# Improving goals-of-care discussions for patients with chronic life-limiting illness and acute respiratory failure

> **NIH NIH K23** · UNIVERSITY OF WASHINGTON · 2024 · $187,920

## Abstract

PROJECT SUMMARY/ABSTRACT
Patients with chronic life-limiting illness who develop acute respiratory failure are at high risk of death and
disability. Because some such patients would choose to forego life-sustaining treatments in certain conditions,
it is important that ICU clinicians assess patients’ values, goals, and treatment preferences, and incorporate
these findings into shared decision-making to provide goal-concordant care. Unfortunately, my preliminary data
as well as qualitative studies of other hospitalized populations suggest that ICU clinicians often miss
opportunities to assess or incorporate patients’ goals of care into decision-making. This may lead to the
delivery of unwanted intensive care and life-sustaining treatments, which is harmful to both patients and
families, and results in the delivery of high-cost, low-value care.
The proposed research in this application will use multimethod and mixed-methods approaches to: (1) examine
current implementation of goals-of-care discussions for patients with acute respiratory failure and chronic life-
limiting illness; (2) identify potentially modifiable clinician behavioral determinants that underlie deficiencies in
goals-of-care communication, and iteratively redesign an existing outpatient communication-priming
intervention toward the goal of promoting high-quality goals-of-care discussions in the ICU; and, (3) conduct a
pilot randomized trial of the redesigned communication-priming intervention to improve the occurrence and
quality of documented goals-of-care discussions for patients with acute respiratory failure and chronic life-
limiting illness.
Through a combination of mentored research activities and formal research training, I will receive valuable
research training in analytical methods to enhance the validity of studies that use “real-world” data, application
of mixed-methods research to inform health intervention design, and clinical trials. The proposed research and
training activities will prepare me for a career as an independent clinical investigator, and will form the
foundation for a body of research designed to improve outcomes for patients with acute respiratory failure.
These research and training activities will be facilitated by the academically rich research environments of the
University of Washington Schools of Medicine, Nursing, and Public Health, as well as the Cambia Palliative
Care Center of Excellence at UW Medicine.

## Key facts

- **NIH application ID:** 10909005
- **Project number:** 5K23HL161503-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Robert Ying-Fu Lee
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $187,920
- **Award type:** 5
- **Project period:** 2022-08-01 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10909005

## Citation

> US National Institutes of Health, RePORTER application 10909005, Improving goals-of-care discussions for patients with chronic life-limiting illness and acute respiratory failure (5K23HL161503-03). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10909005. Licensed CC0.

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