Arem Hannah, Scott Remle, Greenberg Daniel, Kaltman Rebecca, Lieberman Daniel, Lewin Daniel
Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
George Washington Cancer Center, Washington, DC, United States.
JMIR Cancer. 2020 May 26;6(1):e15859. doi: 10.2196/15859.
Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it.
This study aimed to better understand BCSs' experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa).
We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs' perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data.
We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family.
This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations.
乳腺癌幸存者（BCS）群体日益壮大，与无癌症病史的同龄女性相比，其失眠患病率更高。失眠的认知行为疗法（CBT-I）已被证明对该群体有效，但有需求的人无法广泛获得该疗法。
本研究旨在更好地了解BCS的失眠经历，并探讨使用虚拟助手（亚马逊Alexa）提供CBT-I的可行性和可接受性。
我们首先进行了一个形成阶段，包括2个焦点小组和3次深入访谈，以了解BCS对失眠的看法以及他们对使用虚拟助手了解CBT-I的兴趣和接受程度。然后，我们开发了一个包含参与者偏好和CBT-I组件的原型，并在小组和个人环境中向BCS展示，以评估该原型的可接受性、兴趣、感知可行性、教育潜力和可用性。我们还收集了关于内容的开放式反馈，并使用频率来描述定量数据。
我们在形成阶段招募了11名患有失眠的BCS，在原型展示阶段招募了14名BCS。在形成性工作中，焦虑、恐惧和潮热被确定为失眠的原因。在原型展示后，近79%（11/14）的参与者表示有兴趣使用虚拟助手记录睡眠模式，并且认为其具有可行性。大约三分之二的参与者认为生活方式改变（9/14，64%）和睡眠限制（9/14，64%）是可行的，并且对该计划的这一功能感兴趣（分别为10/14，71%和9/14，64%）。71%（10/14）的参与者认为使用虚拟助手进行放松练习既有趣又可行。可用性被评为高于平均水平，所有女性都表示会向朋友和家人推荐该计划。
这个通过智能音箱提供CBT-I组件的虚拟助手原型被评为可行且可接受，这表明该原型应进行全面开发并测试其在BCS群体中的疗效。如果在该群体中显示出疗效，该原型也应适用于其他高危群体。
