Living with persistent insomnia after cancer: A qualitative analysis of impact and management
Living with persistent insomnia after cancer: A qualitative analysis of impact and management
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DOI：
10.1111/bjhp.12446
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发表时间：
2020-06-17
影响因子：
7.9
通讯作者：
Fleming, Leanne
中科院分区：
文献类型：
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作者：
Reynolds-Cowie, Paul;Fleming, Leanne
目的对混合诊断的癌症存活者的失眠障碍生活经历及其处理进行定性探讨。方法对27例乳腺癌、前列腺癌、结直肠癌和妇科癌症治疗结束后的持续性失眠患者进行了定性研究。符合DSM-5失眠障碍标准的11名男性和16名女性(平均年龄62岁)参与了四个焦点小组讨论之一，旨在探索癌症护理服务中持续性失眠的生活经历及其管理。结果在积极的癌症治疗完成后很长一段时间内，睡眠不佳一直是参与者的困扰。失眠对所有参与者的影响都很大，有六个关键领域受到的影响最大：气质、社交能力、身体健康、认知功能、人际关系和心理健康。在失眠管理方面，由于在癌症护理环境中缺乏专业的失眠专业知识，参与者经常求助于无效的自我管理策略。与失眠管理相关的三个主题出现了：自我管理，寻求专业干预，以及缺乏对睡眠的关注。临床医生缺乏对睡眠健康重要性的理解，以及缺乏基于证据的失眠干预措施，如失眠认知行为疗法(CBT-I)，这些都是癌症护理方面的重大差距。结论失眠对癌症存活者的生活质量有不利和普遍的影响，这种影响会持续很长一段时间。在整个癌症护理过程中，缺乏对睡眠的专业关注，这导致了睡眠的流行、持续和影响。为了打破这一循环，睡眠健康应该被整合为癌症治疗和康复的一个关键方面，就像保持健康的饮食和适当的体力活动一样。
Objectives To conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed-diagnoses cancer survivors. Methods Twenty-seven cancer survivors with persistent insomnia were recruited to this qualitative study following completion of treatment for breast (12), prostate (7), colorectal (7), and gynaecological (1) cancers. Eleven males and 16 females (mean age 62 years), who met DSM-5 criteria for insomnia disorder, contributed to one of four focus group discussions, designed to explore the lived experience of persistent insomnia and its management within cancer care services. Results Poor sleep was a persistently troubling complaint for participants, long after the completion of active cancer treatment. The impact of insomnia was significant for all participants, with six key domains emerging as those most affected: temperament, sociability, physical well-being, cognitive functioning, relationships, and psychological well-being. In terms of insomnia management, participants frequently resorted to unfruitful self-management strategies, due to the lack of professional insomnia expertise within cancer care settings. Three main themes emerged in relation to insomnia management: self-management, seeking professional intervention, and a lack of focus on sleep. A lack of clinician understanding of the importance of sleep health and the poor availability of evidence-based insomnia interventions, such as cognitive behavioural therapy for insomnia (CBT-i), were highlighted as important gaps in cancer care. Conclusions Insomnia was found to have a detrimental and pervasive impact on cancer survivors' quality of life, which persisted long into survivorship. There is an absence of professional attention to sleep throughout the cancer care trajectory, contributing to its prevalence, persistence, and impact. In order to break this cycle, sleep health should be integrated as a key aspect of cancer treatment and rehabilitation, much like maintaining a healthy diet and appropriate levels of physical activity.