# Research Project 3

> **NIH NIH U54** · DUKE UNIVERSITY · 2020 · $217,228

## Abstract

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.

## Key facts

- **NIH application ID:** 9932830
- **Project number:** 5U54MD012530-04
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Christopher Ethan Cox
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $217,228
- **Award type:** 5
- **Project period:** — → —

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9932830

## Citation

> US National Institutes of Health, RePORTER application 9932830, Research Project 3 (5U54MD012530-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9932830. Licensed CC0.

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