Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
Support Care Cancer. 2024 Aug 16;32(9):591. doi: 10.1007/s00520-024-08799-3.
CAR-T therapy has emerged as a potentially effective treatment for individuals diagnosed with hematologic malignancies. Understanding patients' unique experiences with this therapeutic approach is essential. This knowledge will enable the development of tailored nursing interventions that align with the increasing importance of patient-centered care.
To examine and synthesize qualitative data on patients and their family caregivers' experiences during the treatment journey.
We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family caregiver quotes about experiences of CAR-T therapy, published in English or Chinese in a peer-reviewed journal since 2015. Data sources included MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang.
Systematic search yielded 6373 identified articles. Of these, 12 reports were included in the analysis, which covered 11 separate studies. Two reviewers independently extracted data into NVIVO 12.0. Qualitative meta-synthesis was performed through line-by-line coding of full text, organization of codes into descriptive themes, and development themes.
The qualitative meta-synthesis yielded eight primary themes. Noteworthy revelations from patients and their family caregivers regarding the CAR-T therapy journey encompassed various aspects. Prior to CAR-T therapy, patients experienced a lack of actual choice, struggled with expectations for treatment outcomes, and encountered intricate emotional experiences. During or immediately after CAR-T therapy, patients reported both comfortable and uncomfortable experiences. Additionally, patients emphasized that concerns regarding treatment efficacy and adverse reactions intensified treatment-related distress. After CAR-T therapy, significant changes were observed, and the burden of home-based rehabilitation. Additionally, we found factors contributed to the high CAR-T therapy cost.
To ensure the safety and sustainability of CAR-T therapy, it is crucial to address the physical and psychological aspects of the patient's experience. Effective communication and comprehensive management are highly valued by patients and their caregivers. Further research should investigate ways to reduce burdens and develop self-management education programs for patients and their families.
嵌合抗原受体 T 细胞（CAR-T）疗法已成为治疗血液系统恶性肿瘤患者的一种潜在有效治疗方法。了解患者接受这种治疗方法的独特体验至关重要。这方面的知识将有助于制定与以患者为中心的护理日益重要相一致的护理干预措施。
检查并综合分析患者及其家属在治疗过程中的体验的定性数据。
我们进行了系统综述和定性元综合分析。合格的研究包含成年患者或家属对 CAR-T 治疗体验的引用，这些引用发表于 2015 年以来的同行评议期刊上，语言为英文或中文。数据来源包括 MEDLINE、CINAHL、Embase、PsycINFO、Web of Science、Scopus、Cochrane 图书馆、中国知网（CNKI）和万方。
系统搜索产生了 6373 篇已识别的文章。其中，有 12 份报告被纳入分析，涵盖了 11 项独立研究。两名审查员独立地将数据提取到 NVIVO 12.0 中。通过对全文进行逐行编码、将代码组织成描述性主题以及开发主题，进行定性元综合分析。
定性元综合分析产生了八个主要主题。患者及其家属对 CAR-T 治疗之旅的重要启示包括各个方面。在接受 CAR-T 治疗之前，患者缺乏实际选择，对治疗结果的期望感到挣扎，并经历了复杂的情绪体验。在接受 CAR-T 治疗期间或之后，患者报告了既舒适又不舒服的体验。此外，患者强调，对治疗效果和不良反应的担忧加剧了与治疗相关的痛苦。在接受 CAR-T 治疗后，观察到了显著的变化，并减轻了家庭康复的负担。此外，我们发现了导致 CAR-T 治疗费用高的因素。
为了确保 CAR-T 治疗的安全性和可持续性，解决患者体验的身体和心理方面至关重要。患者及其照顾者非常重视有效的沟通和全面的管理。进一步的研究应探讨如何减轻负担并为患者及其家属制定自我管理教育计划。
