PROJECT SUMMARY/ABSTRACT Candidate: This K23 award will provide an opportunity for Dr. Khandelwal to achieve her long-term goal of being an independently funded physician scientist with a focus on improving patient- and family-centered outcomes for patients with acute respiratory failure (ARF) and their family members. Through this proposal, Dr. Khandelwal will achieve her immediate goals of acquiring: 1) expertise in the evaluation of patient-and family-reported outcomes, use of qualitative methods to inform the development and assessment of interventions, and training in advanced multi-level statistical methods and clinical trials; and 2) pilot data and skills to successfully apply for R level grants that include clinical trials and longitudinal cohort studies. These objectives will be achieved through a career development plan that incorporates formal coursework, skilled mentoring, and protected time to gain research experience in an outstanding environment. Research: In this patient-oriented research proposal, Dr. Khandelwal will identify patients with ARF and chronic illness who are at greatest risk for poor outcomes (psychological distress, functional impairment, financial stress), and the types of supportive and palliative interventions that would be most helpful in improving these outcomes. To accomplish this, she will: 1) identify predictors of poor patient and family outcomes, including number and type of chronic conditions, measures of frailty, and prior healthcare use; 2) identify predictors of high hospital and ICU utilization and costs; and 3) explore patient, family, and clinician perspectives on the types, timing, and feasibility of supportive and palliative interventions that they believe would improve these outcomes. To date, attempts to improve patient or family outcomes have been disappointing and suggest the need for interventions targeted to specific populations and specific needs. Findings from these aims will result in innovative interventions for patients with ARF who are at greatest risk for poor outcomes and potentially burdensome, costly care. By efficiently targeting supportive and palliative care resources to those who need and may benefit most, this study has the potential to improve value-driven care to this vulnerable population. Environment: The University of Washington (UW) is an ideal setting for Dr. Khandelwal's research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Department of Anesthesiology & Pain Medicine is widely recognized for its support of early career physician scientists in development of the skills necessary to achieve academic success. In addition to the resources provided within her Department, Dr. Khandelwal 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).

PROJECT NARRATIVE Patients with acute respiratory failure and underlying chronic illness are at high risk for poor patient- and family-centered outcomes, and for receiving potentially burdensome and costly care that may be discordant with their values and goals. These patients and their family are likely to benefit from supportive and palliative interventions—this project will lead to a better understanding of which patients may benefit most from such interventions and which interventions would be most helpful. Knowledge gained from this study will directly inform and result in the design of interventions to improve patient and family outcomes and the delivery of value-driven care to this complex population.