Rina S Fox

Stakeholder-informed refinement of a behavioral sleep/circadian intervention for gynecologic cancer survivors: an application of the MOST preparation phase

Abstract Background Sleep disturbance is among the most frequent and distressing symptoms reported by gynecologic cancer survivors. Existing evidence-based behavioral sleep interventions are limited by implementation burden, which can decrease adherence. Purpose As part of the preparation phase of the multiphase optimization strategy (MOST), this study solicited stakeholder feedback to maximize adherence in a planned behavioral sleep/circadian intervention optimization trial. Methods Thirteen post-treatment survivors of early-stage gynecologic cancer completed the protocol for the planned optimization trial, including simultaneous receipt of all candidate intervention components. This included six weeks of combined sleep restriction, stimulus control, and systematic exposure to morning bright light. Participants then completed a semi-structured interview to provide feedback on their experience. We used a rapid analytic approach to quickly identify actionable feedback from de-identified transcripts. Results Participants generally reacted positively to the intervention components. Actionable feedback identified recommended protocol modifications and was categorized into four overarching themes: (i) remove barriers to engagement; (ii) revise for clarity; (iii) augment content; and (iv) consider individual circumstances. Conclusions Rapid qualitative analysis enabled us to effectively modify our planned study protocol on an expedited timeline. This approach is consistent with the core principles of MOST and can be incorporated into the Preparation phase to enhance optimization efforts.