This application for a T32 predoctoral and postdoctoral training program describes a proposed plan for training in symptom management and palliative care research among adults with advanced disease - specifically cancer, heart failure, and chronic critical illness. The long-term goal of this training program is to train a diverse group nurse scientists who will advance our knowledge and understanding of how to provide effective palliation - - that is, management of symptoms - - that significantly impair quality of life in advanced and incurable disease states. Symptom management investigations are especially challenging in subject populations who have life-limiting, progressive disease, yet these are also the patients usually in greatest need of expert symptom management. In addition to measurement and instrument issues specific to single symptoms (e.g. pain, dyspnea), identifying appropriate end points in the context of disease progression, the high likelihood of missing data from subjects who are quite ill, and accounting for the effects of co-existing depression and anxiety when measuring physical symptoms are common challenges in this population. In order to advance our understanding of symptom management approaches and build the evidence base needed for effective palliative care, specific tailored preparation in methodologies and analytic strategies needed for research with persons with progressive, advanced illness are essential. This training program will address that need. This NRSA will provide support for 8 predoctoral trainees and 9 post-doctoral trainees over the 5 years of the program. In addition to our typical applicant pool, we will particularly target BSN students for entry to the "fast-track" BSN-to-PhD program and members of minority groups. We have an existing internal program to identify promising BSN students in our school who demonstrate exceptional potential for moving directly in to a doctoral program. Our faculty also have leadership roles in national specialty organizations with large BSN memberships, and these will provide additional recruitment opportunities. Through our existing relationships with several colleges that have large minority student populations, we will be able to target recruitment to achieve a demographic balance in the training program. We have established collaborative relationships with a variety of accomplished researchers from other disciplines who will be active faculty participants on this training program. Both the pre- and postdoctoral training plans are built on a successful record of recruitment and productivity of previous graduates and we believe the focus of the proposed program will enable trainees to make significant contributions to this important area of nursing science.
Effective management of symptoms is a crucial aspect of health care in all illnesses;it is even more important in advanced illness, when quality of life becomes the primary goal. Although there has been a great deal of research in symptom management, investigations in states of advanced disease, such as cancer, heart failure, and critical illness, present particular challenges. The proposed training program will prepare pre- and postdoctoral students with training in the content areas, sophisticated methodologies, and analytic techniques needed to prepare them to make significant contributions to this critical topic.