A practicing urologic oncology surgeon at the Ronald Reagan UCLA Medical Center, Chris has served on NQF committees since 2011. Chris currently also serves on the Surgery Standing Committee. His major research area is shared decision-making. Through a grant from the National Cancer Institute, he is working to develop innovative approaches for shared decision making among men with prostate cancer. 

NQF: You’re serving on an NQF panel looking at developing national standards for patient resources, called decision aids. Why is this work important?

CS: Decision-making is increasingly complicated for all patients. Treatment options for conditions such as prostate cancer are proliferating and there are many new approaches to treating any one condition. There’s also a deeper understanding of things like cancer. Is all cancer equally dangerous? The word is scary to patients but we know that some cancers are relatively indolent and don’t kill people so the paradigm of finding it early and treating it may do more harm than good. This is true for men in terms of prostate cancer. It’s also true for women with breast cancer, people with thyroid cancer and so forth. That does complicate decision making in cancer detection and treatment. We need interventions to help patients and physicians make evidence-based choices. There are so many complicated decisions as men age, and we should be able to support them with tools that help them use evidence and incorporate their preferences so that they can come to decisions about the care that best suits them. 

NQF: Why do you think it’s been so difficult for men to take charge of their health? And what are the clinical areas where we still need to move the needle?

CS: Maybe it’s a bit of machismo culture that men will soldier on and tough it out, not worry about things, and not complain. That may be part of it, in terms of gender roles. But there obviously also have been access-to-care issues for a long time. Hopefully, with the recent improvements in access, we’ll see the ability of men to afford care and access good care improve.

I’m a believer that prostate-specific antigen (PSA) testing is useful and saves lives in men who are younger and healthier. Overall, we have improved men’s health in terms of prostate cancer impact over time since the introduction of PSA screening. Where we’re not doing as well may be the basic blocking and tackling of areas such as reduction of cardiovascular risk factors. Those are things like smoking, diet, and encouragement of exercise. Additionally, mental health issues and complications such as alcohol use and opioid addiction—these are very common public health issues that are pernicious. That’s where I think a lot of work can be done in terms of public health.

NQF: What types of resources are available to help patients, such as those with prostate cancer, make more informed decisions about treatment options? Which are most effective among your patients?

CS: There are a lot of decision aids that are out there now. Giving someone a pamphlet is better than doing nothing, because these tools allow patients to think about decisions before meeting with physicians, and formulate questions to ask that might be helpful. However, there is a lot more data out there that may be useful. The amount of published literature now regarding outcomes and risks—which allow personalization of care—is tremendous, but that data is not accessible to most patients.

I think we’re going to learn more about what constitutes high-quality decision support over time, and how can we help patients get the information they need in a way that they can actually use it. It’s an exciting time because the idea that a high-quality decision is one that is shared between patients and physicians is gaining great currency among all stakeholders, including physicians. That will improve the match of patients to appropriate treatments nationally.

NQF: Why is NQF’s work with an expert panel to develop national standards for decision aids, and a process for certifying these tools, important?

CS: We are now at a place where there are all kinds of services and brochures and products out there that are purporting to help guide patients or support them in making decisions. We want to make sure that that is done well, because we know that these things do have impact on decision-making, and thus, on patients’ health and well-being. You want to make sure that what patients are getting is presented in a balanced way, that it is complete, and that it has the effects that it should have in terms of improving decisional quality.