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Patient and Clinician Communication of Self-reported Insomnia During Ambulatory Cancer Care Clinic Visits

Siefert, Mary Lou DNSc, RN, AOCN; Hong, Fangxin PhD; Valcarce, Bianca; Berry, Donna L. PhD, RN, AOCN, FAAN

doi: 10.1097/NCC.0b013e318283a7bc
Articles: Online Only

Background: Insomnia, the most commonly reported sleep-wake disturbance in people with cancer, has an adverse effect on quality of life including emotional well-being, distress associated with other symptoms, daily functioning, relationships, and ability to work.

Objective: The aim of this study was to describe the content of discussions between clinicians and 120 patients with self-reported insomnia and to examine the associations of sociodemographic, clinical, and environmental factors with insomnia.

Methods: A secondary analysis was conducted with self-reported symptom data and sociodemographic, clinical, and environmental factors. Recordings of clinician and patient discussions during clinic visits were examined by conducting a content analysis.

Results: Severe insomnia was more likely to be reported by women, minority, and lower-income individuals. Seven major topics were identified in the discussions. The clinicians did not always discuss insomnia; discussion rates differed by diagnosis and clinical service.

Conclusions: Reporting of insomnia by the patient and clinician communication about insomnia may have differed by demographic and clinical characteristics. Clinicians attended to insomnia about half the time with management strategies likely to be effective. Explanations may be that insomnia had a low clinician priority for the clinic visit or lack of clear evidence to support insomnia interventions.

Implications for Practice: A better understanding is needed about why insomnia is not addressed even when reported by patients; it is well known that structured assessments and early interventions can improve quality of life. Research is warranted to better understand potential disparities in cancer care.

Author Affiliations: Phyllis F. Cantor Center for Research in Nursing and Patient Care Services (Drs Siefert and Berry and Ms Valcarce) and Department of Biostatistics and Computational Biology (Dr Hong), Dana Farber Cancer Institute, Boston, Massachusetts.

Funding was received from National Institute of Nursing Research, National Institutes of Health, through grant no. R01 NR008726, 2004–2007 (Dr Berry).

The authors have no conflicts of interest to disclose.

Correspondence: Mary Lou Siefert, DNSc, RN, AOCN, Dana Farber Cancer Institute, 450 Brookline Ave; LW515, Boston, MA 02215 (;

Accepted for publication December 11, 2012.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins