions for facilitating treatment completion. Methods: We conducted individual semi-structured interviews with 17 Veterans with chronic pain and insomnia who had recently participated in CBT-I, with 10 identified as completers in the medical record and 7 identified as prematurely discontinuing therapy. Thematic analysis was used to identify conceptual themes. After all coding was complete, the analysis team met to organize coded data into categories and to identify higher order themes. Results: Of the 7 patients identified in the medical record as prematurely discontinuing CBT-I, all reported some degree of improvement in sleep and expressed appreciation of CBT-I. Reasons for discontinuing CBT-I varied: satisfaction with current sleep (n=3); assumed that they had successfully completed CBT-I (n=2);, too busy to attend medical appointments (n=1); and surgery that interfered with treatment (n=1). Compared to patients who successfully completed treatment, those who discontinued reported more barriers related to scheduling and transportation. Patients and providers differed in their perceptions of how treatment ended; due to lack of communication, providers may not realize that patients discontinue treatment due to satisfaction with sleep. Conclusion: Efforts to increase CBT-I uptake and adherence should focus on increasing accessibility and feasibility. There may also be a need for improved communication between patients and providers regarding reasons for therapy termination. Support (If Any): VA HSRD CDA 15-063