End-of-Life and Palliative Care Approaches to Advanced Signs and Symptoms (R21- Clinical Trial Optional) | PAR 19 044

Opportunity Information: Apply for PAR 19 044

End-of-Life and Palliative Care Approaches to Advanced Signs and Symptoms (R21 - Clinical Trial Optional) is a National Institutes of Health (NIH) discretionary grant opportunity (Funding Opportunity Number PAR 19 044; CFDA 93.361) designed to push forward early-stage, exploratory research focused on the complicated, often overlapping signs and symptoms that occur in the last phase of life. The central aim is to stimulate studies that dig into the multi-dimensional foundations of these advanced symptoms, how patients and caregivers experience them in real-world settings, and how clinicians and care teams can better assess and manage them. In practical terms, the opportunity is geared toward improving understanding and care for people nearing the end of life by encouraging innovative approaches to symptom science and palliative care, including work that can clarify why certain symptom clusters emerge, how they change over time, and what strategies meaningfully reduce distress and improve quality of life.

A key feature of the FOA is its emphasis on the complexity of end-of-life symptom burden. Rather than treating symptoms in isolation, it encourages research that considers the full picture: physical symptoms (such as pain, breathlessness, fatigue, nausea, constipation, delirium, or agitation), psychological and emotional distress (including anxiety, depression, fear, or existential suffering), social impacts (family strain, caregiver burden, communication challenges), and other contextual factors that shape how symptoms are perceived and managed. The wording highlights "multi-dimensional foundations, experiences and management," which signals interest not only in biological mechanisms and clinical trajectories, but also in patient-centered outcomes, lived experience, and care delivery realities across settings like hospitals, hospices, nursing facilities, and home-based care.

The mechanism is an R21, which generally supports exploratory and developmental research. That typically means projects can be relatively high-risk/high-reward, aimed at generating new insights, pilot data, proof-of-concept findings, or novel methods that could later be scaled up under larger grant mechanisms. The FOA is labeled "Clinical Trial Optional," meaning applicants may propose a clinical trial if it makes sense for the research question, but they are not required to do so. This makes the opportunity flexible for teams pursuing observational studies, measurement development, symptom monitoring approaches, intervention development, feasibility testing, or early efficacy assessments, as long as the work is focused on advanced symptom issues in end-of-life and palliative care contexts.

Funding details provided in the source data indicate an award ceiling of $200,000. The original closing date listed is 2022-01-07, and the opportunity was created on 2018-10-31. Even though this specific closing date has passed, the FOA summary is still useful for understanding the NIH research priorities it represents, and similar or reissued announcements sometimes appear over time under updated numbers or related programs. The activity categories tied to this opportunity are Education and Health, reflecting the broader public health and health services relevance of improving end-of-life symptom care.

Eligibility is broad and includes many types of applicants across the public, nonprofit, academic, and private sectors. Eligible entities listed include state, county, and city/township governments; 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 other than federally recognized tribal governments; public housing authorities/Indian housing authorities; nonprofits with or without 501(c)(3) status (excluding higher education institutions when specified in those categories); for-profit organizations other than small businesses; and small businesses. In addition, the FOA explicitly calls out other eligible applicants such as Alaska Native and Native Hawaiian Serving Institutions, Asian American Native American Pacific Islander Serving Institutions (AANAPISIs), Hispanic-serving Institutions, Historically Black Colleges and Universities (HBCUs), Tribally Controlled Colleges and Universities (TCCUs), faith-based or community-based organizations, eligible federal agencies, regional organizations, non-domestic (non-U.S.) entities (foreign organizations), Indian/Native American tribal governments other than federally recognized, and U.S. territories or possessions. This wide eligibility range reflects an intent to attract diverse perspectives and settings, including organizations that serve populations often underrepresented in research or disproportionately affected by gaps in serious-illness and end-of-life care.

Taken together, this grant opportunity is essentially about improving the science and practice of managing severe, complex symptom burdens near the end of life. It encourages projects that move beyond simple symptom checklists toward deeper understanding of symptom mechanisms, patient and caregiver experiences, and practical strategies for relief. The R21 structure supports creative, early-stage work that can open new directions in palliative care research, with the broader goal of reducing suffering and improving quality of life for people with advanced illness and those who care for them.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "End-of-Life and Palliative Care Approaches to Advanced Signs and Symptoms (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 2018-10-31.
• Applicants must submit their applications by 2022-01-07. (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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