Public record of meeting, 24 June, 2010
Meeting of 24 June, 2010
Southway Inn, Ottawa, Ontario
- Dr. Marcello Tonelli (Chair)
- Dr. Richard Birtwhistle (Vice-Chair)
- Dr. Neil Bell
- Dr. Paula Brauer
- Dr. James Dickinson
- Dr. Michel Joffres
- Dr. Patrice Lindsay
- Dr. Kevin Pottie
- Dr. Elizabeth Shaw
- Dr. Harminder Singh
- Dr. Sarah Connor Gorber
- Tess Grise
- Nancy Hajal
- Meaghan Isaacs
- Dr. Gabriela Lewin
- Catherine Makris
- Christopher Murray
- Donna Fitzpatrick-Lewis
- Dr. Parminder Raina
- Dr. Sharon Straus
- Diane Finkle-Perazzo
- Dr. Donna Ciliska
- Dr. Martin Fortin
- Mary Gauld
- Dr. Nicole Hodgson
- Dr. Patricia Parkin
1. Review of Action Items from April 26–27 Meeting Minutes
Members reviewed the minutes of the previous meeting and noted action items that were completed.
2. Concept Paper
The CTFPHC members reviewed the draft of a concept paper which includes a vision for the CTFPHC . In order for the CTFPHC guidelines to be useful within the context of numerous additional guidelines available to primary health care professionals, it will be important to be clear on how the CTFPHC guidelines differ and how CTFPHC experts will avoid duplication of guideline production. Members discussed the draft concept paper and put forward a number of suggestions. It is expected that the concept paper will be made public in late 2010.
3. Working Group Presentations
3.1 Topic Prioritization
Dr. Sarah Connor Gorber provided an overview of the topic prioritization process by the CTFPHC . The CTFPHC had previously selected four topics for 2010. One additional topic was required for 2010 and 8–10 topics for 2011. The topics identified for 2010 are:
- screening for breast cancer
- screening for hypertension
- screening for diabetes
- screening for depression
- screening for cervical cancer
Dr. Connor Gorber provided a detailed review of the process used for topic selection. This process resulted in a short list of 30 new topics which was ranked and used to determine the final recommendations for topics. Following the meeting, the list of topics will be voted upon by CTFPHC members and the final list of topics will be made public on the CTFPHC website.
CTFPHC Members discussed the topic prioritization process and had a number of suggestions to ensure that priorities are driven by what practitioners need. Recommendations should be framed in order of priority so that practitioners can determine how to be most effective when counselling patients.
Dr. Marcello Tonelli provided a report from the Methods Working Group and is in the process of revising the methods manual of the CTFPHC . Guidelines will generally be provided in a number of formats: a one-page clinician summary; a four–five page published manuscript and a twenty-five page technical document.
CTFPHC members raised a number of lenses and contextual factors to consider during the research and guideline process (e.g. aboriginals, elderly, remote dwellers, children and gender). There was discussion about the importance of communicating with Statistics Canada about data collection issues around these population groups.
3.3 Breast Cancer
Dr. Tonelli reported on activities of the breast cancer working group. The project scope includes an update of the 2008 U.S. Preventive Services Task Force USPSTF guidelines; reformatting according to grade and the addition of new CTFPHC sections according to contextual questions.
CTFPHC members provided a number of suggestions related to issues such as over-diagnosis and the need for guidance on other populations with a low/high incidence of breast cancer.
3.4 Breast Cancer Evidence Summary
Dr. Parminder Raina and Donna Fitzpatrick-Lewis provided a presentation and discussion of the breast cancer evidence collected by the ERSC. The purpose of the review is to provide an update of the 1994 CTFPHC recommendations on breast cancer screening and the 2009 USPSTF recommendations on breast cancer screening. In addition to the presentation slides, participants also examined a handout which provided grade tables and plots.
CTFPHC members raised a number of points related to the presentation of age range and the need for a uniform language and scale.
Dr. Patty Lindsay provided a report from the hypertension working group and presented a draft of several key questions. CTFPHC members made suggestions such as including sub-populations and the value of treatment issues.
Dr. Kevin Pottie provided an overview of the evidence protocol for diabetes. Recent work by the diabetes working group has included the development and refining of the decision process: population, intervention, control and outcome PICO; refining an analytical framework to assist with key questions; selecting key outcomes; considering other recommendations as well as contextual issues.
CTFPHC members discussed issues such as the fact that age group is an important consideration given that diabetes is being seen in younger groups. There is currently an increase in interest in diabetes in children and there is knowledge that incidence will rise in this group. It was agreed that there should be a separate guideline that covers diabetes in children.
It was agreed that the working group would re-rank the outcomes, work on the questions to make them consistent with the previous guidelines and develop an approach to improve outcomes.
Dr. Michel Joffres provided an overview of the evidence protocol for depression. A conference call has been held as well as e-mails to discuss key questions. There has also been a follow-up call to discuss the list of questions and presentation. Next steps will involve refining questions and creating an algorithm and ranking outcomes/harms as well as further involvement and discussions with the ERSC.
Task Force members suggested that the list of outcomes be reduced and raised a number of additional issues for discussion at the next working group teleconference.
4. Knowledge Transfer and Exchange—Status and Next Steps
Dr. Sharon Straus joined the meeting by teleconference and provided an update on the work of the KTWG. The objectives of the work group are to tailor the KT strategy for each guideline including consideration of relevant integrated and end of guideline KT approaches; identify and engage relevant partners/stakeholders early in the guideline development process and strive to keep them engaged throughout the dissemination process.
CTFPHC members suggested that the electronic health records initiatives be examined as a basis for ongoing evaluation of guideline uptake and practice.
The CTFPHC will establish a stakeholder advisory group focused on engaging experts in implementation of working groups and methodology development to provide continuing expertise.
5. Strategic Planning and Discussion on Member Roles and Responsibilities
Dr. Tonelli congratulated CTFPHC members on their work and acknowledged how far they had come in two months. The CTFPHC then discussed a number of process issues such as the extensive time commitment and frequency of meetings. It was suggested that a regular teleconference be held at a time that CTFPHC members can attend.