Project Summary Patients with COPD have a high burden of illness and poor quality of life. Despite clear evidence that such patients frequently lack engagement in health-promoting behaviors and tend to de-value future health consequences, almost no work has investigated whether these patients make predictive errors about future health states nor investigated the association of such errors on future health-related quality of life (HRQL). The proposed study’s broad objective is to improve the outcomes of patients with COPD. The candidate’s completed NHLBI F32-funded study of patients with smoking-associated pulmonary diseases generated a conceptual framework that forms the foundation for the proposed work. She has continued to prepare for scientific independence through an NHLBI K12 that explores the acceptability and competency of specific attributes of physician-patient communication (e.g., choice architecture and the use of beneficent deception). The proposed study builds upon these findings and seeks to 1) assess the accuracy with which patients with severe COPD predict their future health states, 2) evaluate the relationship between accuracy of expectations and patient-reported HRQL, and 3) explore how patients with differing expectations and predictive accuracy generate their predictions and engage in prospection. The study will involve a longitudinal prospective cohort study enrolling 207 patients with severe COPD. Participants will complete baseline measurements of individual characteristics (selected from preliminary data and applicable theories) and measures of HRQL. Participants will, at the time of enrollment, provide predictions of their dyspnea and emotional symptoms for 3 and 12 months in the future. Each patient’s accuracy will be determined by comparing his or her individual predictions to experienced symptoms at these follow-up intervals. Completion of this research will build upon the candidate’s past training and uninterrupted NHLBI support, which includes a Masters in Health Policy Research obtained with NHLBI T32 support, and F32 and K12 periods, and will provide the experience, education, and mentorship to allow the candidate to become a fully independent investigator. The candidate’s rigorous training plan, focused on obtaining advanced skills in behavioral science and patient-centered outcomes research and expertise in prospective studies, will allow her to submit successful R01 or PCORI applications testing interventions developed directly from the results of this work. The candidate’s primary mentor, co-mentor, collaborators, and advisors will ensure adherence to the proposed timeline and goals and provide a supportive environment for her to develop an independent research career investigating decision interventions that improve health outcomes among patients with COPD.