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Principal Investigator: Douglas B White
Organization: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
Fiscal Year: 2024
Award: $125,819
Funding agency: National Heart Lung and Blood Institute
The goal of this renewal K24 proposal is to enhance the ability of Dr. Douglas White to mentor clinician-
scientists focused on developing and testing interventions to mitigate health disparities and promote
goal-concordant care for incapacitated patients with acute respiratory failure (ARF). Patients with ARF
and a poor prognosis often receive intensive, burdensome treatments near the end of life that are
inconsistent with their values and preferences. This is an important public health problem because
providing goal-concordant care is a core element of ethical medical practice. Moreover, it is well
established that there are health disparities in serious illness care; the NIH and NAM have highlighted
that there is a pressing need to determine the extent to which clinicians’ communication patterns
contribute to these health disparities and develop interventions to promote equitable care. Solving this
problem will require the collaboration of scientists with expertise in health disparities, communication
sciences, and health services research. Dr. White is well positioned to lead these efforts. He is a
midcareer investigator with a mature, NIH-funded program of research on surrogate decision making in
ARF. He has a strong record of successful mentoring in patient-oriented research. He has assembled a
team of senior scientists to accomplish the proposed research and mentoring plan. He will increase his
skills as a mentor and expand his scientific expertise by participating in targeted career development
activities in mentoring, academic leadership, and methodology in health disparities research. The
overarching research goal of this renewal K24 proposal is to conduct research examining whether
there are disparities in goals-of-care conversations in patients with ARF and to engage individuals from
marginalized groups in NIH Stage 0 intervention development research to understand their
perspectives on how clinicians can best support them when faced with difficult goals-of-care decisions.
In Aim 1, we will elicit the perspectives of individuals who are Black, Latinx, or have a disability on how
clinicians should support surrogate decision makers of patients with ARF to achieve goal-concordant
care. In Aim 2, we will determine whether racial/ethnic disparities exist in how clinicians counsel
surrogate decision makers in ICUs in a large and diverse dataset of audio recorded clinician-family
conversations (Aim 2a) and conduct exploratory analyses examining associations between
communication patterns in goals-of-care conversations and patient and family outcomes, such as
patient-centeredness of care, psychological distress, trust, and end-of-life health care utilization (Aim
2b). Together, these scientific aims and career development activities will expand Dr. White’s ability to
train the next generation of patient-oriented researchers in developing interventions to promote equity
and goal-concordant care for incapacitated patients with advanced respiratory failure.
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