Objective To construct an evidence-based management of patients with hematologic tumors treated with CAR T cells, to evaluate its clinical effects in improving nurses' and hematologic tumor patients' CAR-T cell therapy knowledge, improving related procedures, relieving patients' anxiety and depression, improving quality of life, and reducing the incidence and severity of related adverse reactions about CRS and ICANS. Method Through literature screening, evaluation and summary, the best evidence of nursing management of patients with hematologic tumors treated with CAR T cells was summarized. Through the expert demonstration meeting, the best evidence was localized debugging, and the review index was formulated according to the best evidence. Based on the theoretical framework of “evidence-based continuous quality improvement model”, evidence-based practice was carried out in two tertiary level A hospitals in Hunan Province. A baseline review was conducted on nurses and patients who met the inclusion criteria and at the system level from May 2023 to August 2023. In September 2023, based on the results of the baseline review, analyze the factors that may be encountered in promoting and impeding the introduction of evidence into the clinical process, and develop action strategies for practice reform. Effect evaluation was conducted from October 2023 to January 2024, and the implementation rate of each review indicator before and after evidence-based practice, the knowledge level of nurses and patients related to CAR T cell therapy, the incidence and severity of anxiety and depression and related complications of patients were compared. Results A total of 25 nurses were included in the evidence-based practice period, 18 patients were included in the baseline review period, and 17 patients were included in the effect evaluation period. After the evidence-based practice, the implementation rate of each review index was improved, the score of nurses' relevant knowledge level was increased from (57.20±8.43) to (82.20±6.78), and the accuracy of patients' relevant knowledge questionnaire was increased from 16.7%-94.4% before the application to 74.4%-100%. The average accuracy increased from 75.0% to 96.9%, and the scores of SAS and SDS decreased from (52.44±2.12) and (52.56±2.62) to (49.94±2.77) and (49.29±3.26). The FACT-G score increased from (67.94±8.31) to (78.06±9.46), and the differences were statistically significant (P<0.05). Conclusion The evidence-based practice of nursing management of patients with hematologic tumor treated with CAR-T cell therapy can improve the relevant department data and procedures, improve the knowledge level of nurses and patients with CAR-T cell therapy, standardize nurses' nursing management of patients with CAR-T cell therapy, relieve patients’ anxiety and depression, and improve the quality of life of patients. It can reduce the severity of complications to some extent.
Key words
chimeric antigen receptor T cells /
hematologic tumor /
evidence-based nursing /
evidence-based practice
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