Patients' and Providers' Perceptions of the Implementation of a Stepped Care Cognitive-Behavioral Therapy for...

Insomnia is one of the most commonly reported challenges among cancer patients and survivors. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment but remains underused in routine cancer care. A stepped-care CBT-I program was developed to address this gap. This study explores facilitators and barriers following the implementation of this program in four Québec cancer centers. Patients and providers participated in two individual interviews and seven focus groups. Interviews were guided by the Consolidated Framework for Implementation Research (CFIR). Data were transcribed and coded in NVivo using the CFIR codebook. A hybrid deductive-inductive thematic analysis was conducted. Codes were interpreted using Proctor's Implementation Outcomes Framework. A total of 14 patients and 18 providers were interviewed. Facilitators and barriers were divided into four key themes: (1) endorsement from trusted professionals; (2) fit with workflows and existing routines; (3) perceived burden for both patients and providers; and (4) readiness and motivation of both patients and providers. This analysis supports the acceptability, adoption, appropriateness, feasibility, and perceived sustainability of a stepped-care CBT-I in routine cancer care and suggests specific implementation strategies to optimize its implementation. Implementation of stepped-care CBT-I in routine cancer care has the potential to improve access to evidence-based treatments for insomnia and make it a standard component of survivorship care.