0589 Stepped-Care Management of Insomnia: Patient Treatment Choices in a Pragmatic Clinical Trial Setting
Bibliographic record
Abstract
Abstract Introduction Informing patients about prospective options for managing insomnia remains challenging in practice given the competing risk-benefit profiles between options. This study evaluated patient treatment choices for insomnia as part of a pragmatic clinical trial for a two-phase cognitive behavioral therapy for insomnia (CBT-I) intervention. Methods Upon enrollment, participants (N=154, 73% women, mean age: 51.8 ± 14.2 years) were guided by a patient decision aid (PtDA), outlining the risk-benefit profiles of in-person CBT-I, digital CBT-I (dCBT-I), and medication. In phase-1, participants were offered a choice between dCBT-I, dCBT-I + medication or medication only. Non-remitters were enrolled into phase-2 (N=69), choosing between in-person CBT-I, medication, or no further treatment. A secondary analysis was conducted evaluating patient treatment choices and the acceptability of the PtDA. The presence of decisional conflict with treatment choice(s) was screened using the 4-item SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) checklist. Results In phase-1, 47.4% (n= 73) of participants chose dCBT-I, followed by dCBT-I + medication (42.3% n=66) and medication (9.74%; n=15). The dCBT-I group were less likely to use medications compared to the other two treatment groups (p < 0.001). Men (p = 0.032) and individuals less motivated to change sleep habits (p=0.014) were more likely to choose medication only in phase-1. In phase-2, 60.9% (n=42) of non-remitters chose in-person CBT-I, followed by no further treatment (23.6%; n=16) and medication (15.9%; n=11). Non-remitters from the medication group were more likely to choose medication again in phase-2 (p< 0.001). Decisional conflict (i.e., SURE score < 4) was only observed in 6% (n=9/154) and 3% (n=2/59) of participants across phase-1 and phase-2, respectively. With respect to acceptability, over 90% of participants (n=145/154; n=57/59) endorsed the PtDA as easy to understand, easy to read, clarified their treatment preferences, and facilitated decision-making. Conclusion The PtDA was endorsed as acceptable and appeared to address the decisional conflict that often arises when choosing between insomnia treatments. This may explain the higher-than-expected uptake of dCBT-I and CBT-I, warranting further research on the impact of PtDAs on insomnia treatment outcomes. Support (if any) This study was funded by the Canadian Institutes for Health Research (Grant #353509).
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".