Janet M. Y. Cheung

The Insomnia Patient Perspective, A Narrative Review

Insomnia is a common sleep disorder associated with substantial direct and indirect costs, yet there is a strong propensity among patients to self-medicate which often delays professional help. Understanding the process which underpins the initiation, engagement and adherence to insomnia treatment(s) is a vital step for understanding this phenomenon. The current paper explores how the patient perspective has been conceptualized in the research literature and its implications for insomnia treatment and health care delivery. A literature search was conducted using Embase, Medline and PsycINFO databases. Articles have been thematically organized into patient correlates of health behaviors, patient experiences and treatment attitudes. Deferral of professional help among insomnia patients is partially related to barriers embedded in the health care system and patient health beliefs.

To Drug or Not to Drug: A Qualitative Study of Patients' Decision-Making Processes for Managing Insomnia.

Treatment preferences play a key role in dictating sleep health outcomes. However, patients’ treatment beliefs, attitudes, and experiences that inform preference conceptualization remain an unknown phenomenon. Therefore, this study aims to explore patient perceptions toward pharmacotherapy and the nonpharmacological management of insomnia. Fifty-one patients with insomnia were recruited from specialist clinics and general community settings. Participants completed a brief questionnaire followed by an in-depth semistructured interview that was digitally recorded, transcribed verbatim, and subjected to Framework Analysis to identify emergent themes. Three key themes were identified: Resolving Insomnia, Self-Imposed Treatment Boundaries, and Treatment Uptake. Patients’ illness, treatment, and psychosocial beliefs and experiences are closely linked to treatment choice. Being attuned to these influences during the clinical encounter can facilitate treatment selection that is meaningful for the patient.

Treating Insomnia: A Review of Patient Perceptions Toward Treatment

Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients’ global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients’ perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed.

People with insomnia: experiences with sedative hypnotics and risk perception

Sedative hypnotics form an important part of managing insomnia and are recommended for short‐term use. It is standard practice for clinicians to inform the patient to use medications only ‘when required’, but the use of these medications is often chronic. Little is known about the impact of standard labelling/instructions on promoting appropriate medication use for managing insomnia.

Pharmacists' perceptions and communication of risk for alertness impairing medications

Background A core role of the pharmacist is to ensure safe and effective medication use. Therapeutic classes that impair alertness (e.g. sedatives or hypnotics) can pose safety concerns for the consumer when undertaking activities requiring psychomotor vigilance (e.g. driving). Objective To explore pharmacists’ perceptions and communication strategy of the risks related to alertness impairing medications in clinical practice. Methods In‐depth semi‐structured interviews explored community pharmacists’ perceptions of medication‐related risks, current medication provision and the feasibility of new practice tools. Interviews were digitally recorded, transcribed verbatim and analysed using Framework Analysis to identify emergent themes. A Psychometric Risk Perception Questionnaire was also used to evaluate pharmacists’ perceptions across 7 common psychotropic drug classes. Results Synthesis of the qualitative dataset of 30 pharmacist interviews revealed three key themes: ‘Safety and Consequences of AIMs’, ‘Factors that Influence Risk Communication’ and ‘Refining Risk Communication’. Participating pharmacists were generally aware of the therapeutic classes associated with medication‐related risks but were concerned about patients’ level of understanding. Counselling approaches were largely dictated by perceived patient interest/experience with a medication. Concerns were centred on inter‐individual pharmacokinetic differences, which could make the precise risk assignment difficult. Pharmacists also highlighted workflow limitations and the need to bring patients’ attention to these resources during the clinical interaction to maximise impact. Conclusions Medication‐related risk communication is a complex clinical phenomenon dictated by patients’ prior experiences and the pharmacists’ practice environment. Extending the evidence base in this therapeutic area and refining clinical resources are key steps towards optimising patient medication safety. HighlightsThis article describes a qualitative exploration of pharmacists’ perceptions of the risks related to alertness impairing medications.Framework Analysis of interview transcripts unveiled key themes around medication safety and factors influencing risk communication.Risk communication was perceived to be an important part of clinical practice but a number of factors influence.

Exploring asthma in the workplace: A triangulation of perspectives from management, employees and people with asthma

ABSTRACT Objective: People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. Method: Using purposive and convenience sampling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. Results: Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. Conclusion: Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.

Patient Perceptions of Treatment Delivery Platforms for Cognitive Behavioral Therapy for Insomnia.

ABSTRACT Objective: Stepped care has given rise to the proliferation of abbreviated CBT-I programs and delivery formats. This includes interventions delivered by allied health professionals and those delivered electronically through the Internet. This article aims to explore patient perceptions between electronic and face-to-face (FTF) delivery platforms for (abbreviated) CBT-I. Participants: Patients with insomnia from specialist sleep or psychology clinics and those from the general community in Sydney, Australia. Method: Semistructured interviews were conducted with patients with insomnia, guided by a schedule of questions and a choice task to explore patient perceptions of the different CBT-I treatment delivery platforms (e.g., perceived advantages and disadvantages or willingness to engage with either platform). Interviews were transcribed verbatim and analyzed using Framework Analysis. Participants also completed a battery of clinical mood and insomnia measures. Results: Fifty-one interviews were conducted with patients with insomnia from specialist sleep or psychology clinics (n = 22) and the general community (n = 29). Synthesis of the qualitative data set revealed three themes pertinent to the patients’ perspective toward electronic and FTF CBT-I delivery: Concepts of Efficacy, Concerns About Treatment, and Treatment on My Terms. Participants’ choice to engage with either platform was also informed by diverse factors including perceived efficacy of treatment, personal commitments, lifestyle, and beliefs about sleep and insomnia. Conclusion: Clarifying patient treatment priorities and allaying potential concerns about engaging with an electronic treatment platform represent important steps for disseminating eCBT-I into mainstream practice.