Full Text CA-94-012


NIH GUIDE, Volume 23, Number 13, April 1, 1994

RFA:  CA-94-012



National Cancer Institute

Letter of Intent Receipt Date:  May 2, 1994
Application Receipt Date:  June 16, 1994


The National Cancer Institute (NCI) invites grant applications to
create new educational programs to address health professional
training in palliative patient care.  The intent of this Request for
Applications (RFA) is to emphasize NCI's concern for this neglected
area with the expectation that any funded programs will act as
catalysts to encourage further interest and development in the
medical community.


The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This Request
for Application (RFA), Hospice and Palliative Care Education
Programs, is related to the priority area of Educational and
Community-based Programs.  Potential applicants may obtain a copy of
"Healthy People 2000" (Full Report:  Stock No. 017-001-00474-0) or
"Healthy People 2000" (Summary Report:  Stock No. 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (telephone 202-783-3238)


Applications may be submitted by domestic for-profit and non-profit
organizations, public and private, such as universities, colleges,
hospitals, hospices, units of State and local governments, and
eligible agencies of the Federal government.  Foreign organizations
are not eligible to apply.  Applications from minority individuals
and women are encouraged.


Support for this effort will be through the NCI Cancer Education
(R25) Award.  This award is a flexible, curriculum-driven program
aimed at developing and sustaining innovative and, possibly, unique
educational approaches that ultimately will have an impact on
reducing cancer incidence, mortality, and morbidity, as well as on
improving the quality-of-life of cancer patients and their families.
The current guidelines for the Cancer Education Program (R25) may be
obtained from the program director listed under INQUIRIES.

Applicants will be responsible for the planning, direction, and
execution of the proposed project.  The total project period for each
application submitted in response to this RFA may not exceed three
years.  The earliest feasible start date for the initial award will
be September 1994.  It is anticipated that the average amount of
direct costs awarded per grant will range from $50,000 to $100,000
depending upon the proposed program.  Indirect costs will be allowed
at the rate of eight percent of total direct costs (exclusive of

This RFA is a one-time solicitation.  Future competitive continuation
applications will compete with all other applications in the Cancer
Education Grant Program (R25).  Should the NCI, however, determine
that there is a sufficient program need, a new request for
competitive continuation and/or new applications will be announced.


For FY 1994, $500,000 in total costs will be available for, it is
estimated, some five to seven new awards.  This funding level is
dependent on the receipt of a sufficient number of applications of
high scientific merit.  A greater or lesser amount of dollars and
number of awards may be negotiated based on the quality of the
applications and the availability of funds.



There are few formally structured programs for training in palliative
patient care available in the United States.  There are far too few
health care professionals who have been trained or have an interest
in dealing with this phase of a patient's disease.  The Hospice
movement in this country, through its own efforts, has developed
largely outside mainline, established treatment and educational

In September 1990, NCI sponsored a workshop on cancer pain.  Although
the focus of this meeting was on the need for state-of-the-art
technology transfer for pain management, the conference did at that
time specify an urgent need for additional educational and training
programs in palliative care.  At the National Cancer Advisory Board
meeting on May 6, 1992, a mini-symposium, "Living with Cancer," once
again emphasized the necessity for training and education in this
area.  In response to these concerns, at the end of FY 1992, the NCI
funded at a level of almost $1.3 million 15 of 55 applications for
its RFA CA-91-25 which was entitled:  "Cancer Education Programs in
Pain Management, Rehabilitation, and Psychosocial Issues."  In
addition, in FY 1993, RFA CA-93-35, "Cancer Pain Management in the
Outpatient Setting" was announced.


This RFA proposes to stimulate medical schools, schools of nursing,
cancer centers, oncology divisions, and other health professional
entities to design methodologies for the education and training of
health care professionals in hospice and palliative care.
Traditionally, the nursing profession has been more involved with
this phase of patient care than physicians.  Hospices have had to
struggle with physician recruitment.  A major challenge is to train
more physicians in a team approach to palliation.  An important
target group for reaching this goal would be medical students during
their clinical training years.  At a minimum, what a hospice is,
issues of hospice care, and the practical aspects of interaction with
patients and their families should be considered.

Hospices, either individually or in regional settings in
collaborative arrangements with other medical centers are
particularly encouraged to submit applications in response to this
RFA.  The development of hospices in academically oriented settings
is definitely encouraged.

The NCI hopes to stimulate multi-disciplinary, team approaches to
palliative care by encouraging a variety of educational programs
aimed at medical students, physicians, other health professionals,
and hospice personnel.  The ultimate goal is to benefit cancer
patients and their families.

Applicants can design curricula, short courses, interactions with
patients and families, and other effective approaches for training
one or more of the target groups mentioned above.  For example,
programs could involve medical students taking a one month elective
or doing a one or two month rotation in a hospice or home health care
setting.  Residents or practicing physicians could have specifically
constructed opportunities in their regular or continuing education to
become more cognizant of palliative care including cancer pain
management and related psychosocial issues in a hospice setting.

These multi-disciplinary programs will require the integration of
several elements that could include, but are not limited to, control
of physical symptoms such as pain, nausea, and hiccups [all
successful applications must deal with pain relief and the
pharmacokinetics of pain medications]; psychological issues of dying,
bereavement, and metaphysical beliefs; medical ethics; health
economics; home health care plus family or social concerns and
values.  In addition to any didactic components, it will be essential
to involve participants in practical demonstrations of care with
patients and families in a hospice or home setting.  It has been
estimated that 80 percent of palliative care occurs in the home.  The
participation of home care nurses with oncology experience,
therefore, will be a critical element in most of these education


Applicants are requested to identify clearly in their application the
following aspects of their proposed initiative:  (1) the content and
scope of the educational activities; (2) the specific populations to
be educated and their availability; (3) the procedures to be used to
announce these educational activities and to recruit participants;
(4) the potential benefits to health professionals, the lay public or
to cancer patients and their families likely to arise as the result
of these educational programs; (5) the methods of evaluation of the
program outcomes; and (6) the specific plans to disseminate aspects
of these educational activities that prove to be effective.

If several institutions are jointly involved or if several
departments within an institution are cooperating in this RFA, a
special, central, interdisciplinary Cancer Education Committee
consisting of members from the collaborating organizations or units
should be in place.  The functions of the Committee would be to
provide effective monitoring and coordination of the program.


Prospective applicants are asked to submit, by May 2, 1994, a letter
of intent that includes a descriptive title of the proposed
educational activity, the name, address, and telephone number of the
Principal Investigator/Educator, the identities of other key
personnel and participating institutions, and the number and title of
the RFA in response to which the application may be submitted.
Although a letter of intent is not required, is not binding, and does
not enter into the review of subsequent applications, the information
that it contains allows NCI staff to estimate the potential review
workload and to avoid conflict of interest in the review.

The letter of intent is to be sent to Dr. Robert C. Adams at the
address listed under INQUIRIES.


The research grant application form PHS 398 (rev. 9/91) is to be used
in applying for these grants.  These forms are available at most
institutional offices of sponsored research; from the Office of
Grants Information, Division of Research Grants, National Institutes
of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone
301/710-0267; and from the NCI Program Director listed under

The RFA label available in the application form PHS 398 must be
affixed to the bottom of the face page of the application.  Failure
to use this label could result in delayed processing of the
application such that it may not reach the review committee in time
for review.  In addition, the RFA number and title must be typed on
line 2a of the face page of the application form.

Submit a signed, typewritten original of the application, including
the Checklist and three signed, exact, clear, and single-sided
photocopies in one package to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At time of submission, also send two additional copies of the
application to:

Ms. Toby Friedberg
Division of Extramural Activities
National Cancer Institute
Executive Plaza North, Room 636
6130 Executive Boulevard
Bethesda, MD  20892

Applications must be received by June 16, 1994.  If an application is
received after that date, it will be returned.  If the application
submitted in response to this RFA is substantially similar to a grant
application already submitted to the NIH for review but not yet
reviewed, the applicant will be asked to withdraw either the pending
application or the new one.  Simultaneous submission of identical
applications will not be allowed, nor will essentially identical
applications be reviewed by different review committees.  An
application, therefore, cannot be submitted in response to this RFA
that is essentially identical to one that has already been reviewed.
This does not preclude the submission of substantial revisions of
applications already reviewed, but such applications must include an
introduction addressing the previous critique.


Review Procedure

Upon receipt, applications will be reviewed initially by the Division
of Research Grants (DRG) for completeness. Incomplete applications
will be returned to the applicant without further consideration.
Applications subsequently will be evaluated by NCI scientific
administration staff to determine how well they meet the objectives
of the program as described in this RFA.  Applications that are not
primarily oriented to the goals of this RFA will be judged
non-responsive and will be returned.  Program staff listed under
INQUIRIES will be happy to address questions concerning the relevance
of any proposed educational or training activity to this RFA.

If number of applications is quite large compared to the number of
awards to be made, the NCI may conduct a preliminary scientific peer
review (triage) to eliminate those applications that are clearly not
competitive and will notify the applicant and institutional business
official of this action.

Those applications judged to be both competitive and responsive will
be further evaluated according to the review criteria stated below
for scientific and technical merit by an appropriate peer review
group convened by the Division of Extramural Activities, NCI.  The
second level of review by the National Cancer Advisory Board will
consider the special needs of the NCI and the priorities of the
National Cancer Program.

Review Criteria

o  The overall quality of the proposed education programs.

o  The responsiveness of the application to the SPECIAL REQUIREMENTS
section described above.

o  Scientific, pedagogic, and administrative qualifications and
experience of the principal investigator and staff.

o  The availability of appropriate resources and facilities for the
proposed activities.

The review committee will critically examine the proposed budget and
recommend an appropriate budget for each approved application.


The anticipated date of award is September, 1994.  Awards will be
made according to priority score, availability of funds, and
programmatic priorities.


Written and telephone inquiries concerning this RFA are encouraged.
The opportunity to clarify any issues or questions from potential
applicants is welcome.

Direct inquiries regarding programmatic issues to:

Dr. Robert C. Adams
Division of Cancer Biology, Diagnosis, and Centers
National Cancer Institute
Executive Plaza North, Room 520
Bethesda, MD  20892
Telephone:  (301) 496-8580
FAX:  (301) 402-4472

Direct inquiries regarding grants management issues to:

Mr. Robert Hawkins
Grants Administration Branch
National Cancer Institute
Executive Plaza South, Room 242
Bethesda, MD  20892
Telephone:  (301) 496-7800, ext. 213


This program is described in the Catalog of Federal Domestic
Assistance Number 93.398, Cancer Research Manpower.  Awards are made
under the authorization of the Public Health Service Act, Title IV,
Part A, Public Law 78-410, as amended by Public Law 99-158, 42 USC
241 and 285 and administered under HHS regulations and PHS grant
policies.  The Public Health Service (PHS) strongly encourages all
grant recipients to provide a smoke-free workplace and promote the
non-use of all tobacco products.  This is consistent with the PHS
mission to protect and advance the physical and mental health of the
american people.


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