Marcello Tonelli welcomed the CTFPHC members. He thanked them for attending the meeting and a round table of introductions was held.
CTFPHC members reviewed the Minutes of the October 2012 Meeting. No errors or omissions were noted. Gabriela Lewin moved to accept the Minutes of the October 2012 meeting and Marcello Tonelli seconded the motion. Approved.
CTFPHC members reviewed the list of actions stemming from the October 2012 Meeting.
CTFPHC members reviewed the meeting agenda. There were no revisions noted.
Marcello outlined the terms of the Contribution Agreements between PHAC, the ERC and the University of Alberta. This new process has allowed for more flexibility regarding meetings, travel and the use of contractors.
Karen reviewed a document entitled “Summary of the Contribution Agreement between the University of Alberta and the Public Health Agency of Canada.”
Rick provided an update regarding the CTFPHC’s mobile app development and reviewed a flow chart which outlined its key functions. Rick also mentioned that it was not possible to put together a proposal for the current round of CLASP Grants which are designed to take known research and put it into practice.
Michel provided an update on the external review process, the main issues raised by external reviewers and their response to comments. He also reviewed the summary of CPGs.
24 reviewers from 18 organizations were engaged in the review of the depression CPGs and provided 317 comments by December 20, 2012. All comments were addressed by the end of January 2013.
Patricia Parkin provided an update regarding the work of the Childhood Obesity Working Group research questions and timelines. She reviewed the current primary and secondary prevention key questions and their inclusion/exclusion criteria as well as the contextual questions.
Amanda Shane presented an update on the integrated process for endorsement and critical appraisal. She reviewed the action items from the October 2012 meeting and outlined next steps. The Critical Appraisal Working Group was absorbed into the Methods Working Group and two new steps were added to the critical appraisal process:
Alejandra Jaramillo presented information regarding efforts to select an IT infrastructure that best meets the needs of the CTFPHC. She reviewed and compared the basic features of two functionalities: Google Drive and Basecamp. It was agreed that Basecamp would be pilot tested by the Colorectal Cancer Screening Working Group.
Sharon outlined the work of the KT Working Group regarding the Type 2 Diabetes, Hypertension, Cervical Cancer, Depression CPGs, KT tool development process, dissemination activities and the CTFPHC website. She thanked the members of the KT working group for their support and valuable input.
Donna provided a brief update regarding the work of the ERSC.
Maria Bacchus provided an update on the work of the Colorectal Cancer Working Group. She reviewed action items and progress since the last meeting, the Analytical Framework, key questions, contextual questions and next steps.
Jim Dickenson, David Rodier and Leigh Cotton provided an overview of the media coverage associated with the release of the Cervical Cancer CPGs. The Canadian Task Force on Preventive Health Care released an updated guideline calling for cervical cancer screening.
The Guideline was published in the CMAJ on Monday, January 7th, 2013 and distributed to national media on the same day. Coverage from the outreach totaled more than 55 million media impressions across Canada. The coverage was positive with key messages, spokesperson quotes and guideline changes prominent in most of the stories. As anticipated, the journalists’ main point of contention was surrounding the frequency and age-specific recommendations for screening.
Coverage was broad and included publications such as the Toronto Star, The Globe and Mail, Canadian Press, CBC, QMi Agency, Global, Postmedia and CTV. It is estimated that the reach was over 55 million. Coverage was largely positive/neutral and slightly negative/neutral.
Alejandra reviewed a chart which predicted the timelines for the development of guidelines for depression, obesity (adult), obesity (childhood) colorectal, prostate and cognitive guidelines. These approximate timelines are based on historical information which has allowed for the determination of average processing times.
Rick Birtwhistle reported that he’d met with several members of CAR regarding their plans to develop guidelines on breast cancer screening. CTFPHC members felt that while it was important to harmonize where possible, the recommended guidelines should not be changed.
There were concerns raised about the tendency of CTFPHC members to re-assess and make changes to previously-made decisions. It was suggested that Working Group Chairs be more assertive in managing the process and discouraging redundant discussion.
Karen reviewed a document entitled “Summary of Roles and Responsibilities in Support of the CTFPHC” which provided guidelines regarding the roles of each group in supporting and providing input in the development of recommendation statements, enhanced dissemination of CTFPHC CPGs, development of partnerships for guidelines, evaluation of the uptake and impact of CTFPHC guidance, public communications and administrative support.
At the end of Day One, the Colorectal and Prostate Cancer Working Groups held meetings.
Marcello and Rick welcomed the members to the second day of the CTFPHC Meeting. Brandee outlined the dates for future meetings and encouraged members to provide feedback regarding locations and facilities.
18.1 Upgrading / Downgrading – Leslea Peirson
Leslea Peirson reviewed the detailed GRADE process used for upgrading and downgrading recommendations. Sarah Connor Gorber reviewed the Task Force publications strategy and provided an update on new processes such as selecting high risk groups and the scoping process.
18.2 Incidence as an Outcome – Maria Bacchus
Maria presented rational to include or exclude incidence. It is very important to be able to justify our inclusion of these factors, e.g. where incidence is lower and mortality is lower. Previously held dogma about biology does change and it should not be used as the sole criteria.
18.3 Overdiagnosis – Neil Bell
Neil pointed out the issues surrounding screening for diseases that may not cause morbidity or mortality, e.g., prostate cancer. He stressed the importance of communicating these values to patients.
18.4 Benefits and Harms – Michel Joffres
Michel asked for more clarity on the comparison of benefits and harms and stressed the need for consistency. The problem arises for the interpretation of benefits and harms in a weak recommendation and this can be difficult to solve. This is an ethical decision and we need a strong, balanced and clear rationale.
Paula reviewed the purpose and background, key questions, contextual questions and decisions made by the Working Group. She also presented and discussed the USPSTF and the Australian obesity screening recommendations.
Neil reviewed the milestones achieved for the Screening for Prostate Cancer CPGs. An initial draft was completed in November and a final version was ready for peer review in December. In January, peer review comments were incorporated: analytical framework and key questions updated; subgroup analysis elaborated; harms of screening specified; and definitions for watchful waiting and active surveillance were included. In addition, new questions on risk assessment tools and differential screening were added. The final protocol was developed early February.
Lesley provided an overview of process and topic selection and reviewed appropriateness and selection criteria as well as reviewing the top ten topics and resulting input from the CFPC and family physicians. She also provided an update on possibilities for USPSTF partnership.
Karen provided a brief update regarding the work of the OCTFPHC. Replacements are currently being sought for two CTFPHC members and a sub-committee will be established. Karen met with the USPSTF and discussed a variety of ways to collaborate. The OCTFPHC has developed a “lessons learned” document regarding the cervical cancer CPGs and it was pointed out that there is a need for process around quality assurance of KT products.
At the end of Day Two, several of the Working Groups held meetings.
Marcello and Richard thanked all present for their hard work and contributions. There was some discussion about a variety of different types of meeting timings schedules that might allow for better travel arrangements.