# Advancing the Conversations Helpful for Awareness of Illness Trajectory (CHAT) Intervention

> **NIH NIH R21** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $255,403

## Abstract

PROJECT SUMMARY
Heart failure with preserved ejection fraction (HFpEF) is a geriatric syndrome that disproportionately impacts
older adults and is associated with high symptom burden, reduced quality of life, and a 5-year survival rate less
than 50%. Yet, few patients with HFpEF understand the condition, its anticipated trajectory, and/or prognosis.
This has several important implications, as our preliminary data show: (1) 33% of patients with a prior
hospitalization for HFpEF are unaware that they have a form of heart failure; (2) symptom burden is high and
engagement in symptom management is low; and (3) advanced care planning (ACP) is vastly underutilized
among this patient population. Symptom management and ACP are key features of palliative care, but
palliative care is either utilized at terminal disease stages or not at all. To address the urgent need to improve
symptom management and ACP earlier in the disease than has traditionally been done, we developed the
Conversations Helpful for Awareness of Illness Trajectory (CHAT) intervention. This intervention is grounded in
self-determination theory, which outlines the importance of competence, autonomy, and relatedness in driving
behavior change. CHAT will provide knowledge (competence), improve patient activation and self-efficacy
(autonomy), and strengthen the patient-physician relationship (relatedness) through a combination of online
patient-facing video-based modules using the Patient Activated Learning System (PALS) platform and a health
coach who will guide patients through the online modules to promote active engagement. The objectives of this
proposal are to: (1) refine the CHAT intervention by incorporating key stakeholders’ feedback through semi-
structured qualitative interviews of patients, caregivers, and physicians, and (2) pilot test the CHAT intervention
for feasibility, acceptability, and preliminary efficacy through a pilot randomized controlled trial. MPIs Goyal and
Shen have complementary areas of expertise in HFpEF, implementation science, communication-based
interventions, and social psychological frameworks. The investigator team also includes a primary care
physician with expertise in intervention development who also created PALS, a nurse scientist with expertise in
heart failure self-care and patient-reported outcomes, and a geriatrician/palliative care specialist with expertise
in decision-making in heart failure and implementation science. The long-term objective is to develop a model
for communicating illness trajectory to promote proactive patient engagement in managing symptoms (and
improve QOL), and engagement in ACP. This proposal seeks to move beyond traditional siloed approaches of
care to address the need to “incorporate palliative care approaches for aging-related conditions by healthcare
practitioners who are not palliative care specialists.”

## Key facts

- **NIH application ID:** 10853068
- **Project number:** 5R21AG077092-02
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** PARAG GOYAL
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $255,403
- **Award type:** 5
- **Project period:** 2023-06-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10853068

## Citation

> US National Institutes of Health, RePORTER application 10853068, Advancing the Conversations Helpful for Awareness of Illness Trajectory (CHAT) Intervention (5R21AG077092-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10853068. Licensed CC0.

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