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嵌合抗原受体 (CAR) T 细胞治疗在接受者、照顾者和转介者中的经验和观点 (RE-TELL):一项旨在为 CAR T 细胞服务设计提供信息的定性研究。

Experiences and perspectives on chimeric antigen receptor (CAR) T-cell therapy among recipients, carers and referrers (RE-TELL): a qualitative study to inform CAR T-cell service design.

机构信息

Malaghan Institute of Medical Research, Wellington, New Zealand

Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand.

出版信息

BMJ Open. 2024 Jan 23;14(1):e071112. doi: 10.1136/bmjopen-2022-071112.


DOI:10.1136/bmjopen-2022-071112
PMID:38262637
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10824048/
Abstract

OBJECTIVES: RE-TELL is a qualitative study, which aims to understand patient, support person, clinician and coordinator experiences and perspectives of chimeric antigen receptor (CAR) T-cell therapy, to inform design of a clinical CAR T-cell service in Aotearoa New Zealand. DESIGN: Semistructured qualitative interviews focused on domains of: experience through treatment, elements that work well and those that could be improved on. Interviews used thematic analysis to identify key themes. A workshop was held to obtain participants' reflections on interim analysis and proposed improvements. PARTICIPANTS: New Zealanders with experience of CAR T-cell therapy, including recipients, support persons, clinicians and coordinators. RESULTS: We interviewed 19 participants comprising 5 CAR T-cell recipients, 3 support persons, 6 clinicians and 5 coordinators. Four participants identified as Māori. Thematic analysis identified three global themes. The first, 'sociocultural factors impact CAR T access', identified potential sources of inequity including geographic, financial and informed consent barriers. The second, 'varying emotions, roles and enablers', identified an easier treatment experience compared with alternatives; an underwhelming cell administration process; frustration with inpatient monitoring; burden on support persons and importance of 'bridge' organisations such as charities and patient support groups. Lastly, 'golden opportunities: reimagining CAR T service delivery', suggested: improved geographical access to CAR T-cell therapy, while retaining consolidated clinician experience; a 'dashboard' with information on CAR T-cell treatment, time frames and manufacture; a health navigator to co-ordinate non-medical aspects of treatment and signpost care; embedding of indigenous data sovereignty and ownership of cells; a cell infusion ceremony, incorporating family involvement and Māori cultural elements and outpatient administration and monitoring where possible. CONCLUSION: This study documented the current experience of New Zealanders receiving CAR T-cell therapy and identified opportunities for future service development. These insights are relevant to service design within Aotearoa New Zealand, and other countries developing equitable CAR T-cell services.

摘要

目的:RE-TELL 是一项定性研究,旨在了解患者、支持人员、临床医生和协调员对嵌合抗原受体(CAR)T 细胞治疗的经验和看法,为新西兰奥特亚罗瓦的临床 CAR T 细胞服务的设计提供信息。

设计:半结构式定性访谈侧重于以下领域:治疗过程中的经验、效果良好的因素和可以改进的因素。访谈采用主题分析来确定关键主题。举办了一次研讨会,以获得参与者对中期分析和拟议改进的反馈。

参与者:有 CAR T 细胞治疗经验的新西兰人,包括接受者、支持人员、临床医生和协调员。

结果:我们采访了 19 名参与者,其中包括 5 名 CAR T 细胞接受者、3 名支持人员、6 名临床医生和 5 名协调员。有 4 名参与者自认为是毛利人。主题分析确定了三个全球主题。第一个主题是“社会文化因素影响 CAR T 治疗的可及性”,确定了潜在的不公平来源,包括地理、财务和知情同意障碍。第二个主题是“不同的情绪、角色和促进因素”,认为与替代治疗方法相比,CAR T 治疗的体验更容易;细胞输注过程令人失望;对住院监测感到沮丧;支持人员负担过重;慈善机构和患者支持团体等“桥梁”组织的重要性。最后一个主题是“黄金机会:重新想象 CAR T 服务提供”,建议:改善 CAR T 细胞治疗的地理可及性,同时保留集中的临床医生经验;一个带有 CAR T 细胞治疗、时间框架和制造信息的“仪表盘”;一个健康导航员来协调治疗的非医疗方面,并提供护理建议;嵌入土著数据主权和细胞所有权;细胞输注仪式,纳入家庭参与和毛利文化元素,并尽可能在门诊进行管理和监测。

结论:本研究记录了新西兰人接受 CAR T 细胞治疗的当前经验,并确定了未来服务发展的机会。这些见解与新西兰奥特亚罗瓦的服务设计以及其他正在开发公平的 CAR T 细胞服务的国家有关。

相似文献

[1]
Experiences and perspectives on chimeric antigen receptor (CAR) T-cell therapy among recipients, carers and referrers (RE-TELL): a qualitative study to inform CAR T-cell service design.

BMJ Open. 2024-1-23

[2]
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N Z Med J. 2021-9-17

[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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Cochrane Database Syst Rev. 2021-9-13

[10]
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BMJ Open. 2020-2-9

本文引用的文献

[1]
Access to and affordability of CAR T-cell therapy in multiple myeloma: an EBMT position paper.

Lancet Haematol. 2022-10

[2]
A unique hub-and-spoke model to optimize patient management in lymphoma using novel CAR-T cell therapy in Southeast and South Asia.

Hematol Oncol. 2022-9

[3]
Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries.

JAMA Health Forum. 2022-5

[4]
Patient experience before and after treatment with idecabtagene vicleucel (ide-cel, bb2121): qualitative analysis of patient interviews in the KarMMa trial.

Leuk Res. 2022-9

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Front Pharmacol. 2022-6-23

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Socioeconomic disadvantage contributes to ethnic disparities in multiple myeloma survival: a matched cohort study.

Blood Cancer J. 2022-5-25

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Demographic differences among patients treated with chimeric antigen receptor T-cell therapy in the United States.

Cancer Med. 2022-12

[9]
A strategic reflection for the management and implementation of CAR-T therapy in Spain: an expert consensus paper.

Clin Transl Oncol. 2022-6

[10]
Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma.

N Engl J Med. 2022-2-17

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