# Communication in the Hospital: Impact on the Patient and Surrogate

> **NIH NIH K24** · INDIANA UNIVERSITY INDIANAPOLIS · 2020 · $166,306

## Abstract

Vulnerable older adults and their families face multiple challenges in medical decision making, health
communication, and the emotional distress involved in facing serious illness and death. Dr. Alexia Torke's
research has focused on the communication, ethical, religious and spiritual aspects of decision making for
those patients who are incapacitated and require a family surrogate to make decisions for them. This K24
award will provide support for Dr. Torke's program of research and will allow her additional protected time to
pursue her passion for mentoring others.
The specific aims of this K24 award are to: train future aging researchers to conduct high quality research
focused on decision making and outcomes for vulnerable older adults and their family members; to study the
experience of family surrogate decision makers, including the impact of communication quality on decision
quality and family outcomes such as anxiety, depression, and posttraumatic stress; and to measure
surrogates' religious and spiritual experiences to determine whether these factors are associated with medical
decision making and the medical care that patients receive at the end of life.
Dr. Torke' research topic is important because nearly half of hospitalized older adults are unable to make their
own medical decisions and require a family member or other surrogate to make decisions for them. Her prior
research has shown that many surrogates make decisions about life and death issues under conditions of high
stress and often with poor support from clinicians. Surrogates rely on various sources of emotional support and
sources of value to make medical decisions, including personal, religious and spiritual beliefs. However, both
surrogates and clinicians report high levels of distress due to the emotional and communication challenges of
making decisions for others. Although there is evidence from patient studies that religion is associated with
preferences for more aggressive care at the end of life, this has not been studied for surrogates making
decisions for others. As the population ages and a greater number of older adults are at risk for cognitive
impairment, the importance of surrogate decision making will only increase. Understanding the mechanisms
underlying high quality decision making will allow us to best support family members and to provide the best
possible care to older adults.
The projects proposed in this award will leverage a database of 359 older hospitalized adults and their
surrogate decision makers that Dr. Torke has developed through funding from an R01 grant from the National
Institute on Aging. Additional funding from the Indiana University Health Values Grant and the Greenwall
Foundation allowed Dr. Torke to also collect data on the goals of care endorsed by the surrogate, care
received at the end of life, and the religious and spiritual experiences of the surrogates. Project 1 will explore
the impact of communication quality on decision making...

## Key facts

- **NIH application ID:** 9940847
- **Project number:** 5K24AG053794-05
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** Alexia Mary Torke
- **Activity code:** K24 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $166,306
- **Award type:** 5
- **Project period:** 2016-09-15 → 2021-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9940847

## Citation

> US National Institutes of Health, RePORTER application 9940847, Communication in the Hospital: Impact on the Patient and Surrogate (5K24AG053794-05). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9940847. Licensed CC0.

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