Early discussion of advance directives for patients with newly diagnosed cancer.

Abstract

91 Background: Although advance care planning and the completion of advance directives (ADs) are important methods to prevent unwanted aggressive care once patients have lost their decision-making capacity, only a minority of patients have ADs at the time of cancer diagnosis. Methods: We established a new multidisciplinary outpatient clinic to provide comprehensive care to patients with newly diagnosed cancer at the Inova Dwight and Martha Schar Cancer Institute in Northern Virginia. Improvement in advance care planning was chosen as one of the first quality improvement initiatives for 2015. We started the first PDSA cycle after creating the team, establishing the problem and goal statement, and reviewing the process map. We had three measures including: 1. Inquiring whether the patient has advance directives or not at the time of scheduling their first appointment, 2. Provide written information about advance directives at the patient’s first visit, 3. Obtain advance directives by the third office visit. The goal for each measure was 90%, 90%, and 50% by the end of 2015. Results: Between May-June 2015, 65 patients were evaluable. Baseline rates were 26%, 2%, and 12%, respectively for measures 1, 2, and 3. In July 2015, we convened a staff meeting to review each staff’s role in the process of advance care planning. The new patient schedulers had training and created a telephone script to effectively communicate advance directives information with patients. The front desk staff included written information about advance care planning in the new patient information folders. Clinical staff were asked to address any questions or concerns that patients have and to encourage patients to complete the ADs by next visit. After this intervention, the rates increased to 100%, 44%, and 33%, respectively for measures 1, 2, and 3 in August and September, 2015 (n = 45). Conclusions: Early discussion about the ADs for newly diagnosed cancer patients at our outpatient clinic showed improvement in the rate of completed ADs by a third office visit.

Carbon Dot-Encapsulated Plasmonic Core-Satellite Nanoprobes for Sensitive Detection of Cancer Biomarkers via Dual-Mode Colorimetric and Fluorometric Immunoassay

“…1,2 One of the best ways to diagnose cancers and help their prognosis or predict response to treatment is the use of cancer biomarkers. 3,4 Therefore, the ultrasensitive quantification of cancer biomarkers in complex samples is of paramount importance for clinical diagnosis. 5,6 Currently, the enzyme-linked immunosorbent assay (ELISA) is the most broadly used format for clinical biomarker detection.…”

“…Early and accurate detection of cancer before it spreads and becomes incurable is a significant and pressing task because of the severe effect on human health and the huge economic cost on society. , One of the best ways to diagnose cancers and help their prognosis or predict response to treatment is the use of cancer biomarkers. , Therefore, the ultrasensitive quantification of cancer biomarkers in complex samples is of paramount importance for clinical diagnosis. , Currently, the enzyme-linked immunosorbent assay (ELISA) is the most broadly used format for clinical biomarker detection. , Although it is simple, of low cost, and easy to operate, the detection sensitivity is not satisfactory especially when the biomarkers are present at very low concentrations in the early stage. , …”