Abstract - Research Project 3 TITLE: The effect of a needs-targeted intervention on racial disparities in unmet needs of patients and families in the intensive care unit The quality of palliative care is highly variable for the nearly 5 million annual ICU admissions. Many patients and families report unmet needs and poor communication and decision making; however, these reports are more common among African Americans and their families who are less satisfied with the quality of ICU care. Improving ICU care quality on a broad scale is challenging because of a limited palliative care workforce and ICU clinicians' difficulties in proactively identifying and addressing unmet needs among diverse patients and family members. To address these challenges to care delivery, we developed a mobile app that allows patients and families to self-report needs, receive information about palliative care, and get examples of questions that can improve understanding. Clinicians can visualize patient/family needs and decisional support on how to address them. In a series of pilot studies, we found that the need app is acceptable, feasible, and can reduce unmet palliative care needs in race/ethnically diverse populations. While our pilot data are promising, we need to definitively determine the effectiveness of the intervention and its effect on racial disparities in care. The proposed study will: (1) Optimize the app platform's usability in a racially diverse population, (2) Test the impact of app-augmented care vs usual care in a stepped-wedge trial on reducing racial disparities (African Americans and Whites) in unmet needs and satisfaction with care; and (3) Explore patient, family member, and clinician experiences using mixed methods to understand intervention mechanisms within unique case contexts. We hypothesize that compared to usual care, needs app-augmented care will reduce family members' unmet needs and psychological distress, increase the frequency of patients' receipt of goal concordant treatment, and reduce hospital length of stay in both whites and African Americans.