Unlike other areas of medicine, the knowledge base to support palliative care clinical practice (i.e., pain and symptom management, communication
skills, care coordination) is small and inadequate and systems of care that truly support the needs of patients and families have yet to be
developed. Evidence is needed to inform and shape the clinical practice of interdisciplinary health care teams who are charged with providing
symptom relief across a wide variety of settings and diseases for this population.
The growing numbers of older Americans and the increasing prevalence of advanced chronic illness create an imperative to advance research in
palliative care for this population. Palliative Medicine was approved as an American Board of Medical Specialties (ABMS) specialty in September
2006, creating additional urgency for increasing the palliative medicine evidence base.
Reports from the Institute of Medicine (IOM) in 1997, 2001, and 2003; the Research Task Force of the American Academy of Hospice and Palliative
Medicine (the membership organization of palliative care physicians) in 2003; and the National Institute of Health's (NIH) State of the Science
Conference on End-of-Life Care in 2004 have called for the development of:
1. A cadre of palliative care experts whose numbers and talents are sufficient to organize and conduct biomedical, clinical, behavioral, and
health services research for patients with serious and chronic illness, and
2. Research networks and multi-site studies to establish the knowledge base of the field and contribute to the goal of bringing an evidence-based
approach to palliative care practice.
By 2030, 20 percent of the United State's population will be over age 65. For most, the years after age 65 are a time of good health,
independence, and integration of a life's work and experience. Eventually, most adults will develop one or more chronic illnesses with which they
will live for years before death. These years are characterized by physical and psychological symptom distress; progressive functional dependence
and frailty; and high family support needs. Recent studies suggest that medical care for patients with advanced illness is characterized by
inadequately treated physical distress; fragmented care systems; poor communication between doctors, patients, and families; and enormous strains
on family caregiver and support systems.
Palliative care focuses on relieving suffering and achieving the best possible quality of life for patients and their caregivers. The development
of the specialty of palliative medicine has been a critical step in addressing the unmet needs of patients with serious illness and their families
and the growth of this field has been remarkable. From 2001-2003, the number of hospital based palliative care programs has grown by over 60% such
that now one in 4 U.S. hospitals has a palliative care program and all U.S. medical schools must provide training in palliative medicine.1
Unlike other areas of medicine, the knowledge base to support palliative care clinical practice (i.e., pain and symptom management, communication
skills, care coordination) is small and inadequate and systems of care that truly support the needs of patients and families have yet to be
developed. Evidence is needed to inform and shape the clinical practice of interdisciplinary health care teams who are charged with providing
symptom relief across a wide variety of settings and diseases for this population. The growing numbers of older Americans and the increasing
prevalence of advanced chronic illness create an imperative to advance research in palliative care for this population. Palliative Medicine was
approved as an American Board of Medical Specialties (ABMS) specialty in September 2006, creating additional urgency for increasing the palliative
medicine evidence base.
Specific areas of research in palliative care that need to be addressed include:
1. Establishing the prevalence of symptoms in older adults with chronic disease;
2. Evaluating the association between symptom treatments and outcomes among older patients;
3. Increasing the evidence base for symptom treatment among older adults;
4. Understanding older adults psychological/spiritual well-being and quality of life;
5. Elucidating sources of burden for caregivers of geriatric patients with advanced illness;
6. Reevaluating service delivery to address the needs of older patients with serious chronic illness; and
7. Adapting research methodologies specifically for palliative care for older patients.
To develop a Program in Palliative Care Research that will expand and promote interdisciplinary clinical research in palliative care by:
1. Providing infrastructural support, mentorship and a venue for collaboration for both established and new investigators,
2. Increasing active engagement in palliative care research among students, trainees, faculty and the academic and provider community; and
3. Identifying gaps in the current evidence base and addressing research priorities relative to care of persons with serious advanced illness.
The expected outcomes of this award are a greater number and diversity of faculty and trainees actively participating in collaborative research
focused on improving care for persons with serious advanced illness, increased grant funding, as well as greater integration of clinical,
psychosocial, and health services research expertise.
Following successful development of the Program during the K07 award period, the eventual goal is to develop a sustainable nationally-recognized
Center of Excellence in research regarding care for persons with serious advanced illness.
David Bekelman, MD, MPH
Division of General Internal Medicine, University of Colorado
Denver (UCD) Expertise: Palliative care in advanced heart failure
Jean Kutner, MD, MSPH (PI)
Division of General Internal Medicine, UCD Symptoms and quality of life;
Expertise: caregivers; hospice-based research
Cari Levy, MD
Division of Health Care Policy and Research and Denver VA REAP, UCD Expertise: Palliative care in nursing homes
Al Marcus, PhD
Director, Cancer Prevention and Control, University of Colorado Cancer Center
Expertise: Behavioral interventions
Daniel Matlock,MD
Division of General Internal Medicine, UCD
Expertise: Decision aids
Robert Schwartz, MD
Division of Geriatrics, UCD
Expertise: Care of older adults with decreased functional status
Lucinda Bryant, PhD
Colorado School of Public Health, UCD
Expertise: Aging research
Mark Laudenslager, PhD
Department of Psychiatry, UCD
Expertise: Psychoneuroimmunology; caregiver research
Carey Candrian, PhD student
Department of Communications, University of Colorado Boulder
Communication Expertise: research
Janet Houser, PhD
Associate Dean for Research, Regis University
Experise: Health services research
Cindy O’Bryant, PhD
School of Pharmacy, UCD
Expertise: Pain management
Brian Greffe, MD
Department of Pediatrics, UCD
Expertise: Pediatric palliative care
Regina Fink, RN, PhD
Office of Research, University of Colorado Hospital
Expertise: Hospital-based palliative care, pain management