The mission of the National Institute of Nursing Research (NINR) is to promote and improve the health of individuals, families, and communities. To achieve this mission, NINR supports and conducts clinical and basic research and research training on health and illness, research that spans and integrates the behavioral and biological sciences, and that develops the scientific basis for clinical practice. From premature infants in neonatal intensive care units, to adolescents living with diabetes, to elderly cancer survivors coping with pain, nursing research develops the science to help people strengthen the quality of their lives. Nursing science transcends the boundaries of disease and research disciplines to better understand the experiences of individuals and families living with illness and to develop personalized approaches that maximize health and well-being for individuals at all stages of life, across diverse populations and settings. NINR?s scientific programs are organized around four major focus areas: symptom science, wellness, self-management of chronic conditions, and the science of end-of-life and palliative care. The Institute also explores ways in which new innovations and technologies can contribute to advancing nursing science across these four areas. In addition, NINR has a longstanding and continuing commitment to developing the next generation of nurse scientists: those individuals and team members who will carry the field of nursing science into the future. NINR?s research program in symptom science seeks a better understanding of the biological and behavioral aspects of symptoms, with the goal of developing and testing new interventions to reduce the disabling effects of symptoms and improving patient health outcomes and quality of life. Research efforts in wellness investigate the key biological, behavioral, and social factors that promote long-term health and healthy behaviors and prevent the development of illness across health conditions, settings, and the lifespan. Research in wellness is also focused on developing and testing culturally appropriate interventions to promote health and prevent illness in minority and underserved groups. NINR research in self-management seeks to engage individuals and families as active participants in maintaining and improving quality of life while living with a chronic condition or multiple chronic conditions. Self-management research encompasses health strategies that allow an individual and their health care provider to adapt treatments to individual circumstances. As the lead NIH Institute for end-of-life research, NINR supports science to assist individuals, families, and health care professionals in managing the symptoms of advanced, serious illness, and planning for end-of-life decisions. NINR also recognizes that high-quality, evidence-based palliative care is a critical component of maintaining quality of life at any stage of illness, not limited to the end of life. In focusing on innovation and technology, NINR promotes technological advancements that address a range of health care challenges and facilitate the delivery of real-time personalized information to individuals and families, health care providers, and communities. In order to prepare an innovative, diverse, and talented next generation of nurse scientists, NINR supports a variety of training opportunities for scientists and trainees at all career levels, particularly those at an early career stage who are so critical to sustaining the future of innovative research and high quality health care. NINR supports individual and institutional pre- and postdoctoral research fellowships, as well as career development awards, and sponsors numerous ?research intensives? for nurse scientists at all career levels. NINR?s Division of Intramural Research conducts basic and clinical research on the interactions among molecular mechanisms underlying symptoms and environmental influences on individual health outcomes. The program focuses on the biological and behavioral underpinnings of symptoms of chronic conditions, including digestive disorders, cancer-related fatigue, neuromuscular disorders, traumatic brain injury, and post-traumatic stress disorders, as well as clinical interventions to alleviate symptoms.
General information about this opportunity
Last Known Status
National Institutes of Health, Department of Health and Human Services
Type(s) of Assistance Offered
B - Project Grants; M - Training
Fiscal Year 2016
246 research grants, 55 NRSA Individual Awards, 152 NRSA Institutional Awards. 250 Research Grants, 47 NRSA Individual Awards, 131 Institutional FTTPs/22 Institutional AwardsFiscal Year 2017
Projection: 258 Research Grants, 47 NRSA Individual Awards, 131 Institutional FTTPs/22 Institutional Awards Actuals: 249 Research Grants, 52 NRSA Individual Awards, 112 Institutional FTTPs/20 Institutional AwardsFiscal Year 2018
Enacted Projection: 259 Research Grants, 53 NRSA Individual Awards, 114 Institutional FTTPs/20 Institutional Awards; Actuals:273 Research Grants, 36 NRSA Individual Awards, 115 Institutional FTTPs/19 Institutional AwardsFiscal Year 2019
Estimate: 283 Research Grants, 35 NRSA Individual Awards, 112 Institutional FTTPs/19 Institutional AwardsFiscal Year 2020
Estimate: 238 Research Grants, 31 NRSA Individual Awards, 108 Institutional FTTPs/20 Institutional Awards
Public Health Service Act, Section 301, 464, 487, 42 U.S.C. 285q
Public Health Service Act, Public Law 115-408
Who is eligible to apply/benefit from this assistance?
Research Grants: Any corporation, public or private institution or agency, or other legal entity, either nonprofit or for-profit, may apply. NRSAs (Individual): An applicant must be a registered professional nurse with either a baccalaureate and/or a master's degree in nursing and must be a citizen of the United States or lawfully admitted for permanent residence. Those on temporary or student visas are not eligible. NRSAs (Institutional): An eligible institution must be capable of providing predoctoral and/or postdoctoral research training opportunities for nurses. SBIR grants: can be awarded only to domestic small businesses (entities that are independently owned and operated for profit; are not dominant in the field in which research is being proposed; and have no more than 500 employees). Primary employment (more than one-half time) of the principal investigator must be with the small business at the time of award and during the conduct of the proposed project. In both Phase I and Phase II, the research must be performed in the United States or its possessions. To be eligible for funding, a grant application must be reviewed for scientific merit and program relevance by a scientific review group and a national advisory council. STTR grants can be awarded only to domestic small business concerns (entities that are independently owned and operated for profit, are not dominant in the field in which research is proposed and have no more than 500 employees) which "partner" with a research institution in cooperative research and development. At least 40 percent of the project is to be performed by the small business concern and at least 30 percent by the research institution. In both Phase I and Phase II, the research must be performed in the U.S. and its possessions. To be eligible for funding, a grant application must be approved for scientific merit and program relevance by a scientific review group and a national advisory council.
Individuals and public or private institutions.
Each applicant for research projects must present a research plan and furnish evidence that scientific competence, facilities, equipment, and supplies are appropriate to carry out the plan. NRSAs (Individual): The applicant's academic record, research experience, citizenship, or permanent resident status, licensure as a registered nurse, and institutional sponsorship should be documented in the application. NRSAs (Institutional): The applicant organization must show the objectives, methodology and resources for the research training program, the qualifications and experience of directing staff, the criteria to be used in selecting individuals for awards, and detailed budget justification for the amount of grant funds requested. Costs will be determined in accordance with 2 CFR, Part 220, Cost Principles for Educational Institutions. For-profit organizations' costs are determined in accordance with 48 CFR Subpart 31.2 of the Federal Acquisition Regulations. For other grantees, costs will be determined by HHS Regulations 45 CFR, Part 75. For SBIR and STTR grants, applicant organization (small business concern) must present in a research plan an idea that has potential for commercialization and furnish evidence that scientific competence, experimental methods, facilities, equipment, and funds requested are appropriate to carry out the plan. The SF 424 (Research and Research-Related) application forms and the SF 424 SBIR/STTR Application Guide are used to apply for both SBIR and STTR, Phase I and Phase II. Application is made electronically through Grants.gov (http://www.grants.gov). 2 CFR 200, Subpart E - Cost Principles applies to this program.
What is the process for applying and being award this assistance?
Preapplication coordination is not applicable.
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Research Grants: Applications must be prepared electronically through Grants.gov (http://www.grants.gov) using the SF 424 (Research and Research-Related) application form. The electronic application format is interactive. For assistance submitting an electronic application, contact GrantsInfo: Telephone (301) 435- 0714, Email: GrantsInfo@nih.gov. NRSAs (Individual): Individuals must submit the SF 424 (Research and Research-Related) application form, and include at least three, but no more than five, letters of reference. Letters of reference must be submitted electronically through the NIH eRA Commons Submit Reference Letter website and not through Grants.gov (http://www.grants.gov). Applicants who have lawfully been admitted to the United States for permanent residence must complete the appropriate section on the Face Page of the SF 424 (Research and Research-Related) application form. Applicants who have applied for and have not yet been granted admission as a permanent resident should check the Permanent resident block on the Face Page of this application form, and also write in the word "pending." A notarized statement documenting legal admission for permanent residence must be submitted prior to the issuance of an award. SBIR and STTR: The SF 424 (Research and Research-Related) application form and the SF 424 SBIR/STTR Application Guide are used to apply for both SBIR and STTR grants, Phase I and Phase II. Application forms must be submitted electronically through Grants.gov (http://www.grants.gov). For further assistance contact GrantsInfo: Telephone: (301) 435-0714, E-mail: GrantsInfo@nih.gov.
Research Grants and National Research Service Awards (NRSAs) (Institutional): All accepted applications are reviewed for scientific merit by an appropriate initial review group and then by a national advisory council. (Individual NRSA applications are not reviewed by council.) All applications favorably recommended compete for available funds on the basis of scientific merit and mission/program relevance. SBIR/STTR Applications: All accepted SBIR/STTR applications are evaluated for scientific and technical merit by an appropriate scientific peer review panel and by a national advisory council. All applications receiving a priority score compete for available SBIR/STTR set-aside funds on the basis of scientific and technical merit and commercial potential of the proposed research, mission/program relevance, and program balance among the areas of research.
Contact the headquarters or regional location, as appropriate for application deadlines
Approval/Disapproval Decision Time
Research Grants: From 6 to 9 months. NRSAs: From 6 to 9 months. SBIR/STTR: About 7-1/2 months. AIDS Grants: About 6 months.
Research Grants: A Program Director/Principal Investigator (PD/PI) and/or applicant institution may question the substantive or procedural aspects of the initial peer review of his/her application by communicating with the appropriate NINR Program Official. NINR follows the NIH Appeals policy, NOT-OD-11-064: http://grants.nih.gov/grants/guide/notice-files/NOT-OD-11-064.html. NINR works with application PD/PI within the NIH appeals policy.
Research Grants: Renewal applications are accepted. NRSAs: Awards may be made for 1 to 5 years. No individual may receive more than 5 years of aggregate NRSA support beyond the predoctoral level, and no individual may receive NRSA support for more than 3 years of support beyond the postdoctoral level. Institutional awards may be renewed.
How are proposals selected?
Reviewers provide an overall impact/priority score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed): (1) Significance: Does the project address an important problem or a critical barrier to progress in the field? Is there a strong scientific premise for the proposed project, including consideration of the strengths and weaknesses of published research or preliminary data crucial to the support of the application? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field? For clinical trial applications, the following additional criteria will be considered. Are the scientific rationale and need for a clinical trial to test the proposed hypothesis or intervention well supported by preliminary data, clinical and/or preclinical studies, or information in the literature or knowledge of biological mechanisms? For trials focusing on clinical or public health endpoints, is this clinical trial necessary for testing the safety, efficacy or effectiveness of an intervention that could lead to a change in clinical practice, community behaviors or health care policy? For trials focusing on mechanistic, behavioral, physiological, biochemical, or other biomedical endpoints, is this trial needed to advance scientific understanding? (2) Investigators: Are the PD/PIs, collaborators, and other researchers well suited to the project? If Early Stage Investigators or New Investigators, or in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance and organizational structure appropriate for the project? For clinical trial applications, the following additional criteria will be considered. With regard to the proposed leadership for the project, do the PD/PI(s) and key personnel have the expertise, experience, and ability to organize, manage and implement the proposed clinical trial and meet milestones and timelines? Do they have appropriate expertise in study coordination, data management and statistics? For a multicenter trial, is the organizational structure appropriate and does the application identify a core of potential center investigators and staffing for a coordinating center? (3) Innovation: Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed? For clinical trial applications, the following additional criteria will be considered. Does the design/research plan include innovative elements, as appropriate, that enhance its sensitivity, potential for information or potential to advance scientific knowledge or clinical practice? (4) Approach: Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? Have the investigators presented adequate plans to address relevant biological variables, such as sex, for studies in vertebrate animals or human subjects? If the project involves human subjects and/or NIH-defined clinical research, are the plans to address 1) the protection of human subjects from research risks, and 2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of age across life span, justified in terms of the scientific goals and research strategy proposed? For clinical trial applications, the following additional criteria will be considered. Is the study design justified and appropriate to address primary and secondary outcome variable(s)/endpoints that will be clear, informative and relevant to the hypothesis being tested? Is the scientific rationale/premise of the study based on previously well-designed preclinical and/or clinical research? Given the methods used to assign participants and deliver interventions, is the study design adequately powered to answer the research question(s), test the proposed hypothesis/hypotheses, and provide interpretable results? Is the trial appropriately designed to conduct the research efficiently? Are the study populations (size, gender, age, demographic group), proposed intervention arms/dose, and duration of the trial, appropriate and well justified? Are potential ethical issues adequately addressed? Is the process for obtaining informed consent or assent appropriate? Is the eligible population available? Are the plans for recruitment outreach, enrollment, retention, handling dropouts, missed visits, and losses to follow-up appropriate to ensure robust data collection? Are the planned recruitment timelines feasible and is the plan to monitor accrual adequate? Has the need for randomization (or not), masking (if appropriate), controls, and inclusion/exclusion criteria been addressed? Are differences addressed, if applicable, in the intervention effect due to sex/gender and race/ethnicity? Are the plans to standardize, assure quality of, and monitor adherence to, the trial protocol and data collection or distribution guidelines appropriate? Is there a plan to obtain required study agent(s)? Does the application propose to use existing available resources, as applicable? Are planned analyses and statistical approach appropriate for the proposed study design and methods used to assign participants and deliver interventions? Are the procedures for data management and quality control of data adequate at clinical site(s) or at center laboratories, as applicable? Have the methods for standardization of procedures for data management to assess the effect of the intervention and quality control been addressed? Is there a plan to complete data analysis within the proposed period of the award? (5) Environment: Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements? For clinical trial applications, the following additional criteria will be considered. If proposed, are the administrative, data coordinating, enrollment and laboratory/testing centers, appropriate for the trial proposed? Does the application adequately address the capability and ability to conduct the trial at the proposed site(s) or centers? Are the plans to add or drop enrollment centers, as needed, appropriate? If international site(s) is/are proposed, does the application adequately address the complexity of executing the clinical trial? If multi-sites/centers, is there evidence of the ability of the individual site or center to: (a) enroll the proposed numbers; (b) adhere to the protocol; (c) collect and transmit data in an accurate and timely fashion; and, (d) operate within the proposed organizational structure? In addition to the above criteria, the following items will continue to be considered in the determination of scientific merit and the impact/priority score. Protections for Human Subjects: For research that involves human subjects but does not involve one of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials. For research that involves human subjects and meets the criteria for one or more of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. Inclusion of Women, Minorities, and Age across Life Span: When the proposed project involves human subjects and/or NIH-defined clinical research, the committee will evaluate the proposed plans for the inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion (or exclusion) of age across life span to determine if it is justified in terms of the scientific goals and research strategy proposed. Vertebrate Animals: The committee will evaluate the involvement of live vertebrate animals as part of the scientific assessment according to the following criteria: (1) description of proposed procedures involving animals, including species, strains, ages, sex, and total number to be used; (2) justifications for the use of animals versus alternative models and for the appropriateness of the species proposed; (3) interventions to minimize discomfort, distress, pain and injury; and (4) justification for euthanasia method if not consistent with the AVMA Guidelines for the Euthanasia of Animals. Reviewers will assess the use of chimpanzees as they would any other application proposing the use of vertebrate animals. For additional information on review of the Vertebrate Animals section, please refer to the Worksheet for Review of the Vertebrate Animal Section. Biohazards: Reviewers will assess whether materials or procedures proposed are potentially hazardous to research personnel and/or the environment, and if needed, determine whether adequate protection is proposed. Resubmission: The committee will evaluate the application as now presented, taking into consideration the responses to comments from the previous scientific review group and changes made to the project. Renewal: The committee will consider the progress made in the last funding period. Revision: The committee will consider the appropriateness of the proposed expansion of the scope of the project. If the Revision application relates to a specific line of investigation presented in the original application that was not recommended for approval by the committee, then the committee will consider whether the responses to comments from the previous scientific review group are adequate and whether substantial changes are clearly evident. For clinical trial applications, the study timeline will be considered in the following. Is the study timeline described in detail, taking into account start-up activities, the anticipated rate of enrollment, and planned follow-up assessment? Is the projected timeline feasible and well justified? Does the project incorporate efficiencies and utilize existing resources (e.g., CTSAs, practice-based research networks, electronic medical records, administrative database, or patient registries) to increase the efficiency of participant enrollment and data collection, as appropriate? Applications compete for available funds with all other recommended applications. The following will be considered in making funding decisions: Scientific merit of the proposed project as determined by peer review; Availability of funds; Relevance of program priorities.
How may assistance be used?
Research Grants: Funds may be used for salaries, consultation, equipment, travel and other usual costs, subject to Federal regulations applicable to the grant. National Research Service Awards (NRSAs) (Individual): Individual awards are made to institutions on behalf of the individual for research training in specified areas related to the mission of NINR. NRSAs (Institutional): Grants may be made to institutions to enable them to accept individuals for research training. Each individual who receives a NRSA postdoctoral fellowship on an NRSA award must comply with all applicable service and payback provisions. SBIR Phase I grants: (of approximately 6-months' duration) are to establish the technical merit and feasibility of a proposed research effort that may lead to a commercial product or process. STTR Phase I grants (normally of 1-year duration) are to determine the scientific, technical, and commercial merit and feasibility of the proposed cooperative effort that has potential for commercial application. Phase II funding is based on results of research initiated in Phase I and scientific and technical merit and commercial potential of Phase II application.
What are the requirements after being awarded this opportunity?
Performance Reports: Progress reports where applicable are required annually for continuing projects.
Grantees generally must retain financial and programmatic records, supporting documents, statistical records, and all other records that are required by the terms of a grant, or may reasonably be considered pertinent to a grant, for a period of 3 years from the date the annual Federal Financial Report (FFR) is submitted. For awards under SNAP (other than those to foreign organizations and Federal institutions), the 3-year retention period will be calculated from the date the Federal Financial Report (FFR) for the entire competitive segment is submitted. Those grantees must retain the records pertinent to the entire competitive segment for 3 years from the date the FFR is submitted to NIH. Foreign organizations and Federal institutions must retain records for 3 years from the date of submission of the annual FFR to NIH. See 45 CFR Part 75.361 for exceptions and qualifications to the 3-year retention requirement (e.g., if any litigation, claim, financial management review, or audit is started before the expiration of the 3-year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken). Those sections also specify the retention period for other types of grant-related records, including F&A cost proposals and property records. See 45 CFR Part 75.361 and Part 75.364 for record retention and access requirements for contracts under grants. In accordance with 45 CFR 75.364, the HHS Inspector General, the U.S. Comptroller General, or any of their duly authorized representatives have the right of timely and unrestricted access to any books, documents, papers, or other records of recipients that are pertinent to awards in order to make audits, examinations, excerpts, transcripts, and copies of such documents. This right also includes timely and reasonable access to a recipient's personnel for the purpose of interview and discussion related to such documents. The rights of access are not limited to the required retention period, but shall last as long as records are retained.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching requirements are not applicable to this assistance listing.
MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
Research Grants: Awards are usually made annually with no project periods to exceed 5 years in length. NRSAs: Institutional awards may be made for up to 5 years; and Individual awards may be made for up to 5 years at the predoctoral level, 3 years at postdoctoral level, and 2 years at senior level. SBIR: Normally, Phase I awards are for 6 months and normally Phase II awards are for 2 years. STTR: Normally, Phase I awards are for 1 year and normally Phase II awards are for 2 years. Grant awards are made annually.
Who do I contact about this opportunity?
Regional or Local Office
Dr. Yvonne Bryan- Acting Director, Division of Extramural Science Programs (DESP)
, National Institute of Nursing Research, National Institutes of Health, Room 710, One Democracy Plaza, 6701 Democracy Blvd.
Bethesda, MD 20892 US
(Training) FY 18$7,294,262.00; FY 19 est $7,452,000.00; FY 20 est $7,085,000.00; FY 17$7,438,885.00; FY 16$7,998,401.00; - National Research Service Awards (NRSA)(Project Grants) FY 18$115,247,480.00; FY 19 est $120,666,000.00; FY 20 est $102,128,000.00; FY 17$109,058,689.00; FY 16$106,770,328.00; - Research Grants
Range and Average of Financial Assistance
FY18 Research Grants: $10,698 to $1,649,033; Average cost $426,548; FY18 NRSA Individual Awards:$11,007 to $63,154; Average cost of FTTP/Award $38,844; FY18 NRSA Institutional Awards: $49,265 to $507,675; Average cost of FTTP $52,642/Average cost of Award $302,689
Regulations, Guidelines and Literature
Research Grants: Grants will be available under the authority of and administered in accordance with the NIH Grants Policy Statement and Federal regulations at 42 CFR 52 and 42 USC 241; Omnibus Solicitation of the Public Health Service for Small Business Innovation Research (SBIR) Grant and Cooperative Agreement Applications. Omnibus Solicitation of the National Institutes of Health for Small Business Technology Transfer (STTR) Grant Applications.
Examples of Funded Projects
Fiscal Year 2016
No current data available. See NIH Research Portfolio Online Reporting Tools (RePORT) to examine funding information for projects: https://projectreporter.nih.gov/reporter_summary.cfm and https://report.nih.gov/categorical_spending.aspxFiscal Year 2017
No current data available.Fiscal Year 2019
(1) Advancing chronic condition symptom cluster science through use of electronic health records and data science techniques; (2) Peer i-coaching for activated self-management optimization in adolescents and young adults with chronic conditions; (3) Enhanced ultrasound treatment of chronic wounds with monitoring of healing and quality of life outcomes; (4) A clinician-in-the-loop smart home to support health monitoring and intervention for chronic conditions; (5) Development of an automated healthcare system for effective management of patients with chronic diseases; (6) Pilot feasibility testing of a small randomized controlled trial to evaluate a telemedicine stress management and lifestyle group intervention for patients with symptomatic chronic hepatitis C; (7) Resilience skills self-management for chronic pain; (8) Advanced training in self-management interventions for serious chronic conditions; (9) An upstream palliative care intervention for rural family caregivers; (10) A community-developed, culturally-based PC tele-consult program for African American and White rural Southern elders with a life-limiting illness; (11) The role of palliative care interventions to reduce circadian rhythm disorders in persons with dementia; (12) Effectiveness of concurrent care to improve pediatric and family outcomes at end of life; (13) Study of infection management and palliative care at end-of-life; (14) Apoyo con carino: patient navigation to improve palliative care for seriously ill Latinos