The adherence and response of a combined approach of online self-help cognitive behavioral therapy and phone-based psychological guidance among French patients with cancer with insomnia.
Bibliographic record
Abstract
12100 Background: Insomnia affects 30–60% of patients with cancer. Cognitive behavioral therapy for insomnia (CBT- I) is the gold-standard treatment for insomnia. However, the uptake of CBT-I in routine care remains low. Technology can be leveraged to facilitate the access and delivery of CBT-I. Nevertheless, adherence rates to online self-help interventions seem low (50-60%), and is associated with reduced intervention efficacy. The Sleep-4-All-2.0 is a prospective multicentric single arm study that evaluated an approach that combined a validated online self-help CBT-I program (Insomnet, 6 modules) to a phone-based guidance with a psychologist (3 orientation meetings). This study assessed: 1) how this combined approach performed in terms of adherence, behavior change and insomnia remission rates compared to prior literature investigating self-help CBT-I, and 2) the patients’ characteristics that are associated with a better or a poorer response. Methods: Data were collected with online questionnaires to compare outcomes: adherence (5 to 6 modules completed), behavior change (ad hoc questionnaire), insomnia remission (Insomnia Severity Index, ISI < 8), sleep perception (ad hoc questionnaire), response to the program (changes in ISI score) at post intervention (week 6, 12 and 24). A descriptive analysis of patient characteristics at each time point was performed. Then, multivariate analyses were conducted: mixed models with a random effect at patient level (repeated measures) and fixed effects for the other variables. The following variables at baseline were used in the adjusted models: socio-demographic and clinical variables, ISI score, symptoms (ESAS), digital skills, barriers to change, motivation, social support and the referring professional. Results: Among the 348 patients included: 79% were women, 59% had breast cancer and 68% were undergoing treatment. A total of 310 patients (89%) initiated Insomnet. The adherence rate was 74% and 79% have changed their behavior. Insomnia remission rates were 34%, 46% and 50% at week 6, 12 and 24, respectively. Insomnia was no longer a problem for 48%, 63% and 66% at week 6, 12 and 24, respectively. Female gender (β=-1.22; p=0.05) and unemployed patients (β=-1.77; p<0.01) were associated with a decrease in ISI scores. Sleep medication (β=1.58; p<0.01), patients with a high sleepiness score (ESAS) (β=0.25; p=0.02) and patients with less digital skills (β=1.85; p<0.01) were associated with an increase in ISI scores. Conclusions: A combination of online self-help CBT-I with phone-based guidance showed satisfactory rates of program adherence, change behavior and insomnia remission. However, some patient profiles such as the ones with lower digital skills and severe insomnia at baseline seemed to benefit less from this approach, and may require further care intensification. Clinical trial information: CONVENTION DE RECHERCHE no. 2020-1-PL SHS-03-IGR-1.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.003 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".