(From application) The applicant states that most elders in the US die in acute care hospitals where serious shortcomings in end-of-life care are endemic. Palliative care has made substantial improvements in the care of older Americans at the end of life, but these advances have been largely limited to the outpatient setting. The American Geriatrics Society (AGS) position statement on the care of dying patients outlines specific issues that should be addressed in palliative care, including relief of symptoms such as pain, dyspnea, and anxiety, as well as attention to the emotional, psychological and spiritual needs of the patient and family. The applicant has developed a novel approach to addressing the issues raised in the AGS position statement. This grant application has two complementary long-term goals: 1) to improve palliative care for hospitalized elders, and 2) to provide an experience for the applicant, leading him to a career as an independent investigator in aging by supporting an incremental research and training program. During the first three years of the proposed award, the applicant plans to conduct a clinical trial whose aim is to determine whether a multidisciplinary palliative care consultation will improve management of three critical symptoms (pain, dyspnea, and anxiety), advance care planning, and spiritual issues for seriously-ill, hospitalized older patients. The proposed program of palliative care consultation is based on a conceptual model of terminal illness in which biological, psychological, spiritual, and social factors lead to suffering and death. The proposed research will test the following five specific hypotheses: Compared with usual care, seriously ill, hospitalized older patients who receive a daily, multidisciplinary palliative care consultation will: 1) have lower pain scores; 2) have lower dyspnea scores; 3) have lower anxiety scores; 4) be more likely to have their choice of a surrogate decision-maker documented by the primary teams; 5) be more likely to have the offer of chaplain services documented by the primary team. This proposal incorporates mentored- research experience, tutorials, structured reading, and courses that will develop the applicant's research skills necessary to design and conduct clinical trials and other patient-based research. In addition, it is anticipated that the proposed research will develop the UCSF palliative care service into a unit for conducting clinical research focused on improving inpatient palliative care.
