Improving clinical outcomes after ICU transfer for acute respiratory failure

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PROJECT SUMMARY/ABSTRACT Candidate: Dr. Long’s long-term goal is to improve patient- and family-centered outcomes for patients with acute respiratory failure and their family members. This award will provide Dr. Long with essential research training to support her goal of becoming an independent investigator in the fields of palliative care and pulmonary and critical care medicine. Through this proposal Dr. Long will acquire new skills through four specific learning objectives designed to provide structured training in: 1) the role of mood disorders and the use of psychological outcomes in critical care research; 2) advanced epidemiologic and biostatistics techniques; 3) rigorous qualitative methods; and 4) the design and implementation of randomized trials. These objectives will be achieved through a career development plan that incorporates formal coursework, mentoring by experts in clinical outcomes research, and protected time to gain research experience in an exceptional learning environment. Research: Patients transferred from acute care to the intensive care unit (ICU) for acute respiratory failure represent a population at high risk for poor clinical outcomes. These patients and their family members are likely to benefit from high-quality palliative care tailored to their needs. Palliative care is care focused on patients with serious illness with the goal of improving quality of life for both the patient and family by providing high-quality communication, symptom control, and emotional and spiritual support. Interventions to improve palliative care for patients transferred to the ICU for acute respiratory failure will require a substantial improvement in our understanding of the experiences and needs of patients and their family members. To date, studies of transfers from acute care to the ICU have focused on predictors of ICU transfer and mortality after ICU admission. The research proposed in this application is innovative because it represents a substantive departure from these approaches. The primary objective of this K23 is to develop an understanding of the transfer process from a patient- and family-centered perspective in order to facilitate implementation of an intervention to improve palliative care for patients and their family members after patient transfer from acute care to the ICU for acute respiratory failure. To achieve this objective, Dr. Long will identify a cohort of patients transferred from acute care to the ICU for acute respiratory failure at two medical centers. With this cohort of patients and their family members, Dr. Long will: 1) conduct a prospective cohort study to identify elements of the transfer process associated with family member symptoms of depression, anxiety, and posttraumatic stress; 2) use qualitative interviews of patients, family members, and clinicians to define the palliative care needs of patients and family members; and 3) conduct a pilot randomized trial to test the feasibility and preliminary efficacy of an intervention to improve palliative care for patients and their family after patient transfer from acute care to the ICU. Environment: The University of Washington (UW) is an ideal setting for Dr. Long’s research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Division of Pulmonary and Critical Care Medicine is widely recognized for its Clinical Research Training Track and offers an intellectual environment that supports development of the skills necessary to achieve academic success. In addition to the resources provided within the Division, Dr. Long will also have the full support of the Cambia Palliative Care Center of Excellence at UW (directed by her primary mentor) and will have access to clinical research and biostatistical support through the UW School of Public Health and the Institute of Translational Health Sciences (the Clinical and Translational Science Award program at UW).