End-of-Life and Palliative Care Health Literacy: Improving Outcomes in Serious, Advanced Illness (R21 Clinical Trial Optional) | PA 18 499

Opportunity Information: Apply for PA 18 499

This NIH funding opportunity (PA 18-499) supports early-stage, exploratory research aimed at strengthening end-of-life and palliative care (EOLPC) health literacy for people living with serious, advanced illness, along with their families and caregivers. The core purpose is twofold: first, to identify the most important barriers that prevent patients, families, and caregivers from understanding, finding, and using palliative and end-of-life care information; and second, to develop and test new strategies, interventions, or care models that improve EOLPC health literacy and, in turn, improve real-world outcomes in serious illness. The FOA explicitly emphasizes that these barriers and solutions should be examined in diverse settings and populations, reflecting the reality that palliative and end-of-life care decisions are shaped by culture, language, education, health system complexity, access to services, and trust in care providers and institutions.

The announcement uses the R21 mechanism, which is designed for exploratory and developmental work, meaning it is well-suited for pilot studies, proof-of-concept projects, and early testing of innovative approaches that could later be scaled or expanded under larger grant mechanisms. Clinical trials are optional under this FOA, so applicants may propose studies that are observational, qualitative, mixed-methods, intervention development, implementation-focused, or clinical trial work, depending on what best fits the question. In practical terms, a competitive project could focus on mapping where misunderstandings commonly arise (for example, misconceptions about hospice eligibility, pain management fears, confusion about advance directives, or difficulty navigating goals-of-care conversations), and then designing tools or workflows that make these topics clearer and more actionable for patients and caregivers.

A major theme is improving outcomes, not just knowledge. Projects are expected to connect improved EOLPC health literacy to meaningful results for people with advanced illness and their support networks. Outcomes could include better communication and shared decision-making, improved alignment of care with patient values, more appropriate use of palliative care services, reduced unwanted or non-beneficial interventions near the end of life, improved symptom management understanding, reduced caregiver burden, higher satisfaction with care, or smoother care transitions across settings such as hospitals, outpatient clinics, nursing homes, home-based care, and community programs. The FOA is also implicitly concerned with equity: by targeting diverse populations and settings, it encourages work that addresses disparities driven by language barriers, limited access to specialty palliative care, rurality, socioeconomic constraints, cultural differences in discussing serious illness, and health system fragmentation.

In terms of funding details provided in the source data, the award ceiling is listed as $200,000, and the opportunity is categorized as a discretionary grant in the health and education activity areas (CFDA 93.361). The sponsoring agency is the National Institutes of Health. The original closing date shown is May 7, 2021, and the FOA record creation date is December 15, 2017. (Because the closing date listed is in the past, anyone considering applying would typically confirm whether NIH has reissued, extended, or replaced the announcement, or whether there are active receipt dates under the same FOA number.)

Eligibility is broad and includes many types of applicants across government, academia, nonprofits, and industry. Eligible entities include state, county, city or township, and special district governments; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; federally recognized Native American tribal governments; tribal organizations that are not federally recognized; public housing authorities/Indian housing authorities; nonprofits with and without 501(c)(3) status (other than institutions of higher education); for-profit organizations (other than small businesses); and small businesses. The FOA also highlights additional eligible applicants such as Alaska Native and Native Hawaiian Serving Institutions; Asian American Native American Pacific Islander Serving Institutions (AANAPISI); Hispanic-serving Institutions; Historically Black Colleges and Universities (HBCUs); Tribally Controlled Colleges and Universities (TCCUs); faith-based or community-based organizations; eligible federal agencies; U.S. territories or possessions; regional organizations; and even non-U.S. (foreign) entities. This wide eligibility reflects the reality that effective EOLPC health literacy work often requires partnerships beyond traditional academic medical centers, including community organizations, tribal and territorial health systems, and culturally grounded institutions that can design and deliver interventions that are trusted and relevant.

Overall, the opportunity is centered on making serious-illness and end-of-life care information and decision-making more understandable, usable, and supportive across populations and care settings. It encourages applicants to bring forward innovative, practical approaches that reduce confusion and barriers at the most difficult points in the care journey, with the goal of improving patient- and family-centered outcomes when the stakes are highest.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "End-of-Life and Palliative Care Health Literacy: Improving Outcomes in Serious, Advanced Illness (R21 Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.361.
• This funding opportunity was created on 2017-12-15.
• Applicants must submit their applications by 2021-05-07. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $200,000.00 in funding.
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

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