Susan Wong, MD, MS
Susan Wong, MD, MS, is the recipient of the 2019 HSR&D Best Research Paper of the Year Award, which honors a single article or collection of articles resulting from one or more HSR&D- or QUERI-funded investigations. Research studies also must involve Veterans, with results that are important to Veterans’ health and care, and to the VA healthcare system.
Dr. Wong’s and colleagues’ article, “Care Practices for Patients with Advanced Kidney Disease Who Forgo Maintenance Dialysis,” was published in JAMA Internal Medicine in March 2019. This groundbreaking work, partly funded by HSR&D, provides an extraordinary level of detail about care practices for patients with advanced kidney disease who forgo treatment with maintenance dialysis, a group that has been largely overlooked in prior research. By describing themes that emerged from a qualitative analysis of the clinical progress notes for a national sample of 851 Veterans with advanced kidney disease not treated with dialysis, the authors were able to provide a detailed picture of dialysis decision-making as it unfolds in real-world clinical settings. Findings describe an all-or-nothing approach to caring for patients with advanced chronic kidney disease, in which dialysis served as a powerful default option with few perceived alternatives. Specifically, this work reveals how difficult it can be for patients, families, and clinicians to forgo dialysis when faced with this decision. Thus, stronger efforts are needed to develop a more patient-centered approach to caring for patients with advanced kidney disease that includes proactive support for those who do not wish to start dialysis.
Results of this study attracted significant media attention and have been widely disseminated; for example, Dr. Wong was interviewed by The New York Times, Reuters, and Kaiser Health News. The manuscript findings also have provided impetus for new efforts to improve care processes for Veterans with advanced kidney disease. The study attracted the attention of the VA National Center for Ethics in Health Care (NCEHC) that led to a formal operational partnership with Dr. Wong and colleagues to investigate documentation practices for goals-of-care conversations with VA patients with advanced kidney disease. This partnership strives to identify opportunities to promote the VA’s Life-Sustaining Treatment Decisions Initiative among Veterans with advanced kidney disease.
Dr. Wong is an Investigator with the HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care located in Seattle, WA and Denver, CO. She is a current recipient of an NIH K23 Career Development Award and Pilot Award from the National Palliative Care Research Center. Her areas of research interest focus on health services research, end-of-life care, decision-making, and treatment practices for advanced kidney disease. She also serves as an editorial board member for the Clinical Journal of the American Society of Nephrology. In addition, Dr. Wong is a member of the American Society of Nephrology and the American Academy of Hospice and Palliative Medicine.
HSR&D thanks Dr. Wong and her colleagues for their exceptional work and contributions to the literature, which will help VA improve the quality of life and care for Veterans with advanced kidney disease.
HSR&D also thanks the following Best Research Paper of the Year Nominees for their outstanding work and contributions to the field of health services research.