T32 Training in Interventions to Improve Outcomes in Chronic Conditions Abstract This revised research training grant renewal application seeks to educate and train nurse scientists in the development and testing of interventions to address some of the most compelling issues confronted by persons with chronic conditions and their families, and to improve the outcomes of both. The need for evidence-based interventions to improve outcomes in chronic conditions has never been greater as the prevalence of heart disease, stroke, cancer, and diabetes continue to escalate across all age groups. Nurse researchers are pivotal in addressing and reducing the individual, family, and health care system burden imposed by chronic illness through interventions to improve prevention, treatment, and self-and symptom management. This training program is embedded in the rich interdisciplinary environment of Emory University and the School of Nursing. This renewal training grant aims to provide rigorous pre- and post-doctoral research preparation centered on design and testing of innovative and theory-based interventions leading to improved health outcomes for those at risk for or with chronic conditions. The goals are to provide: 1) the theoretical and conceptual basis to generate a program of research concentrated on interventions to improve individual, family or health resource use outcomes, 2) methodological skills to support innovative design and rigorous testing of interventions measuring outcomes through biobehavioral markers, health indicators, and incorporating improved precision and responsiveness (–omics), and big data approaches; 3) mentorship of trainees to support their science and career development to initiate and sustain interdisciplinary scholarly inquiry in this substantive area. Support for training 2-3 predoctoral trainees and 1 postdoctoral trainee each year is requested. The science and training activities will be guided by a broad conceptual model incorporating individual and family or context factors that characterize and influence self-management behaviors related to prevention, management or palliation in chronic conditions including but not limited to cardiovascular, cancer, pulmonary, neurological, immunological, and diabetes/endocrine health problems. Predoctoral fellows will take core courses in the existing doctoral program, which includes a strong science focus on biobehavioral determinants and influences on health, biobehavioral markers of health outcomes and intervention responsiveness, complex analytic techniques, and exposure to and conduct of research through mentored research experiences. Additionally they will take graduate-level electives in the biological, behavioral, and nursing sciences. Postdoctoral work will be guided by an interdisciplinary team of researchers and include coursework, research experiences and individual activities designed to meet their training needs. All trainees will develop and conduct research projects, develop grant writing skills, research dissemination, and team science skills. The program coalesces core and collaborating faculty with active research programs, expertise in the substantive area, and a rich interdisciplinary academic, clinical and research environment.

Narrative The burden of chronic conditions on individuals, family, health care systems, and society requires new approaches to prevention and management. Nurse researchers, highly trained in the behavioral and biological sciences, including emerging and team science, are needed to deepen our knowledge of how to help individuals and families make lifestyle changes, reduce symptom distress, improve illness self-care, and make critical decisions at the end of life. This program will prepare pre and postdoctoral nurse scientists to address these compelling questions which will ultimately improve health and health outcomes, such as quality of life, and reduce health care costs.