The BETTER WISE Project
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 screens for poverty.
BETTER WISE is a 6-year project (2016-2022) 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:
- 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 a screen for poverty.
- 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.
- 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.
Are you a patient participating in the BETTER WISE Project? You can complete your health survey by following the link below:www.better-survey.ca
The BETTER WISE Project Team (2016 – 2022)
Project Lead: Dr. Donna Manca
Project Co-Leads: Dr. Kris Aubrey-Bassler, Dr. Denise Campbell-Scherer, Dr. Eva Grunfeld, Dr. Aisha Lofters, Dr. Melissa Shea-Budgell
Collaborators: A. Bencivenga, G. Bloch, J. Britten, J. Carroll, C. Davis, E. Denga, K. Dong, R. Elford, L. Green, N. Hans, F. Janke, D. Klein, P. Krueger, C. Leduc, R. Lewanczuk, K. McBrien, C. Meaney, R. Moineddin, C. Nykiforuk, M.A. O’Brien, S. Oddie, A. Pinto, M. Rose, S. Ross, G. Salvalaggio, C. Scrimshaw, N. Sopcak, W. Tink, M. Wilson
Community and Policy Partners: C. Campbell, C. Chan, P. Corcoran-Mooney, A. Gogan, R. Hiscock, J. MacWhirter, F. McCrate, B. Meade, K. Milley, R. Goodyear, A. Robinson Vollman, T. Wong
Statistical Analysis: R. Moineddin, C. Meaney.
Economic Assessment: K. McBrien
Project Coordination: C. Fernandes, M. Chow, I. Khalil, K. Sivayoganathan
Research Assistant: D. Ofosu
Students/Trainees: M.K. Blackbyrne, I. Carneiro, M. Kebbe, C. McCartan, F. Nagase, D. Patel, S. Yildirim-Erbasli
The BETTER Mainpro+ Workshop
We can do BETTER – Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care Mainpro+ Workshop
The BETTER Program is currently accredited by The College of Family Physicians of Canada as a Maintenance of Proficiency (MainPro+) program. Participants can claim up to 3 MainPro+ credits for participating in a 3-hour workshop and completing a post-session self-reflective exercise, however, sessions can be tailored to accommodate different time constraints.
Additional information on MainPro accreditation can be found here.
Whenever possible, primary care professionals from diverse backgrounds, family medicine, nursing, pharmacy, etc. are encouraged to participate in the sessions as participants can learn from one another through sharing of differing perspectives and experiences.
- Identify how to enhance the quality of care in your practice by integrating the best evidence for prevention and screening.
- Identify how to incorporate prevention and health promotion in a clinical encounter in your practice.
- Recognize how to engage patients and health professionals in shared decision-making to develop a plan of care (prevention prescription).
- Identify how you can apply an intervention in your practice to improve prevention and screening.
- Recognize how to work with others to assess, plan, provide, and integrate prevention and screening care for individual patients.
- Identify how you could evaluate prevention and screening outcomes.
The BETTER trial and subsequent studies have demonstrated that training a clinician to become a Prevention Practitioner, an individual within the primary care setting who develops specialized skills in cancer and chronic disease prevention and screening, significantly improved prevention and screening in patients 40-65 years of age as measured by a composite outcome. The BETTER approach: 1) is personalized to the patient and the practice; 2) addresses multiple conditions, including lifestyle factors; 3) is integrated with local, regional and national resources; and 4) is longitudinal, assessing patients over time. Through group discussions, participants will explore how they can adapt this novel, effective approach to their settings. The resources and tools developed to support this approach will be shared.
For more information about upcoming sessions or if you are interested in holding a BETTER MainPro+ session in your area, please contact us.