Learning Objective #1: Describe a clinically useful instrument for measuring insomnia severity

Learning Objective #2: Discuss the use of an insomnia severity instrument with breast cancer survivors

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One approach to the measurement of insomnia, the Insomnia Severity Index (ISI), was used in an insomnia intervention study for breast cancer survivors. The ISI is a practical, reliable, and valid instrument (Bastien et al., 2001). The purpose of this paper is to examine the ratings of insomnia severity from study participants, significant others, and the nurse therapist at pre- and post-treatment. Breast cancer survivors who were at least 3 months post completion of primary cancer treatment and without active disease were randomly assigned to either theory-driven multi-component intervention (MCI) or a component comparison group (CC). Seventy-two women, 32 significant others, and the research nurse therapist completed pre and post-treatment ISI assessments. Data were examined using Pearson correlation coefficients and repeated measures analysis of variance (ANOVA). Seventy-two women (mean age=58.2 years, SD=10.3; mean insomnia duration=5.2 years, SD=6.7) participated. Prior to treatment, the participants' and therapist ISI scores were correlated (r=.33, p=.004). For the MCI group post-treatment, the participant score was correlated with the significant other (r=.60, p=.01) and the therapist (r=.56, p=.001) ratings. The participant and therapist ratings were correlated (r=.42, p=.01) post-treatment in the CC group. The repeated measures ANOVAs revealed significant group by time interactions for the participants and clinicians (ps= .01), and a significant time effect for the significant others (p= .000). Pairwise comparisons showed a pre to post-treatment decrease in insomnia severity by all raters for both groups. Similar ratings of insomnia were found primarily between the participants and the therapist. Participants in both groups rated themselves as improved after treatment, and the significant others and therapist ratings paralleled the findings. Possible explanations for pre and post-treatment associations among raters and the improvement in both groups will be discussed. The clinical usefulness of the instrument and findings will be examined.

Funding: The National Cancer Institute CA91869