EXPIRED
12/01/2022
National Institute on Aging (NIA)
National Heart, Lung, and Blood Institute (NHLBI)
National Institute of Nursing Research (NINR)
National Institute on Minority Health and Health Disparities (NIMHD)
National Cancer Institute (NCI)
All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.
Office of Research on Women's Health (ORWH)
Background
As the population of older adults continues to increase, the prevalence of diseases and conditions common in aging is expected to rise. Cardiovascular diseases, cancer, chronic lung diseases, dementia, and chronic kidney disease will likely continue to be the greatest contributors to morbidity and mortality, as well as the costliest conditions to healthcare systems. However, older Americans infrequently have just one chronic health condition. In 2017, over two-thirds of Medicare beneficiaries had more than one chronic condition, and over 17% had six or more chronic conditions. Disability and greater care needs associated with these conditions is leading to an increase in residence in nursing homes and other long-term care facilities. Healthcare costs will continue to grow, with health-related spending expected to reach nearly 20% of gross domestic product by 2027.
Serious illnesses resulting from the progression of chronic health conditions pose particular challenges for healthcare decision-making. While treatments with curative intent may forestall complications and relieve some symptoms, disease progression ultimately leads to increased disability and symptom burden that compromise quality of life. In addition, among patients with multiple morbidities, treatments for co-occurring conditions may antagonize each other (also known as therapeutic competition), and patients must evaluate trade-offs among multiple sub-optimal treatment options. As a result, patients' values, preferences, and goals become essential to inform care decisions.
Providing care that is consistent with a patient's values, preferences, and goals is a cornerstone of palliative care. Palliative care focuses on several objectives, including relief of symptoms and suffering, communication of prognosis and treatment options in the context of patients' goals, and coordination of care within and across healthcare settings. Palliative care is not synonymous with hospice or end-of-life care. Rather, the latter are parts of the spectrum of care for serious illness that is addressed by palliative care, from diagnosis through terminal stages of disease. Moreover, palliative care does not necessarily entail withholding or curbing treatment. Relief of symptoms, enhancing quality of life, and other specific aspects of goal-concordant care may involve optimal medical or surgical treatment of disease. Furthermore, proactive approaches to disease management, such as prehabilitation strategies prior to surgery to improve functional recovery, can be consistent with goal-concordant care. However, without knowing patients' values and preferences, care may be inconsistent or even run counter to patients' goals.
Scope
This Notice of Special Interest (NOSI) encourages research grant applications focused on palliative care in geriatric populations. This NOSI covers studies in a variety of settings including hospitals (and specific sites within hospitals including specialty medical or surgical wards, intensive care units, and emergency departments), post-acute care settings, outpatient clinics and doctors' offices, patients' homes and other residential settings, long-term care facilities, hospices, and other healthcare or community settings. This NOSI encourages both prospective studies and analyses of existing datasets, health and medical records, claims data, or other sources. Leveraging ongoing cohorts, intervention studies, networks, data and specimen repositories, and other existing research resources and infrastructure is encouraged. Study designs may include observational approaches, quasi-experimental designs, and interventional studies.
Topics of interest among Institutes and Centers (ICs) participating in this NOSI are summarized below. Applicants are encouraged to contact the Scientific/Research contacts listed below to ensure that proposed aims are consistent with the mission(s) of the intended IC(s). Where IC topic areas overlap, applicants are especially encouraged to contact the respective IC representatives to discuss appropriate arrangements for dual assignment.
National Cancer Institute (NCI)
The NCI is interested in studies that focus on advancing the science of geriatric palliative care in the context of cancer patients, cancer populations, and other persons affected by cancer. Examples of studies of interest include, but are not limited to, the following:
Note: For this NOSI, NCI participates in the following FOAs:
National Institute on Aging (NIA)
NIA is interested in studies that focus on palliative care in individuals and populations with age-related diseases, conditions, and/or special problems and needs associated with older age, such as multiple chronic conditions, polypharmacy, cognitive impairment/dementia, age-related disabilities, and other geriatric syndromes. For applications focused on behavioral interventions, including pragmatic trials and trials involving health systems interventions, NIA seeks applications aiming to develop interventions that: 1) are defined by their principles (mechanisms) and 2) ultimately can be delivered with fidelity in the community, in accordance with the NIH Stage Model.
Topics of interest include, but are not limited to, the following:
NIA-supported Research Centers may be particularly useful for accessing recruitment resources, analytic capabilities, specimens, specialized expertise, and other aging-related research resources. More information about each of these Center's programs can be found at their respective links: Alzheimer's Disease Research Centers, Centers on the Demography and Economics of Aging, Claude D. Pepper Older Americans Independence Centers, Edward R. Roybal Centers for Translational Research in the Behavioral and Social Sciences of Aging, and Resource Centers for Minority Aging Research. Coordination among all of NIA's Centers programs is facilitated through the NIA Research Centers Collaborative Network.
For this NOSI, NIA participates in all applications listed under Application and Submission Information below.
National Institute of Nursing Research (NINR)
NINR is interested in research to improve the care of individuals with advanced stage illness and their family caregivers. NINR’s research is focused on palliative and end-of-life care across a spectrum of conditions and across the lifespan. It includes the management of symptoms and the provision of physical, psychosocial, spiritual, and supportive palliative and end-of-life care for individuals and their caregivers within a variety of settings including the home and community, acute and long-term care, rural and remote settings, or hospice. NINR's studies of interest include, but not limited to, the following:
Develop and test interventions for managing pain and other symptoms (e.g., fatigue, dyspnea, nausea, constipation, weight loss, decreased intake, distress, etc.)
Investigate physical, psychosocial, spiritual, or supportive care interventions that improve outcomes and quality of care (e.g., symptom management, informed decision-making for goal-directed care, care coordination and transitions, and bereavement support)
Employ interventions, strategies, and clinical tools to increase early engagement in the advance care planning process, improve individual-family-provider communication and shared goals of care (e.g., treatment preferences, values, clinical outcomes, and resources)
Investigate culturally congruent, individual and family-centered palliative and end-of-life care interventions that include diverse and underserved groups and includes geographic, social determinants, or socioeconomic variations
Test interventions that promote continuity of care across the end-of-life trajectory, including the development and evaluation of interventions to decrease care fragmentation and promote timely and appropriate transitions (e.g. to hospice)
Develop and test interventions that enhance communication between individuals, caregivers, and health care providers or strategies that facilitate shared understanding of palliative or end-of-life care goals
Develop new technologies, electronic health tools, or communication strategies to promote individual and family-centered decision-making during advanced stage illness or at the end of life
Interdisciplinary collaborations that include nurse scientists in the project team are strongly encouraged. Additionally, applicants are encouraged to engage the resources and expertise of existing Palliative Care Networks such as the Palliative Care Research Cooperative Group when appropriate.
For this NOSI, NINR participates in the following FOAs:
National Institute on Minority Health and Health Disparities (NIMHD)
Racial/ethnic minorities may have unique preferences, decision-making, self-care strategies, access and use of informal or complementary therapies, caregiving, and family and social networks that support geriatric care which affect their choice and use of palliative care. Minorities are less likely to use advanced directives and hospice care and are more likely to die in hospitals after undergoing aggressive care and accruing financial burdens. There also remains an overall distrust of the healthcare system and institutions, as well as underutilization of current palliative care services. Minorities are also more likely to have multiple chronic diseases and experience a greater impact on health-related quality of life based on these diseases, thus requiring more complex care, and they are more likely to experience racially discordant care. Less is known about geriatric palliative care among populations stratified by socioeconomic status independent of race/ethnicity, among those living in underserved rural residences, and among those of sexual and gender minority status.
NIMHD is interested in supporting research on one or more minority or health disparity populations (e.g., African Americans/Blacks, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and Other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minority populations) that focuses on understanding the mechanisms and pathways that contribute to disparities in palliative care by examining the interplay of factors from multiple levels (e.g., individual, family, community, clinician, and health systems). Research may propose using available secondary data, health system data, and/or collection of primary data.
Research topics of interest include, but are not limited to, the following:
For this NOSI, NIMHD participates in the following FOAs:
National Heart, Lung, and Blood Institute (NHLBI)
The NHLBI is interested in studies that focus on how to better integrate and implement palliative care into the management of patients with heart, lung, blood, and sleep (HLBS) diseases. Studies that focus on HLBS patients with biologic, physiologic, functional, clinical, and/or psychosocial issues that accompany older age or HLBS patients with multiple chronic conditions would be appropriate for this NOSI.
Questions that could be addressed in response to this NOSI could include, but are not limited to, the following:
Note: NHLBI will only accept applications in response to PA-20-183 and PA-20-185. For PA-20-183, only mechanistic clinical trials will be accepted in accordance with NOT-HL-19-690. Applicants wishing to propose non-mechanistic clinical trials may consider applying to one of the NHLBI clinical trial mechanisms described at https://www.nhlbi.nih.gov/grants-and-training/clinical-trial-development-continuum.
Office of Research on Women's Health (ORWH)
2019-2023 Trans-NIH Strategic Plan for Women's Health Research includes goals and objectives that aim to increase and improve women's health research supported by NIH. Goal two of the strategic plan is to "develop methods and leverage data sources to consider sex and gender influences that enhance research for women's health." Consistent with this goal, the ORWH is interested in supporting research studies that focus on advancing the science of geriatric palliative care in understudied, underrepresented, and underreported women such as racial and ethnic minority populations of women, women with complex health needs such as the co-occurrence of cardiovascular disease, diabetes mellitus, chronic lung disease, or obesity; women of low socioeconomic status (SES), women residing in rural or underserved urban areas, women in migrant and immigrant populations, women experiencing homelessness or living in overcrowded congregate housing, or women incarcerated or under community supervision. Interests include research to understand the mechanisms and pathways that contribute to disparities in palliative care in these populations by examining the interplay of factors from multiple levels (e.g., individual, family, community, clinician, and health systems). Research may propose using available secondary data, health system data, and/or collection of primary data.
For this NOSI, ORWH participates in the following FOAs:
Application and Submission Information
This notice applies to due dates on or after October 5, 2020 and subsequent receipt dates through September 8, 2023.
Submit applications for this initiative using one of the following Funding Opportunity Announcements (FOAs) or any reissues of these announcement through the expiration date of this Notice. Note that not all Institutes/Centers in this Notice participate in all of the FOAs below. Applicants should verify that the target Institute/Center to which they intend to apply participates in the FOA through which they will apply.
Applicants must select the IC and associated FOA to use for submission of an application in response to this NOSI. The selection must align with the IC requirements listed in order to be considered responsive to that FOA. Non-responsive applications will be withdrawn from consideration for this initiative. In addition, applicants using NIH Parent Announcements (listed below) will be assigned to those ICs on this NOSI that have indicated those FOAs are acceptable and based on usual application-IC assignment practices.
All instructions in the SF424 (R&R) Application Guide and the FOA used for submission must be followed, with the following additions:
Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.
Scientific/Research Contact(s)
Diane St. Germain
National Cancer Institute (NCI)
Telephone: 240-276-7082
Email: [email protected]
Basil Eldadah, M.D., Ph.D.
National Institute on Aging (NIA)
Telephone: 301-496-6761
Email: [email protected]
Karen A. Kehl, PhD, RN
National Institute of Nursing Research (NINR)
Telephone: 301-594-8010
Email: [email protected]
Nancy L. Jones, Ph.D.
National Institute on Minority Health and Health Disparities (NIMHD)
Telephone: 301-594-8945
Email: [email protected]
Mihaela Stefan, MD, PhD
Division of Lung Diseases
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301 435 4782
Email: [email protected]
Patrice Desvigne-Nickens, MD
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-0504
Email: [email protected]
Nahed El Kassar, MD, Ph.D.
Division of Blood Diseases and Resources
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-827-8268
Email: [email protected]
Xinzhi Zhang, MD, PhD
Center for Translational Research and Implementation Science
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-6865
Email: [email protected]
Chyren Hunter, Ph. D.
Office of Research on Women's Health
Office of the Director (OD)
Phone: 301-496-7849
Email: [email protected]
Peer Review Contact(s)
Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).
Financial/Grants Management Contact(s)
Sean Hine
National Cancer Institute (NCI)
Telephone: 240-276-6291
Email: [email protected]
John Bladen
National Institute on Aging (NIA)
Phone: 301-402-7730
Email: [email protected]
Ronald Wertz
National Institute of Nursing Research (NINR)
Telephone: 301-594-2870
Email: [email protected]
Priscilla Grant, J.D.
National Institute on Minority Health and Health Disparities (NIMHD)
Telephone: 301-594-8412
Email: [email protected]
Anthony Agresti
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-0186
Email: [email protected]