Society is facing one of the largest public health challenges in its history - the growth of the population of older adults and increasing morbidity due to chronic serious illness. Over the next decades, most physicians will be caring for seriously ill elders with multiple comorbidities and lengthy duration of illness. Abundant evidence suggests that the advanced stages of disease are often characterized by inadequately treated physical distress;fragmented care systems;poor communication between doctors, patients, and families;and strains on family caregiver and support systems. In their report, Approaching Death: Improving Care at the End of Life, the Institute of Medicine called for a cadre of experts to supply leadership for scientifically- based and practically useful medical education and to organize and conduct clinical, behavioral, and health services research for patients with serious and chronic illness. In 2006, the National Palliative Care Research Center (NPCRC) was established at the Mount Sinai School of Medicine with a mission to stimulate, develop, and fund new research directed at providing relief from distressing symptoms and improving care for patients with serious illness, their families, and caregivers. Over the past six years, the NPCRC has emerged as a key contributor to the movement to improve quality of care for the sickest and most vulnerable patients in our nation's healthcare system. We have created a network of palliative care researchers who are addressing the most pressing problems of our most vulnerable patients. Building on the success of the NPCRC, we are seeking funding through this R24 mechanism to enhance our efforts to stimulate research for seriously ill older adults by creating a research technical assistance program for early- stage investigators through the NPCRC research network and catalyzing the development of research networks and multi-site studies in geriatric palliative care by supporting pilot/exploratory projects and the development of research collaborative for experienced investigators. Through these efforts, our goal is to ensure that all health care professionals have the knowledge and evidence base to provide high quality palliative care to the rapidly increasing numbers of older adults living with serious illnes.
The Institute of Medicine has called for a cadre of experts to organize and conduct clinical, behavioral, and health services research for patients with serious illness. This R24 proposal responds directly to the lOM by using an existing national research organization to leverage scarce NIH monies to provide research technical assistance to early-stage and experienced investigators and to expand and solidify the community and network of geriatric palliative care researchers throughout the U. S.