# A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2021 · $504,941

## Abstract

Project Summary .
Over 1 million older (≥65 years) adults with serious illness have major surgery or severe trauma each year.
After surgery or trauma, older seriously ill patients are at risk for increased healthcare use, functional and
cognitive decline, and mortality. National quality guidelines highlight that palliative care focused on aligning
treatments with health goals, improving quality of life, alleviating physical and psychological suffering, and
addressing social needs, should be provided alongside surgical care at all stages of serious illness. Palliative
care for hospitalized seriously ill patients is associated with reduced symptoms and less healthcare utilization
after discharge. Although seriously ill surgical patients benefit from palliative care, they are less likely than
other hospitalized patients to receive it; this is in part due to research gaps that have inhibited implementation
of practical palliative care interventions for older seriously ill surgical patients. Gaps include a dearth of data on
patient-oriented surgical outcomes such as pain, depression, and caregiving that can be targeted by palliative
care, methodological barriers to measuring palliative care delivery in surgical practice, and little understanding
of contextual factors that influence implementation of palliative care in surgery. The proposed study will
address these gaps by providing an innovative and layered examination of the role of palliative care in surgery.
The study has three specific aims. Aim 1 identifies a cohort of seriously ill older surgical patients (≥66y) using
Health and Retirement Study data linked to Medicare claims, and determines the association between direct
targets of palliative care (pain, depression, and caregiving needs) and less proximal benefits (reduced
healthcare utilization) to demonstrate the important role of palliative care in surgery. Aim 2 identifies a
retrospective cohort of older seriously ill surgical patients (≥66y) in a large regional health system and uses
Natural Language Processing in electronic health data linked to Medicare Claims to identify palliative care
processes (goals of care discussions, healthcare proxy documentation, pain and caregiver assessments)
delivered during the surgical episode. The association between palliative care and healthcare utilization in the
year after surgical discharge will be tested. Aim 3 uses qualitative interviews and direct observations to obtain
an in-depth understanding of contextual factors influencing implementation of palliative care processes in the
care of seriously ill older surgical patients (≥65 years). This proposal uses complementary data sources to
assess patient-centered outcomes in older seriously ill surgical patients, uses novel methods to evaluate the
impact of palliative care processes on outcomes, and deeply examines barriers to implementation of
perioperative palliative care in clinical practice. These results will directly inform bedside clinical decis...

## Key facts

- **NIH application ID:** 10297423
- **Project number:** 1R01AG070252-01A1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Zara R Cooper
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $504,941
- **Award type:** 1
- **Project period:** 2021-08-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10297423

## Citation

> US National Institutes of Health, RePORTER application 10297423, A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults (1R01AG070252-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10297423. Licensed CC0.

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