Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

COIN Investigators

Susan P. Y. Wong, MD, MS

Title: Core Investigator
Associate Professor, University of Washington, School of Medicine

Contact: Susan.Wong2@va.gov

Location: Seattle

University of Washington webpage

 

Dr. Wong will serve as a Fulbright Distinguished Professor to the United Kingdom 2024-2025. She will investigate the feasibility of adapting kidney palliative care models in the United Kingdom's National Health Service for implementation within the infrastructure of the United States Department of Veterans Affairs.

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Research Interests

See Dr. Wong's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials

I lead a research program on treatment practices for patients with advanced kidney disease, including kidney replacement therapy, conservative kidney management without dialysis, palliative care, and end-of-life care. My work encompasses developing interventions that promote more patient-centered approaches to healthcare delivery.
I believe deeply in the VA’s mission to put the patient at the center of care practices and policies. It’s an incredible honor to do work that helps to support this mission.
The VA is always seeking better ways of providing care to its Veterans and has been a source of inspiration to other health systems of innovative models of care. My hope is that my research will generate evidence-based models of care for kidney disease that will improve care experiences and outcomes for patients.

Poster presentation for National Kidney Foundation Spring Clinical Meetings 2023 (click the image to enlarge):

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Grants & Funding

Home-based conservative care model for advanced kidney disease

Role: Investigator
Conservative care (CC) is an important therapeutic option for Veterans who do not wish to pursue maintenance dialysis for their advanced chronic kidney disease (CKD). It offers a whole-person, multidisciplinary approach to care that is focused on slowing disease progression, active symptom management, advanced care planning, and provision of appropriate palliative care.
Recent evidence from observational studies of CC programs in other developed countries indicates that for older patients (aged ≥75 years) with significant comorbidity and functional limitation, dialysis may not meaningfully lengthen survival or improve quality of life beyond what can be achieved with CC.
Although 1 in 7 Veterans with advanced CKD does not pursue dialysis, there are no formal CC programs within the VA and few, if any, concerted efforts to establish these programs in non-VA settings. While CC programs do not currently exist in the VA, many of the elements found in other developed countries and desirable to Veterans, families, and healthcare providers can be found in the VA’s Home-Based Primary Care (HBPC) program. HBPC provides home-based multidisciplinary primary care to Veterans with multimorbidity and functional limitations to support Veterans’ quality of life and mitigate the complications of illness through to the end of life. 
We hypothesize that the multidisciplinary care (MDC) framework of HBPC serves as the ideal starting ground to build the VA’s first CC program for Veterans with advanced CKD.
Funder: Veterans Affairs
NIH Reporter: NIH website

Dialysis decision-making among adults with advanced kidney disease

Chronic kidney disease is a significant public health concern, and over half a million Americans receive maintenance dialysis to treat their end-stage renal disease (ESRD).
Patients often face difficult trade-offs between the potential benefits of life prolongation and the potential harms of frequent hospitalization and physical and social impairment after initiation of dialysis therapy.
We are highlighting the need for improved understanding and approaches to supporting patients in making treatment decisions about ESRD.
Funder: National Institute of Diabetes and Digestive and Kidney Diseases
NIH Reporter: NIH website
Publications of note:
— Perspectives on Conservative Care in Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members
— Reconciling Short- and Long-Term Outcomes of In-Hospital Cardiac Arrest in Patients undergoing Maintenance Dialysis — Experiences of US Nephrologists in the Delivery of Conservative Care to Patients With Advanced Kidney Disease: A National Qualitative Study

Decision Aid for Conservative Management of Advanced Kidney Disease

The primary goal of this study is to develop a conceptual model for patient- and caregiver-centered conservative care that can support patients with advanced chronic kidney disease (CKD) and their caregivers who are considering or have chosen not to initiate maintenance dialysis.
This research will provide a roadmap for implementing and evaluating a model of conservative care in the US that can promote shared decision-making for the treatment of ESRD and improve end-of-life care for patients with advanced CKD.
Funder: National Palliative Care Research Center (NPCRC)
NPCRC Website summary

Improving Medical Decision Making for Older Patients with End Stage Renal Disease

Role: Co-Investigator, Site Principal Investigator
It is imperative to develop scalable and practical approaches to supporting persons with advanced kidney disease and their family caregivers.
By providing video education tools to better inform persons making decisions about medical care and offering evidence-based options for kidney care, there is an opportunity to improve quality of life throughout the care trajectory.
Funder: National Institute on Aging
NIH Reporter: NIH website
Publications of note:
— Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial

Promoting Goal Concordant Care among Patients with Advanced Kidney Disease

Role: Principal Investigator
The overarching goal of this project is to bridge the gap between the healthcare values and goals that patients hold and the care they ultimately receive.
We aim to identify the clinical context in which documentation of healthcare goals for patients with advanced kidney disease occurs and their downstream patterns and quality of end-of-life care.
Additionally, we plan to assess the feasibility and acceptability of a novel intervention to promote conversations about healthcare goals between patients with advanced kidney disease and their clinicians and explore preliminary outcomes of the intervention.
Funder: The Doris Duke Charitable Foundation

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Recent Publications

2024

Montez-Rath ME, Thomas IC, Charu V, Odden MC, Seib CD, Arya S, Fung E, O'Hare AM, Wong SPY, Kurella Tamura M. Effect of Starting Dialysis Versus Continuing Medical Management on Survival and Home Time in Older Adults With Kidney Failure : A Target Trial Emulation Study. Ann Intern Med. 2024 Aug 20. doi: 10.7326/M23-3028. Epub ahead of print. 
PMID: 39159459.

Wong SPY, Chotivatanapong J, Lee D, Lam DY, van Eijk MS. Providers' experiences discussing care for patients with kidney failure who forgo kidney replacement therapy: A national qualitative study. Clin J Am Soc Nephrol. 2024 Jul 18. doi: 10.2215/CJN.0000000000000522. Epub ahead of print.
PMID: 39024162

deGraauw J, Wong SPY. Engaging Patients in Decision Making about Treatment of Kidney Failure: The Art and Science of Communication. J Am Soc Nephrol. 2024 May 7. doi: 10.1681/ASN.0000000000000374. Epub ahead of print.
PMID: 38713530

VA Kidney Palliative Care Workgroup; Palevsky PM, Shreve S, Wong SPY. Implementation of kidney palliative care-lessons learned from the US Department of Veterans Affairs. Ann Palliat Med. 2024 Apr 25:apm-23-584. doi: 10.21037/apm-23-584. Epub ahead of print.
PMID: 38735693

Chotivatanapong J, Prince DK, Davison SN, Kestenbaum BR, Oestreich T, Wong SPY. A National Survey of Conservative Kidney Management Practices for Patients who Forgo Kidney Replacement Therapy. Kidney360. 2024 Jan 23. doi: 10.34067/KID.0000000000000367. Epub ahead of print.
PMID: 38254255

Kiernan E, Wong SPY. Challenges to Informed, Patient-Centered, and Shared Decision Making for Treatment of Kidney Failure in Older Adults. Am J Kidney Dis. 2024 Jan 11:S0272-6386(23)00971-X. doi: 10.1053/j.ajkd.2023.12.003. Epub ahead of print.
PMID: 38206253

2023

Wong SPY, Prince DK, Kurella Tamura M, Hall YN, Butler CR, Engelberg RA, Vig EK, Curtis JR, O'Hare AM. Value Placed on Comfort vs Life Prolongation Among Patients Treated With Maintenance Dialysis. JAMA Intern Med. 2023 Mar 27. doi: 10.1001/jamainternmed.2023.0265. Epub ahead of print.
PMID: 36972031
Learn more about this publication at Dimensions

Johansen KL, Chertow GM, Gilbertson DT, Ishani A, Israni A, Ku E, Li S, Li S, Liu J, Obrador GT, Schulman I, Chan K, Abbott KC, O'Hare AM, Powe NR, Roetker NS, Scherer JS, St Peter W, Snyder J, Winkelmayer WC, Wong SPY, Wetmore JB. US Renal Data System 2022 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2023 Mar;81(3S1):A8-A11. doi: 10.1053/j.ajkd.2022.12.001.
PMID: 36822739.
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Liu CK, Taffel L, Russell M, Wong SPY, Russell H, Vig EK. Decision-making about dialysis: Beyond just dialysis or death. J Am Geriatr Soc. 2023 Feb 15. doi: 10.1111/jgs.18256. Epub ahead of print.
PMID: 36790053.
Learn more about this publication on Dimensions

Wong SPY, Oestreich T, Prince DK, Curtis JR. A Patient Decision Aid About Conservative Kidney Management in Advanced Kidney Disease: A Randomized Pilot Trial. Am J Kidney Dis. 2023 Feb 3:S0272-6386(23)00065-3. doi: 10.1053/j.ajkd.2022.12.007. Epub ahead of print.
PMID: 36740038.
Learn more about this publication on Dimensions

2022

Wong SPY, Oestreich T, Chandler B, Curtis JR. Using Human-Centered Design Principles to Create a Decision Aid on Conservative Kidney Management for Advanced Kidney Disease. Kidney360. 2022 May 11;3(7):1242-1252. doi: 10.34067/KID.0000392022. PMCID: PMC9337892.
PMID: 35919540.
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Jennerich AL, Brown CE, Khandelwal N, Sharma RK, Wong SPY. Mentoring women well: Perspectives of junior physician-scientists on what it really takes. J Pain Symptom Manage. 2022 Jun;63(6):e649-e650. doi: 10.1016/j.jpainsymman.2022.02.010.
PMID: 35595381.
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Butler CR, O'Hare AM, Wong SPY. Supporting scholarship in palliative care across the medical specialties. J Pain Symptom Manage. 2022 Jun;63(6):e665-e666. doi: 10.1016/j.jpainsymman.2022.02.007.
PMID: 35595386.
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Wong SPY, Foglia MB, Cohen J, Oestreich T, O'Hare AM. The VA Life-Sustaining Treatment Decisions Initiative: A qualitative analysis of veterans with advanced kidney disease. J Am Geriatr Soc. 2022 Apr 18. doi: 10.1111/jgs.17807. Epub ahead of print.
PMID: 35435246.
Learn more about this publication on Dimensions

Eneanya ND, Lakin JR, Paasche-Orlow MK, Lindvall C, Moseley ET, Henault L, Hanchate AD, Mandel EI, Wong SPY, Zupanc SN, Davis AD, El-Jawahri A, Quintiliani LM, Chang Y, Waikar SS, Bansal AD, Schell JO, Lundquist AL, Tamura MK, Yu MK, Unruh ML, Argyropoulos C, Germain MJ, Volandes A. Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial. BMJ Open. 2022 Apr 8;12(4):e059313. doi: 10.1136/bmjopen-2021-059313.
PMID: 35396311
Learn more about this publication on Dimensions

Wong SPY. Mixed Methods Research To Advance Nephrology. Kidney360. 2021 Mar 17;2(6):1011-1014. doi: 10.34067/KID.0005972020. PMCID: PMC8791383.
PMID: 35373085
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Wong SPY, Rubenzik T, Zelnick L, Davison SN, Louden D, Oestreich T, Jennerich AL. Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review. JAMA Netw Open. 2022 Mar 1;5(3):e222255. doi: 10.1001/jamanetworkopen.2022.2255.
PMID: 35285915
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Thorsteinsdottir B, Espinoza Suarez NR, Curtis S, Beck AT, Hargraves I, Shaw K, Wong SPY, Hickson LJ, Boehmer KR, Amberg B, Dahlen E, Wirtz C, Albright RC, Kumbamu A, Tilburt JC, Sutton EJ. Older Patients with Advanced Chronic Kidney Disease and Their Perspectives on Prognostic Information: a Qualitative Study. J Gen Intern Med. 2022 Jan 26. doi: 10.1007/s11606-021-07176-8. Epub ahead of print.
PMID: 35083651
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2021

House TR, Wightman A, Rosenberg AR, Sayre G, Abdel-Kader K, Wong SPY. Challenges to Shared Decision Making About Treatment of Advanced CKD: A Qualitative Study of Patients and Clinicians. Am J Kidney Dis. 2021 Oct 18:S0272-6386(21)00919-7. doi: 10.1053/j.ajkd.2021.08.021. Epub ahead of print.
PMID: 34673161

Butler CR, O'Hare AM, Kestenbaum BR, Sayre GG, Wong SPY. An Introduction to Qualitative Inquiry. J Am Soc Nephrol. 2021 Jun 1;32(6):1275-1278. doi: 10.1681/ASN.2021040473. Epub 2021 May 26.
PMID: 34039668.

House TR, Wong SPY. What Is the "Maintenance" in Maintenance Dialysis? Am J Kidney Dis. 2021 May 12:S0272-6386(21)00564-3. doi: 10.1053/j.ajkd.2021.04.002. Epub ahead of print.
PMID: 33992470.

Butler CR, Wong SPY, Vig EK, et al. Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians. BMJ Open 2021;11:e047782. doi:10.1136/bmjopen-2020-047782.

2020

Butler CR, Wong SPY, Wightman AG, O'Hare AM. US Clinicians' Experiences and Perspectives on Resource Limitation and Patient Care During the COVID-19 Pandemic. JAMA Netw Open. 2020 Nov 2;3(11):e2027315. doi: 10.1001/jamanetworkopen.2020.27315. PMCID: PMC7648254.
PMID: 33156349.

Oestreich T, Sayre G, O'Hare AM, Curtis JR, Wong SPY. Perspectives on Conservative Care in Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members. Am J Kidney Dis. 2020 Sep 30:S0272-6386(20)31007-6. doi: 10.1053/j.ajkd.2020.07.026. Epub ahead of print.
PMID: 33010356.

O'Hare AM, Butler CR, Taylor JS, Wong SPY, Vig EK, Laundry RS, Wachterman MW, Hebert PL, Liu CF, Rios-Burrows N, Richards CA. Thematic Analysis of Hospice Mentions in the Health Records of Veterans with Advanced Kidney Disease. J Am Soc Nephrol. 2020 Nov;31(11):2667-2677. doi: 10.1681/ASN.2020040473. Epub 2020 Aug 6. PMCID: PMC7608965.
PMID: 32764141.

Ramer SJ, Baddour NA, Siew ED, Salat H, Bian A, Stewart TG, Wong SPY, Jhamb M, Abdel-Kader K. Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD. Am J Nephrol. 2020;51(8):641-649. doi: 10.1159/000509046. Epub 2020 Jul 28.
PMID: 32721980.

Hsu S, Wong SPY. Reconciling Short- and Long-Term Outcomes of In-Hospital Cardiac Arrest in Patients undergoing Maintenance Dialysis. Clin J Am Soc Nephrol. 2020 Feb 7;15(2):165-167. doi: 10.2215/CJN.14121119. Epub 2020 Jan 7. PMCID: PMC7015081.
PMID: 31911424.

Butler CR, Vig EK, O'Hare AM, Liu CF, Hebert PL, Wong SPY. Ethical Concerns in the Care of Patients with Advanced Kidney Disease: a National Retrospective Study, 2000-2011. J Gen Intern Med. 2020 Apr;35(4):1035-1043. doi: 10.1007/s11606-019-05466-w. Epub 2019 Oct 25. PMCID: PMC7174459.
PMID: 31654358.

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Awards, Honors

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