The Canadian Task Force on Preventive Health Care (CTFPHC) is composed of experts who develop recommendations for clinical preventive services delivered by Canadian primary care practitioners. The CTFPHC is responsible for prioritizing the topics that will be reviewed and is supported by the Global Health and Guidelines Division (GHGD) of the Public Health Agency of Canada to define the analytic framework and scope of each topic. The CTFPHC collaborates with two evidence review and synthesis centres from the University of Ottawa and the University of Alberta, which conduct evidence reviews that the CTFPHC uses to develop its recommendations. The CTFPHC’s Knowledge Translation (KT) Team from St. Michael’s Hospital in Toronto leads KT activities to promote guideline reach and uptake and to support practitioners and patients in shared decision making.
Message From the Chair
Greetings! In this issue, I am pleased to share information on a number of exciting activities in which the CTFPHC is involved.
The CTFPHC has developed an Internship Program to provide mentoring and training opportunities to Canadian healthcare trainees and early career professionals. CTFPHC Interns engage in short-term and longer-term bi-directional training opportunities with CTFPHC members and partners. For more information, see below and visit our website.
In addition, the CTFPHC is leading a 2-year pilot initiative of to develop and evaluate a network of Canadian Clinical Prevention Leaders (CPLs) who are trained in peer education and CTFPHC guideline development and implementation. The purpose of this network is to develop Canadian capacity in evidence-based guideline development, to promote the uptake of evidence-based guidelines, and to address barriers to guideline implementation at a local level through educational outreach and peer-to-peer learning, in conjunction with other knowledge translation activities. For more information, see below or visit our website.
In 2017, the CTFPHC launched an Article Series, Prevention in Practice, in the Canadian Family Physician. To date, the series has released six articles covering topics such as communicating the balance between benefits and harms, shared decision making, and using knowledge translation tools in preventive health care. The latest article, published in January 2018, discusses incorporating patient values and preferences into guidelines and clinical decision-making. For the first time in the series, a Patient Perspective essay accompanies the article. See the section, “Canadian Family Physician” below to learn more.
The CTFPHC continues to offer two Continuing Medical Education modules through our e-learning platform: Obesity Prevention and Management and Screening for Cervical Cancer – see “Continuing Medical Education” below for more information.
As always, we appreciate your interest in the CTFPHC and we encourage you to stay up to date on our work by visiting our website at www.canadiantaskforce.ca.
Brett Thombs, PhD
In February 2018 the CTFPHC hosted a booth at the annual Centre Intégré de Santé et de Services Sociaux de l’Outaouais (CISSSO) conference on ‘Overdiagnosis and overuse of resources.’ This annual conference is organized by the CISSSO’s Continuing Professional Development Committee. CTFPHC member Guylène Thériault commented “the event was a great success; more than two thousand French-language CTFPHC knowledge translation tools were distributed!”
Canadian Family Physician
Prevention in Practice Article Series
The CTFPHC is pleased to expand the article series, Prevention in Practice, which appears in the Canadian Family Physician. This series is intended to support primary care providers with strategies on how to implement preventive health evidence into their work and engage in shared, informed decision making.
The article series covers topics such as communicating the balance between benefits and harms; shared decision making, measures of outcome and effect size, assessing guidelines, eliciting patient values and preferences, and KT tools.
Access the first six parts of the series here:
- Better decision making in preventive health screening: Balancing benefits and harms
- Shared decision making in preventive health care: What it is; what it is not
- Knowledge Translation tools in preventive health care
- Eliciting patient values and preferences to inform shared decision making in preventive screening
- Patient perspectives – Exploring patient values and preferences
NEW – Eliciting patient values and preferences to inform shared decision making in preventive screening
The most recent CTFPHC article within the Canadian Family Physician Prevention in Practice Series discusses eliciting patient values and preferences to inform shared decision making in preventive screening. It is co-authored by Dr. Dawn Stacey who is an expert in enhancing patient engagement in shared decision making.
The authors write, “For clinicians to help their patients navigate a path to the most appropriate decision, they need to understand how much each individual values the potential benefits of an intervention and how much each individual fears the unanticipated repercussions or harms.”
Read the Eliciting Patient Values and Preferences article here: http://www.cfp.ca/content/64/1/28
NEW – Patient perspectives – Exploring patient values and preferences
The CTFPHC is excited to introduce the first Patient Perspective to accompany its Prevention in Practice series. This Patient Perspective is written by Cathy Telfer, a retired educator who lives and volunteers in Chatham-Kent, Ontario. Cathy is also a volunteer author of The Canadian Cancer Society monthly newsletter column “Concerning Cancer”. In this Patient Perspective, Cathy shares her personal story and practical advice to help guide both primary care practitioners and patients in the process of exploring patient values and preferences.
Read the Patient Perspective article here: http://www.cfp.ca/content/64/1/10
Continuing Medical Education
The Obesity Prevention and Management e-learning module
The Obesity Prevention and Management e-learning module expands on the CTFPHC’s 2015 guidelines on the prevention and management of obesity in adults and in youth and children. The module is intended to help primary care providers better understand the impact of obesity on patients; explains measures for assessing and monitoring obesity in adults, youth, and children; and provides an overview of behavioural and pharmacotherapeutic interventions available to patients.
This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits.
Screening for Cervical Cancer e-learning module
The CTFPHC is pleased to offer the accredited e-learning module “Screening for Cervical Cancer with the 2013 Canadian Task Force on Preventive Health Care (CTFPHC) Guidelines.”
This e-learning module represents a unique learning opportunity for primary care providers to develop a deeper understanding of the 2013 CTFPHC guidelines on cervical cancer screening and some of the nuances of how they can be applied in clinical practice.
This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits.
Clinical Prevention Leaders Network Update
The CPL Networks is intended to provide training on the processs involved in evidence-based guidelines, promote the uptake of evidence-based guidelines, and address barriers to guideline implementation at a local level through educational outreach and other KT activities.
To date, 13 CPLs have been selected to undergo training before engaging in educational outreach activities. The CPLs are from across Canada (Ontario, Quebec, Manitoba, Alberta, and Saskatchewan) and include physicians, nurse practitioners, residents, and allied health professionals. CPLs have attended three introductory training sessions covering the scope of the initiative and their roles, the background of the CTFPHC, and the fundamentals of KT.
For more information on this initiative, please contact Danica Buckland (research coordinator) (BucklandD@smh.ca) with the subject line ‘CPL Network’.
Meet the CTFPHC
Dr. Roland Grad – Member
In my daily work as a family doctor, I see people of all ages. For the last 4 years, I’ve enjoyed being a member of the CTFPHC. In this time, I’ve learned so much! Beyond learning about how guidelines are produced, and how recommendations are made, I have enjoyed contributing to a series of articles for Canadian Family Physician on Prevention in Practice. My writing helps to improve my decision-making in practice by better equipping me to implement and teach shared-decision making around preventive health care. I am grateful to fellow CTFPHC members and colleagues at the Public Health Agency of Canada for teaching me about this. I am also grateful to McGill University, as I receive salary support for CTFPHC activities. At McGill, I oversee the teaching of evidence-based medicine to medical students and lead the Clinician Scholar Program for residents in Family Medicine.
In my practice, I struggle to help my patients see how their decisions about cancer screening should be better informed. I often ask myself, “Does this patient understand the risks of a false–positive result?” What about the anxiety a false positive can generate? What about the burden of further testing, or the consequences of an overdiagnosis?” Many patients seem to overestimate the potential for benefit from screening or preventive interventions while they underestimate the potential for harm. It can be challenging to explain this in the typical primary care visit.
Yet, my objective is to help patients arrive at a decision that is patient-centred and evidence-informed. In so doing, I can provide what some call “Goldilocks” health care: not too much and not too little. But how can I do this given the time constraints of practice? I offer the following example of practice change and improvement in relation to shared-decision making and cancer screening:
First, I use some of the tools developed by the Knowledge Translation Program. For example, I now commonly show a 1000 person diagram to patients considering screening for lung cancer. And, I suggest a return visit to the office to discuss patient preferences. This takes off some of the pressure to decide right away, and helps us move beyond a binary ‘do it, don’t do it’ approach to cancer screening. As I see it, given a close trade-off between the potential for benefit and the potential for harm, a better understanding of patient preferences should lead to a better decision from their perspective.
-Roland Grad, MDCM, MSc, FCFP
CTFPHC Internship Program
The CTFPHC is committed to providing mentored training opportunities to Canadian healthcare trainees and early career professionals. Opportunities for CTFPHC Interns include short-term training opportunities and longer-term internships. Both short-term and longer-term internships involve working closely with a CTFPHC member who will supervise and provide mentorship to the intern.
- Short-term Internships
Include projects that can be completed in a period consistent with a residency research rotation and could be used to fulfill rotation requirements.
- Longer-term Internships
Involve a mentored experience working with the Chair of a CTFPHC guideline working group from the initiation of the guideline process through completion.
Eligible applicants include MDs in residency training programs or who are conducting fellowships, trainees in doctoral programs, and practicing healthcare professionals in the first 5 years of their careers.
For more information regarding specific eligibility for short-term and long-term internships and the application procedure, please visit the CTFPHC Internship Program page.
Opportunities for Engagement
Usability Testing of Practitioner Tools
The CTFPHC produces practitioner tools to support each of its guidelines. To ensure that the content, layout, navigation, and aesthetics of these tools are appropriate and useful for practice, we conduct usability testing with practitioners. If you are interested in reviewing and providing feedback on one of our upcoming guideline tools, please email Rossella Scoleri, research assistant, at firstname.lastname@example.org for more information. Note that we offer $100 compensation for a one-hour telephone interview.
Patient Engagement in Guideline Development
The CTFPHC engages patients in its guideline development process. Specifically, the CTFPHC recruits patients to provide input at up to three stages of the guideline development process: (1) when outcomes are selected for inclusion in the systematic review protocol; (2) when the final guideline recommendations and KT tools are developed; and (3) when patient KT tools are usability tested. The CTFPHC uses feedback provided by patients to guide the search for evidence on the harms and benefits of preventive health care interventions and to develop KT tools to accompany the guidelines.
Guidelines in Progress
Upcoming CTFPHC clinical practice guidelines will include the following topics:
- Screening for asymptomatic bacteriuria in pregnancy
- Screening for visual acuity
- Screening for breast cancer (update)
- Screening for esophageal adenocarcinoma
For more information about these forthcoming guidelines, please visit our upcoming guidelines website page.
Is there a preventive health topic that you would like to see the CTFPHC develop a clinical practice guideline for? Let us know what you are passionate about! We accept topic suggestions on a rolling basis and would love to hear from you. To submit a suggestion, please complete an online form.
Suggestions for the next newsletter
Is there a subject that you would like to see addressed in the next issue of the CTFPHC newsletter? Let us know what you’d like to see covered! We are always accepting suggestions. To submit a suggestion, please email Rossella Scoleri, research assistant, at email@example.com with the subject line “Newsletter Suggestions”.