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

Abstract

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.

SUPPLEMENTAL MATERIAL

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Notes

¹ The Woolcock Institute of Medical Research (WIMR) and Brain and Mind Research Institute.

² The University of Sydney campus, primary care physicians (General Practitioners) and community pharmacies.

³ The ISI is a 7-item Likert-type scale that measures the nature and symptoms of insomnia. Score ranges from 0 to 28. Insomnia severity is classified as: no clinically significant insomnia (score: 0 to 7), subthreshold insomnia (score: 8 to 14), moderate clinical insomnia (score: 15 to 21), and severe clinical insomnia (score: 22 to 28)

⁴ The BMQ general is made up of two components: a General Harm scale (5 items, total scores range from 5 to 25) and a General Overuse scale (3 items, total scores range from 3 to 15) assessing beliefs about pharmaceuticals as a class of treatment (Kumar et al., 2008).

⁵ The FIRST is a 9-item self-measure of the likelihood of the occurrence of sleep disturbance; a score ranges from 9 to 36. A cutoff score of 19 is indicative of high vulnerability to stress-related sleep disturbance (Fernández-Mendoza et al., 2010).

⁶ The DASS-21 is a 21-item measure (i.e., a score of 0 to 3 for each item), which is composed of three 7-item subscales: a depression subscale (Normal: 0 to 4, Mild: 5 to 6, Moderate: 7 to 10, Severe: 11 to 13, and Extremely Severe: ≥ 14), an anxiety subscale (Normal: 0 to 3, Mild: 4 to 5, Moderate: 6 to 7, Severe: 8 to 9, Extremely Severe: ≥ 10), and a stress subscale (Normal: 0 to 7, Mild: 8 to 9, Moderate: 10 to 12, Severe: 13 to 16, and Extremely Severe: ≥ 17; Ng et al., 2007)

⁷ Proprietary trade name for temazepam in Australia.

⁸ Pro Re Nata (when required) is a standard prescription shorthand that is used to guide intermittent medication use.

⁹ Over-the-counter proprietary product containing Doxylamine Succinate 25mg.

¹⁰ Proprietary over-the-counter product containing Paracetamol 450 mg, Codeine Phosphate 9.75 mg, and Doxylamine Succinate 5 mg