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Name of Submitter:
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J. Randall Curtis
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Title of proposed idea:
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Interdisciplinary approach to improving care for patients with serious illness
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What is the major obstacle/challenge in the biomedical research field? What is needed to overcome this obstacle/challenge?
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Decades of research have demonstrated that many patients with serious or life-limiting illness are suffering with pain ad other symptoms and receive high intensity medical care that they would not choose. Healthcare costs are continuing to rise in an unsustainable way and more than a quarter of these costs are spent in the last year of life. Recent studies have shown that advance care planning and clinician-patient communication about end-of-life care can improve quality of life and reduce intensity of care at the end-of-life, while also decreasing stress and psychological burden on family members. However, there has been only limited success at identifying effective ways to conduct advance care planning and communication about end-of-life care and we have not identified effective and cost-effective ways to implement this communication in routine clinical practice.
In order to overcome this challenge, we will need a coordinated and interdisciplinary approach that incorporates diverse areas of science including but not limited to a) social and behavioral sciences; b) communication sciences; c) decision sciences; d) bioinformatics incorporating the electronic health record and novel electronic technologies; e) health disparities and cultural competence; f) implementation and dissemination sciences; e) health and behavioral economics; and f) comparative effectiveness. This effort would need to be coordinated across many clinical disciplines and disease areas. |
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What emerging scientific opportunity is ripe for investment by the Common Fund?
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Recent advances in advance care planning, including several randomized trials and observational studies showing improvements in patient and family outcomes and reduced intensity of care at the end of life, suggest an exciting opportunity to advance the science of advance care planning and communication about end-of-life care in a way that could make dramatic improvements in the care received by many patients and their families and also reduce inappropriate healthcare costs. To achieve these potential opportunities, we need to identify how to best change the processes of care for seriously ill patients so that the care delivered reflects the values and preferences of patients and families as well as the scientific evidence base for efficacy and effectiveness. |
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What are the potential Common Fund investments that could accelerate scientific progress in this field?
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A Common Fund program that required interdisciplinary approaches to address this problem offers the opportunity to bring together basic, clinical, and health services scientists working in a number of different disease-areas and using diverse areas of science to create innovative and effective solutions that could be successfully implemented in diverse practice settings. This Common Fund program could include a targeted series of RFAs that span from the basic science of communication and decision-making to the implementation science for translating these discoveries into clinical and public health practice. These RFAs would include most of the diseases and areas covered by the NIH Institutes and Centers. |
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If a Common Fund program on this topic achieved its objectives, what would be the impact?
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Implementing effective advance care planning, palliative care, and communication about end-of-life care is one of the few areas of medical science that offers the opportunity to improve outcomes for patients and families, allow patients to receive the care they would want if fully informed, and reduce healthcare costs. Advances in life-sustaining technology have been remarkable and needs to continue, but our ability to communicate with patients and families about the best ways to use (or not use) these technologies lag dramatically behind. We need an integrated, interdisciplinary, trans-NIH approach to address this important problem. The outcomes of such a program could be clearly delineated and tracked and would include increased quality of life, decreased symptoms, improved concordance between treatment desired and treatment received, and reduced intensity of care at the end of life. |
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