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This study was funded by Daiichi Sankyo Inc.

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Shared decision making (SDM) is essential to advancing patient-centered care in emergency medicine. Despite many documented benefits of SDM, prior research has demonstrated persistently low levels of patient engagement by clinicians across many disciplines, including emergency medicine. An effective dissemination and implementation (D&I) framework could be used to alter the process of delivering care and to facilitate SDM in routine clinical emergency medicine practice. Here we outline a research and policy agenda to support the D&I strategy needed to integrate SDM into emergency care.

Background People with advanced, serious illnesses experience a high burden of physical and psychosocial symptoms, limitations in functioning, and declining quality of life (QOL) over the course of their illness. Caring for these patients can take a significant physical and emotional toll on their caregivers as well. Palliative care has been defined as ''patient-and family-centered care that optimizes QOL by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice.'' 1,2 Evidence reviews show that receipt of palliative care can provide clinically meaningful relief of a broad range of patient symptoms, reduce caregiver burden, and improve patient and caregiver QOL. 3e5 At the same time, patients and caregivers report significant barriers to receiving comprehensive palliative care services (i.e., care that facilitates advance care planning [ACP] and medical decision-making, systematically assesses and manages patient symptoms, and addresses caregiver burden). Access to comprehensive palliative care is typically limited to either inpatient hospitals or endof-life hospice settings. Thus, patients who are not terminally ill and their caregivers report an unmet need for receiving palliative care where they live (i.e., in their communities). 6 The challenge of accessing effective palliative care services is only expected to exacerbate, due to increasing demand from the aging U.S. population with multiple comorbid health conditions and limited supply from a projected shortage of competent clinicians to provide these services. 5 There is an urgent need for research studies to generate evidence for identifying the optimal mix of providers, settings, and content of palliative care needed at different stages of an advanced illness, from diagnosis until death. In the following section, we discuss the Patient-Centered Outcome Research Institute's (PCORI's) current and future investments in research on palliative care.

Cancer survivors expressed gaps in their care with respect to reviewing information, asking questions, obtaining answers, and making decisions. Implementing decision and communication aids immediately upon diagnosis, when treatment decisions are being made, would address these gaps.

T he 2016 Academic Emergency Medicine (AEM) Consensus Conference was focused on creating a policy-relevant, patient-centered research agenda for shared decision making (SDM) in the emergency department (ED). As part of the conference, representatives of a diverse group of funding agencies were assembled to serve on a panel addressing strategies and opportunities to secure funding in ED SDM research. The panel met as a group three times in the year leading up to the conference to identify examples

More than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, obstacles to achieving high-quality care remain, and studies suggest that cancer care is often not as patient centered, accessible, coordinated, or evidence based as it could be. Patients, their families, and clinicians face a wide range of complex and often confusing choices regarding their health and health care concerns and require trustworthy information to decide which options are best for them. The Patient-Centered Outcomes Research Institute (PCORI) strives to fund clinical comparative effectiveness research, guided by patients, caregivers, and the broader health care community, that will provide high-integrity, evidence-based information to help people make informed health care decisions. This mission is well aligned with the IOM's recent conceptual framework and corresponding recommendations that recognize that addressing the needs of patients with cancer and their families is the most important component of a high-quality cancer care delivery system. PCORI seeks the opportunity to partner with diverse interdisciplinary research teams who demonstrate a strong commitment to the inclusion and engagement of patients and stakeholders as they work to develop high-quality cancer care delivery systems. We see rich opportunities for such partnership in the cancer care community, given the wealth of well-established patient advocacy groups and organizations and cutting-edge research institutions, all of which are working toward the common goal of improving the quality of cancer care for patients and their families. This article and the project it describes provide an example of an avenue for advancing this goal.