Stony Brook's Dr. Isadora Botwinick, of the Department of Surgery's Division of Trauma, Emergency Surgery, and Surgical Critical Care; and
Dr. Wan-Zi Lu, PhD, of the Department of Sociology, have been awarded two internal grants for their collaborative research project titled “Quality Measures and Shared Decision-Making in Emergency Surgery.” The grants, the Center for Interprofessional Innovation's (CIPI) inaugural mini grant and the Faculty in the Arts, Humanities and Social Sciences (FAHSS) Interdisciplinary Research Award, total $8,000.
The Doctors' research is based on a tool for surgeons who daily confront difficult decisions, regarding whether to perform a surgery or not, which is called Shared Decision Making (SDM). SDM is a model used by surgeons in which they work together with their patient and the patient's loved ones to create a treatment plan that fits the patient's goals and preferences.
“Surgeons should speak out about how external metrics impact clinical decision-making." -- Isadora Botwinick, MD
SDM is an ideal choice, but it is currently underutilized in the surgical decision-making process; especially in emergency surgery cases. Research has been done on SDM use in general medicine, but very few studies have focused on emergency surgery. In addition to the less-than-common use of SDM in surgical decisions, surgeons also must consider external quality metrics. These metrics, created by regulatory bodies and professional societies, may inadvertently influence a surgeon's decision-making process when considering what treatment option is best for the patient.
This is what sparked Doctor Botwinick's and Lu's study. They aim to examine the role of external quality metrics and its influence on SDM in emergency surgery decisions.
“Surgeons should speak out about how external metrics impact clinical decision-making," said Dr. Botwinick. "Our input can help regulatory bodies better align metrics with patient-centered care.”
According to Dr. Lu, this research project was prompted by her and Dr. Botwinick's shared interest of learning what makes SDM possible in surgical situations. They also want to examine the influence of performance metrics and quality measures on a surgeon's treatment choices.
"The project advances key questions in medical sociology by examining the conditions that enable or constrain shared decision-making in clinical care," said Dr. Lu. "By investigating how metrics influence everyday surgical practice, our research can help inform institutional designs that better support patient-centered care while respecting professional expertise."
"The project advances key questions in medical sociology by examining the conditions that enable or constrain shared decision-making in clinical care." -- Wan-Zi Lu, PhD
Doctors Botwinick and Lu launched their study by surveying faculty, residents and physician extenders in Stony Brook Medicine's Department of Surgery. The mini grants will allow them to expand that pool by conducting research at multiple centers and additional study populations to create a comparative analysis. They will use computational and natural language processing techniques combined with qualitative thematic coding to analyze how metrics shape surgical decision-making.
"Our goal is to eventually develop strategies to better align quality metrics with ethical principles of equity and patient-centered care," said Dr. Botwinick. "This broader scope will strengthen the quality and impact of our findings, allowing us to generate insights that are relevant across different clinical and organizational contexts," added Dr. Lu.
The “Quality Measures and Shared Decision-Making in Emergency Surgery” study is unique in its interprofessional collaboration between sociology and medicine. This, and the team's recognition of the interconnectedness of high-risk medical conditions and social considerations of health, were supporting factors in the awarding of the mini grants.
About Isadora Botwinick, MD
Dr. Isadora Botwinick earned her medical degree from Columbia University, College of Physicians and Surgeons in 2011, completed a residency at Albert Einstein College of Medicine, Montefiore Medical Center, in 2016, and a Surgical Critical Care fellowship at R Adams Cowley Shock Trauma Center, University of Maryland, in 2017. Her clinical interests/expertise include pre- and post-operative critical care of surgical patients, management of diseases involving the liver, spleen, and upper/lower gastrointestinal systems; basic and advanced minimally invasive and laparoscopic surgery, hernia repairs, surgical treatment of benign soft-tissue tumors, tracheostomy and tracheotomy.
About Wan-Zi Lu, PhD
Dr. Wan-Zi Lu earned her PhD at the University of Chicago in 2021 and is currently an Assistant Professor in Stony Brook University's Department of Sociology. Her areas of interest include medical sociology, comparative-historical analysis, political economy, global health and culture.
For More Information
- Isadora Botwinick, MD
- Wan-Zi Lu, PhD
- Center for Interprofessional Innovation
- Faculty in the Arts, Humanities and Social Sciences (FAHSS) Interdisciplinary Research Award
- Stony Brook Medicine Department of Surgery
- Stony Brook University