Research on Clinical Decision Making in Life Threatening Illness (R21) | Apply Online

Opportunity Summary:

The NIH funding opportunity "Research on Clinical Decision Making in Life Threatening Illness (R21)" (Funding Opportunity Number PA-07-316) is designed to support exploratory studies on how people make clinical and health-related decisions when they are facing conditions that can become fatal relatively quickly if untreated, but that may be manageable as chronic diseases or even curable when caught early. The opportunity is sponsored by the National Institute of Nursing Research (NINR) and the National Cancer Institute (NCI), reflecting an interest in both nursing-centered and cancer-centered perspectives on decision processes across the full course of serious illness. The central goal is to stimulate research that clarifies what drives decision making, how decisions change over time, and how individuals weigh risks, benefits, uncertainty, personal values, and the practical realities of treatment and care.

The announcement emphasizes that "life threatening illness" includes conditions that have a high likelihood of leading to death in a short period without treatment, while also acknowledging that modern medicine can transform some of these illnesses into longer-term conditions or cure them if addressed early. The examples provided illustrate this range: HIV infection can become a chronic condition for many people with effective therapy, while cancers such as breast cancer may be curable when detected and treated early. Because decision points arise throughout prevention, diagnosis, treatment, and end-of-life care, the opportunity is intentionally broad about where research can focus along the illness trajectory.

A key feature of the FOA is its interest in decision making from the earliest stages through the final stages of life. That includes decisions about adopting preventive behaviors, seeking screening or testing, and evaluating whether to participate in research. It also includes choices made after diagnosis, such as selecting among treatment options, deciding between active treatment and watchful waiting (the example given is early-stage prostate cancer), enrolling in therapeutic clinical trials, and making end-of-life care decisions. In practice, this means projects could examine how patients and families interpret information, how clinicians communicate risk and prognosis, how cultural or spiritual beliefs influence preferences, how prior experiences shape choices, and how factors like health literacy, trust in the medical system, cost burdens, or access to care change what people decide and when.

This opportunity uses the NIH Exploratory/Developmental Research Grant (R21) mechanism, which is typically meant for early-stage, high-potential studies that generate preliminary data, develop measures or methods, or test innovative concepts that can lead to larger projects later. The FOA notes it runs in parallel with a companion announcement of identical scientific scope that uses the R01 mechanism (PA-07-062), which is generally more appropriate for mature, fully powered studies. In other words, PA-07-316 is aimed at investigators who want to explore emerging questions or build foundational evidence about decision processes in serious illness, potentially laying the groundwork for subsequent R01-level research.

In terms of funding parameters, the award ceiling listed is $200,000, and there is no cost sharing or matching requirement. The number of awards is not fixed; awards depend on congressional appropriations, NIH institute budgets, and the submission of enough high-quality applications. The opportunity is categorized as discretionary and uses the grant funding instrument, with activity areas spanning education and health. The CFDA numbers associated with the program are 93.361 (Nursing Research) and 93.395 (Cancer Treatment Research), which signals the cross-cutting relevance to nursing science and oncology-related decision making.

Eligibility is broad and includes public and private institutions of higher education, nonprofit organizations (including both 501(c)(3) and non-501(c)(3) entities), for-profit organizations (including small businesses and other for-profit entities), and a range of government bodies such as state governments, county governments, city or township governments, special district governments, and independent school districts. Native American tribal governments (federally recognized) and tribal organizations (including those not federally recognized) are also eligible, as are public housing authorities/Indian housing authorities. The announcement additionally specifies that foreign institutions may apply, eligible federal agencies may apply, and faith-based or community-based organizations are permitted applicants, which broadens the potential for community-engaged or internationally relevant work in decision making around life-threatening disease.

Administratively, the FOA was originally posted on January 19, 2007, with multiple receipt dates rather than a single deadline, and it reflects a closing date of May 7, 2009, with an archive date of June 7, 2009. Applicants were directed to the full announcement for the specific receipt schedule and detailed instructions, and NIH provided a contact route through the NIH Office of Extramural Research (OER) webmaster for access or linking problems. Overall, the opportunity is best understood as an NIH effort to encourage innovative, early-stage research that explains and improves the real-world decision making that patients and families must navigate when confronting illnesses where timing, uncertainty, and high stakes can profoundly shape outcomes and quality of life.

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