An Innovative Ambulatory Nurse Training Program, SBIRT, Improves Oncology Patients' SLEEP

Introduction: Evidence suggests patients with cancer experience sleep disruption or sleep-wake disturbances before diagnosis, during cancer treatment, and for a long time after completing treatment (Berger, Matthews, Kenkel, 2017). The effects of poor sleep, occurring in nearly 40% of cancer survivors, include poor wound healing, an increased chance of cancer recurrence, decreased cognitive functioning, decreased work productivity, increased safety issues, medication misuse, and abuse, poor moods, and relationships, lower quality of life (QOL), and increased healthcare costs. Although research has indicated the pervasiveness of sleep disturbances, it also suggests that provider communication, assessment, and treatment of sleep-wake disturbances are sub-optimal (Berger, Matthews, Kenkel, 2017). Ambulatory nurses are well positioned for a training program to provide sleep screening, brief intervention, and referral for treatment (Sleep SBIRT) to improve sleep quality and ultimately improve outcomes.

Methods: A pilot feasibility and acceptability study is proposed. Data will be collected from patients with a thoracic, gynecologic, and/or dermatologic cancer diagnosis and a positive response to one of four sleep screening questions from the dysfunctional beliefs and attitudes about sleep scale (Morin et al., 2007). Any positive response will illicit a brief educational discussion by the SBIRT-trained nurses. Following the intervention, the sleep screening questions will be repeated to determine efficacy of the education along with completion of the Holland sleep disorders questionnaire (HSDQ), a 32-item survey used to screen for a variety of sleep disorders including sleep disordered breathing, circadian rhythm sleep disorders, parasomnias, narcolepsy, restless legs syndrome, and insomnia (Kerkhof et al., 2013). The HSDQ has good construct validity (6-factors, accounting for 55.7% variance), internal reliability (Cronbach’s alpha 0.90 total score; coefficients ranged from 0.73-0.81 for 6 different categories of individual sleep disorders), and diagnostic accuracy (84.5% of participants were classified correctly). Screen positive for anything other than insomnia will trigger a referral for back to primary care for further evaluation. Insomnia patients will be provided with a brief behavioral intervention provided by the nurses with a one-week follow-up to determine further treatment or resolution determined by repeating the four sleep screening questions from the dysfunctional beliefs and attitudes about sleep scale and the HSDQ. demographic and sleep screening questionnaires will be summarized using descriptive statistics (means, frequencies, confidence intervals). Post-test results will be compared with pre-test results using parametric vs. nonparametric tests depending on normality of the data.

Results: Following IRB approval, data analysis and final outcomes from the study will be available to share at the AAACN Conference.

Conclusion: Next steps will include reporting results to nursing leadership (feasibility and acceptability), adding sleep questions to electronic health record, and expanding this sleep SBIRT program to other ambulatory clinics.