Cancer survivors’ acceptability and perspectives on engagement with digital cognitive-behavioral therapy for insomnia: a mixed methods perspective

Purpose: Insomnia is one of the most prevalent, persistent, and impairing conditions for which cancer survivors want treatment. However, the evidence-based first-line treatment, cognitive-behavioral therapy for insomnia (CBT-I), is seldom available to cancer survivors. Digital CBT-I improves dissemination, but its impact depends on patients’ acceptance and preferences. We aimed to determine the acceptability of and explore perspectives of digital CBT-I for cancer survivors. Methods: Responses collected at study exit by 123 cancer survivors (mean age 47.1 years, 95.9% women, 76.4% breast cancer) who completed a digital CBT-I, OncoSleep, were analyzed using mixed methods. The exit survey included quantitative measures of acceptability, and qualitative insights were gathered through a free-response item. Responses were systematically coded and analyzed using deductive and inductive approaches to identify recurrent themes. Results: The digital CBT-I, OncoSleep, received high ratings for perceived efficacy, satisfaction, helpfulness, usability, likelihood of future use of therapeutic techniques, likelihood of recommendation, and user experience. Patients who showed clinically significant improvements in insomnia severity reported better user experience. Analyses revealed eight themes were relevant for engagement with treatment: clinician support and monitoring, interactive features and ease of use, perceived efficacy of treatment techniques, convenience and non-hospital setting, validation of unmet needs, sleep medication discontinuation, tailored treatment content, and empowerment. Conclusions: Results suggest digital CBT-I is well-accepted among cancer survivors. Digital CBT-I offers opportunities for treatment engagement.