Research on Clinical Decision Making in People with or at Risk for Life Threatening Illness (R21) | Apply Online

Opportunity Summary:

The grant opportunity "Research on Clinical Decision Making in People with or at Risk for Life Threatening Illness (R21)" (Funding Opportunity Number PA-09-121) is a National Institutes of Health program sponsored by the National Institute of Nursing Research (NINR) and the National Cancer Institute (NCI). Its central goal is to encourage exploratory and early-stage studies that improve understanding of how people make clinical and health-related decisions when they either have, or may be at risk for, illnesses that can become fatal relatively quickly if not addressed. The FOA frames "life threatening illness" broadly, including conditions that might be managed over many years with effective treatment (for example, HIV infection) as well as conditions that may be curable when detected and treated early (for example, early-stage breast cancer). The emphasis is not simply on medical outcomes, but on the real-world decision processes that shape whether individuals pursue prevention, screening, diagnostic evaluation, treatment, research participation, or end-of-life care.

A key feature of this opportunity is its focus on decision making across the entire trajectory of illness and risk, from the earliest point of considering preventive behaviors through advanced disease and end-of-life choices. The announcement highlights many kinds of decisions that can be studied, such as whether to join a preventive clinical trial (like an HIV vaccine study), whether to undergo genetic testing, how to choose between active treatment and "watchful waiting" approaches (as often discussed in early-stage prostate cancer), how to select among multiple treatment options, whether to participate in a therapeutic clinical trial, and how individuals and families make decisions about palliative care or other end-of-life preferences. Because these decisions frequently involve uncertainty, risk tradeoffs, changing values over time, and complicated information, the FOA is meant to stimulate research that clarifies how decisions are formed, what influences them, and how clinical communication and care systems can better support patients and those close to them.

This FOA uses the NIH Exploratory/Developmental Grant mechanism (R21), which is designed for early, innovative, and potentially high-impact projects that may still be at the hypothesis-building or pilot-testing stage. In other words, it supports research that can open new lines of inquiry, develop methods, generate preliminary data, or test promising approaches in a limited way before larger-scale studies. The R21 described here runs in parallel with a companion FOA of the same scientific scope that uses the R01 mechanism (PA-09-122), which is typically intended for more mature, fully developed research programs. Applicants should see the R21 as an opportunity to propose focused, well-justified exploratory work that can rapidly advance the science of clinical decision making in serious illness contexts.

Funding levels are presented with some flexibility because projects may vary widely in design, population, setting, and methods. The listing includes an award ceiling of $200,000, and it notes that the size, duration, and number of awards depend on the volume and quality of applications received, as well as the costs and timelines proposed. There is no cost sharing or matching requirement. The program is categorized under health and education-related federal assistance, with CFDA numbers 93.361 (Nursing Research) and 93.399 (Cancer Control), signaling relevance to both nursing science priorities and cancer control decision-making needs, while still being broadly applicable across life-threatening conditions.

Eligibility is intentionally broad and includes many organization types that might be positioned to study decision making in clinical, community, and health systems contexts. Eligible applicants include public and private institutions of higher education, nonprofits with and without 501(c)(3) status, for-profit organizations (other than small businesses) as well as small businesses, state and local governments (including counties, cities, townships, special districts, and independent school districts), public housing authorities and Indian housing authorities, federally recognized tribal governments and other tribal organizations, and U.S. territories or possessions. The FOA also explicitly recognizes additional eligible entities such as Historically Black Colleges and Universities (HBCUs), Hispanic-serving institutions, Tribally Controlled Colleges and Universities (TCCUs), Alaska Native and Native Hawaiian Serving Institutions, faith-based and community-based organizations, regional organizations, eligible federal agencies, and even non-U.S. entities (foreign organizations). This breadth reflects the reality that decision making around life-threatening illness occurs in many settings and populations, and that strong research teams may emerge from academic medical centers, community organizations, or cross-sector partnerships.

In terms of administrative details, the opportunity was posted on March 17, 2009, with a closing date of May 7, 2012, and it was archived on June 7, 2012. While the program itself is historical in the form provided, the underlying topic area remains a core NIH interest, and the FOA points users to the official NIH grants page for the complete announcement and to NIH Office of Extramural Research support contacts for access or technical issues.

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