Dissertation
Baseline Matters: Implementation of a Brief Cognitive Screening Tool in Older Adults with DLBCL Preceding CAR T-cell Therapy
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: Mild cognitive impairment (MCI) in older adults with cancer is often subtle and under-assessed in routine evaluations. Individuals may only present with subjective memory impairment while retaining the ability to perform activities of daily living. Compounded further, older adults with diffuse large B-cell lymphoma (DLBCL) presenting for chimeric antigen receptor (CAR) T-cell therapy may have comorbidities and a history of numerous rounds of systemic chemotherapy, leading to cancer-related cognitive decline (CRCD). This creates challenges when MCI is detected following admission to the hospital for CAR T-cell therapy, increasing the risk of adverse side effects and decreased quality of life in these older adults. Purpose: To implement a standardized cognitive screening tool to identify older adults with DLBCL at risk for MCI before CAR T-cell therapy in an outpatient cancer clinic at a large academic medical center. Methods: This evidence-based practice project employed the Iowa Revised Model. It introduced the Mini-Cog screening tool to a setting that lacked a baseline cognitive screening. The project focused on three outcomes: evaluating the cognitive screening tool completion rate, frequency of supportive referrals placed for patients at risk of MCI, and increasing provider knowledge and confidence in using the screening tool. Findings: Post-implementation, 80% of patients seen in the outpatient cancer clinic preceding CAR T-cell therapy were screened using the Mini-Cog tool. Due to limited time from screening to admission, supportive inpatient consults were evaluated, with 100% (n=10) of patients receiving at least one consult during their hospitalization. Provider knowledge and confidence in using the Mini-Cog tool increased. Discussion: This project underscored the importance of assessing baseline cognitive function in older adults with DLBCL preceding admission for CAR T-cell therapy. Future projects should focus on screening patients with DLBCL earlier in the treatment process to promote increased optimization of these patients.
Details
- Title: Subtitle
- Baseline Matters: Implementation of a Brief Cognitive Screening Tool in Older Adults with DLBCL Preceding CAR T-cell Therapy
- Creators
- Amanda Robertson - University of Iowa
- Contributors
- Nicola Jane Stickney (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Family Nurse Practitioner
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Amanda Robertson
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841526202771
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