A large and growing population of patients survives acute critical illness only to become """"""""chronically critically ill,"""""""" with profound debilitation and often permanent dependence on life-sustaining technology. Despite intensive care, outcomes for these patients remain poor: mortality rates are high and extreme functional dependence is typical for survivors. Evidence suggests substantial patient suffering during care. Chronic critical illness is a serious health problem for the nation and especially for older adults; the majority of these patients are over age 65. The Candidate for this K02 award brings expertise in critical care and palliative medicine to this important new area for aging research. Overall goals of her research program are: I. To assess palliative care needs of chronically critically ill older adults; II. To evaluate the influence of unmet palliative needs on important clinical/utilization outcomes of chronic critical illness; and III. To test targeted interventions to improve palliative care/associated outcomes of older adults with chronic critical illness. She recently received her first R01 award for research with these specific aims: 1) To assess symptom distress during chronic critical illness; and 2) To analyze associations between symptom experience and other outcomes including success in/time to liberation from mechanical ventilation, functional status and survival. ? Here, the Candidate presents a plan for further career development/research that will enhance the current R01 and facilitate her transition from newly independent investigator to leader of a strong, expansive, and sustainable program that continues to inform and improve palliative care for older adults with chronic critical illness. Whereas she currently carries substantial non-research responsibilities, a K02 award would protect the Candidate's time to: 1) Advance her skills/knowledge/experience in clinical research methods/project leadership, palliative medicine and geriatrics; 2) Use her ongoing observational research as a platform for successful applications for federal funding of interventional studies; and 3) Establish herself as an investigator of international stature. The environment is a renowned center for research in geriatric palliative care and chronic critical illness and for clinical research training; the institution offers enthusiastic support. ? ?
| Boss, Renee; Nelson, Judith; Weissman, David et al. (2014) Integrating palliative care into the PICU: a report from the Improving Palliative Care in the ICU Advisory Board. Pediatr Crit Care Med 15:762-7 |
| Penrod, Joan D; Pronovost, Peter J; Livote, Elayne E et al. (2012) Meeting standards of high-quality intensive care unit palliative care: clinical performance and predictors. Crit Care Med 40:1105-12 |
| Nelson, Judith E; Puntillo, Kathleen A; Pronovost, Peter J et al. (2010) In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med 38:808-18 |
| Nelson, Judith E; Walker, Amy S; Luhrs, Carol A et al. (2009) Family meetings made simpler: a toolkit for the intensive care unit. J Crit Care 24:626.e7-14 |
| Gay, Elizabeth B; Pronovost, Peter J; Bassett, Rick D et al. (2009) The intensive care unit family meeting: making it happen. J Crit Care 24:629.e1-12 |
| Camhi, Sharon L; Mercado, Alice F; Morrison, R Sean et al. (2009) Deciding in the dark: advance directives and continuation of treatment in chronic critical illness. Crit Care Med 37:919-25 |
| Nelson, Judith E; Mercado, Alice F; Camhi, Sharon L et al. (2007) Communication about chronic critical illness. Arch Intern Med 167:2509-15 |
| Nelson, Judith E; Angus, Derek C; Weissfeld, Lisa A et al. (2006) End-of-life care for the critically ill: A national intensive care unit survey. Crit Care Med 34:2547-53 |
| Nelson, Judith E (2006) Identifying and overcoming the barriers to high-quality palliative care in the intensive care unit. Crit Care Med 34:S324-31 |
| Nelson, Judith E; Tandon, Nidhi; Mercado, Alice F et al. (2006) Brain dysfunction: another burden for the chronically critically ill. Arch Intern Med 166:1993-9 |
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