Insomnia is a significant but inadequately addressed symptom endured by a large number of patients with breast cancer. Evidence suggests that insomnia often becomes chronic after cancer treatment is completed, and contributes to functional impairments and reduced QOL. CBTI is a theoretically-driven and well supported treatment for primary and comorbid chronic insomnia, and its use in women post breast cancer treatment has been shown to be efficacious. Internet-based CBT has been used effectively in other studies, but there are no studies that demonstrate the use of an internet-based CBT for insomnia in breast cancer survivors. Furthermore, women in medically underserved areas are often at higher risk for mental health deficits and functional impairment after breast cancer treatment, and an internet- based CBTI may be an accessible therapy for these women. CBTI-trained nurses have effectively delivered this therapy in a variety of insomnia settings. The applicant's training plan includes comprehensive didactic and supervised clinical experiences that will enable her to delivery CBTI via the internet. Testing this innovative method of CBTI delivery will provide important information about the efficacy of nurse led internet based behavioral therapies. Results may support a broader availability of this established therapy. This proposal will enhance scientific knowledge regarding treatment of individuals with comorbid insomnia, increase technical capability through a therapist delivered internet-based CBTI. This study has broad implications for clinical practice with specific applications to a rural patient base, sleep medicine, and cancer survivors.
In accordance with the mission and strategic plan of the NINR, this study will promote health and improve quality of life by mitigating the impact of insomnia in patients after treatment for breast cancer. The innovative internet-based delivery of CBTI will allow women in rural Medically Underserved Areas (MUA's) to receive an intervention that would otherwise be unavailable to them, thus working to eliminate health disparities for this population.