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Centers of Excellence in Symptom Science: Building Research Teams for the Future (P20)

The National Institute of Nursing Research (NINR) invites applications to establish Centers of Excellence for Symptom Science Research: Building Research Teams for the Future (P20).The purpose of the proposed grant program is to plan and develop the sustainability of and to enhance interdisciplinary, biobehavioral research for scientists conducting Symptom Science Research by enabling development of research infrastructure and centralized resources in support of research programs in these science areas:

(1) enhance research infrastructure by expanding and targeting research resources available to promote and support Symptom Science research;

(2) expand the number and quality of research projects aimed at improving (a) symptom management in persons of all ages with chronic and acute disorders, (b) the quality of life in persons with function-impairing symptoms and their caregivers, or (c) expand the number and quality of research projects aimed at improving health and quality of life in both healthy and chronically ill persons;

(3) expand the number of research investigators involved in interdisciplinary nursing science research;

(4) increase the quantity and quality of research projects utilizing, genetics/genomics, and biobehavioral methods;

(5) plan for and develop sustainability of research programs by building an active and growing research program with collaborations and partnerships both inside and outside of the applicant organization.

Chronic diseases and their symptoms account for 70% of all deaths in the U.S., which is 1.7 million each year. These diseases also cause major limitations in daily living for almost 1 out of 10 Americans or about 25 million people. Symptom management is an urgent public health concern. Each year chronic pain alone affects over 116 million Americans and accounts for $650 billion in health care costs and lost productivity (IOM report, June 2011). Fifty to 70 million Americans chronically suffer from sleep difficulties, hindering daily functioning and adversely affecting health and longevity (Report Brief: Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, 2006, April National Academy of Sciences). Depressive symptomatology and depression significantly affect approximately 7 - 25 percent of the US population and are associated with increased medical illness, higher rates of comorbid conditions such as obesity and cardiovascular disease, and increased mortality.

Symptoms are the result of a complex interaction of biological, cognitive, behavioral, sociocultural, spiritual, and environmental factors. The responses to symptom treatment and management are equally complex. Managing recurring or chronic symptoms is often challenging as symptoms rarely remain static. Some patients may experience isolated symptoms (e.g., headache pain); however, many conditions result in characteristic symptom clusters (e.g., pain, sleep difficulties, and mood changes). Symptom management research seeks to identify and test interventions that will reduce the burden of symptoms on affected persons and improve their quality of life.

Begun in 2004 as part of the NIH Roadmap for Medical Research, the PROMIS (Patient-Reported Outcomes Measurement Information System) initiative is developing new ways to measure symptoms or patient-reported outcomes (PROs), such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality of life across a variety of chronic diseases (http://nihroadmap.nih.gov/clinicalresearch/overview-dynamicoutcomes.asp). In addition, it is developing a web-based system to give clinical researchers access to the item banks and the computer adaptive testing (CAT) system.

NINR seeks to support research that will leverage the successes of initiatives like PROMIS to:

1. Delineate causative mechanisms underlying symptoms.

2. Improve recognition of symptoms by patients, their caregivers, and health care providers.

3. Develop technologies and interventions that improve patient response and adaptation to symptoms and symptom clusters in discrete and co-morbid conditions.

4. Design strategies to improve management of symptoms over disease trajectories, including the transition from acute to chronic illness and periods of long-term survivorship of formerly life-threatening illnesses.

5. Develop strategies for assessment and intervention to improve health-related quality of life in persons with chronic or life-threatening illnesses.

This call for Center applications focuses on the most frequently reported symptoms already being studied by PROMIS:

1. pain,

2. sleep disturbances,

3. fatigue, and

4. cognitive/affect changes, as well as their interactions.

Applicants must select one of these symptoms and build their Center application around this symptom, the organizing central theme of the application, so as to develop strong expertise in this research domain and move the field of science forward significantly.

NINR Centers

NINR currently supports a number of Exploratory/Developmental Center (P20s) and Centers of Excellence (P30s) grants. The purpose of an NINR P20 Center is to: (1) develop sustainable interdisciplinary, biobehavioral research capacity for scientists conducting nursing research by establishing centralized research resources and a research infrastructure; (2) advance the Center’s thematic science area through complementary, synergistic research activities; and (3) enable feasibility research that will develop into new programs of research and independent investigator research applications.

It is expected that new biomedical and behavioral knowledge will be discovered for improving symptom management of persons with acute and chronic disorders, and for improving the quality-of-life of all patients and their caregivers, across the NINR research mission areas and strategies presented in the 2011 NINR Mission and Strategic Plan (http://www.ninr.nih.gov/ AboutNINR/NINRMissionandStrategicPlan).

The Public Health Service (PHS) is committed to achieving the symptom management and health promotion and disease prevention objectives of "Healthy People 2020," a PHS-led national activity for setting priority areas. This FOA is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2020" at http://www.health.gov/healthypeople/.

Interdisciplinary and biobehavioral approaches to improve understanding of symptom science is needed. Attention to health disparities in symptom management is encouraged. Applicant organizations should submit nursing research proposals in areas specific to the Symptom Science research areas in the NINR strategic plan priority areas. Applicants are to select a topical area for their application based on a conceptually sound integration of the currently funded projects that comprise the research base of the Center. Applications should propose innovative ideas consistent with NINR's mission. Although not inclusive of all topics that would be considered responsive to this FOA, applicants are encouraged to review the NINR’s Strategic Plan document (http://www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan/) that includes but is not limited to the following examples of Symptom Science areas of scientific opportunity at NINR:

1. Improves knowledge of biological and genomic mechanisms associated with symptoms and symptom clusters

2. Designs interventions to improve the assessment and management of symptoms over disease trajectories, including the transition from acute to chronic illness

3. Studies the multiple factors that influence the management of symptoms and applies this knowledge to the design of personalized interventions

4. Develops strategies to improve self-management of chronic illness across the lifespan, particularly in the context of comorbidities

5. Develops strategies to assist individuals and their caregivers in managing chronic illness, including analyses of caregiver burden and cost-effectiveness

Friday, March 09, 2012

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Wednesday, May 16, 2012

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