Reconceptualising Patient Centred Care: New Insights for Managing Insomnia

Abstract

Insomnia is a common sleep disorder that continues to pose a substantial social and economic burden to society. Despite rapid advancements in sleep research and the availability of effective treatments in the form of pharmacological and non-pharmacological treatment options, the management of insomnia remains suboptimal. Misalignment between the patient and clinician during the treatment selection process might perpetuate the problem. The current body of work presents a comprehensive mixed-methods investigation into the insomnia patient perspective in terms of how patients with insomnia relate and engage with treatment both cognitively and behaviourally. Using semi-structured interviews and Discrete Choice Experiments, different dimensions of the patient illness/treatment experiences were unveiled and explored in both a sociological and clinical paradigm. Research findings reveal that key patient priorities stem from psychosocial domains (e.g. sustaining meaningful relationships) rather than clinical outcomes (e.g. total sleep time). Importantly, findings from the respective studies provide new insight for reappraising many of the so-called clinically deviant patient health behaviours such as delayed medical help-seeking, chronic sleep medication use and poor uptake of non-pharmacological treatment. Recommendations are made for ways to better represent the insomnia patient perspective. Collectively, the current body of work serve as a useful framework to reconceptualise the application of Patient Centred Care in sleep medicine, moving away from a one-size-fits-all approach towards a dynamic and flexible framework that is attuned to patient needs and priorities at various stages of their illness trajectory.