The BETTER WISE project
Although most patients have multiple risks, most guidelines and resources are focused on one specific disease, organ system, or lifestyle risk. Furthermore, cancer survivors and patients living in poverty achieve fewer prevention and screening goals and patients may lack awareness of how lifestyle contributes to cancer and chronic disease. Building on the work of the BETTER trial and the BETTER 2 program, the BETTER WISE (Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening for Wellness of Cancer Survivors and Patients) project will conduct an intervention that includes electronic tools, pathways for cancer survivors, and a tool that assesses poverty.
BETTER WISE is a 5-year project (2016-2021) that brings together diverse stakeholders (policy, practice, research, patients) in Alberta, Ontario, and Newfoundland and Labrador.
The primary objective of the BETTER WISE project is to determine if patients aged 40-65, including cancer survivors (breast, colorectal, or prostate) and general health patients (i.e., patients without a previous history of breast, colorectal, or prostate cancer), randomized to receive an individualized visit with a Prevention Practitioner have improved cancer surveillance and general prevention and screening outcomes determined by a composite index as compared to standard care in a wait-list control group twelve months after the initial prevention visit.
The BETTER WISE project will comprise of 3 phases:
1. Knowledge harmonization and integration - Working with primary care practices and Prevention Practitioners, a revised BETTER WISE tool kit will include blended care pathways for cancer survivors (breast, colorectal, prostate) and cancer and chronic disease prevention and screening (CCDPS), including behavioural lifestyle risk factors and an assessment of poverty.
2. A pragmatic cluster randomized controlled trial - Sixteen primary care practices, 8 in Alberta, 4 in Ontario, and 4 in Newfoundland and Labrador will participate in the project. It is expected that 2-10 primary care providers (PCPs) from each primary care practice will be engaged, for a total of 64 PCPs across the 3 participating provinces. Patients will be randomized at the physician level to receive an early BETTER WISE intervention or to wait-list control. The BETTER WISE intervention is depicted below.
3. Evaluation of the impact of the intervention - The main outcome for the project will be the individual patient-level summary composite index defined as the proportion of CCDPS maneuvers for which the patient was eligible at baseline, that is met (according to pre-defined targets) at 12-month follow-up. Qualitative methods will be used to explore the facilitators and barriers to the implementation and uptake of the BETTER WISE intervention as well as to address any modifications needed to scale and spread the approach and the PP role. An economic assessment will also be undertaken to inform the health care payer and policy makers of the projected cost-benefit impact of investing in the BETTER WISE approach.
For more information about the BETTER WISE project, please contact us.
More information on the Prevention Practitioner role can be found here.
The BETTER WISE project is made possible through a financial contribution from Alberta Innovates - Health Solutions.
The BETTER website and tools are licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
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