Q&A with Dr. Eva Grunfeld, Program Lead of the BETTER Program

The BETTER program is part of the CLASP Initiative launched by the Canadian Partnership Against Cancer in 2009, which brought together research, practice, and policy experts to form coalitions that integrate cancer prevention with strategies to prevent other chronic diseases. The Partnership has provided over $6.7 million to BETTER since 2009 including $2.98 million for a new three-year period to “scale up and spread” in seven provinces focusing on primary care clinical settings serving rural, remote and Indigenous populations. We connected with Dr. Eva Grunfeld, co-creator and program lead of BETTER, to learn more about the next phase.

What is the BETTER Program?

The World Health Organization has stated that the rise in chronic diseases is the most pressing health challenge facing the world today. Prevention and screening are the best hope to curtail that rise. Research shows that primary care practitioners in Canada are not able to optimally focus on prevention given current practice demands and health system constraints. This creates a situation where conversations about prevention are often episodic and opportunistic. We developed the BETTER program in 2009 as a way of facilitating discussions and recommendations about prevention and screening of chronic diseases in primary care. The idea was to train health practitioners – such as nurses, nurse practitioners and dietitians – as “Prevention Practitioners,” who meet with patients for a dedicated prevention visit. Patients will meet with a health practitioner to have a focused discussion on risk factors for cancer and other chronic diseases encompassing their lifestyle risk factors as well as their personal medical and family history. This would be augmented by evidence-based processes including motivational interviewing and goal setting. Patients are then provided with a personalized “prevention prescription.” For a visual explanation of how BETTER works, see this infographic video we developed.

What is the new phase of BETTER?

In the first phase of BETTER in 2009, along with my colleague Dr. Donna Manca, we looked at the impact of Prevention Practitioners in primary care clinics in Edmonton and Toronto. The study showed that the Prevention Practitioner intervention improved the number of prevention actions each patient completed. The second phase of the BETTER Program was in the Northwest Territories as well as Newfoundland and Labrador to understand the implementation factors in a real-world setting. This new phase of BETTER will facilitate widespread adoption of evidence-based cancer and chronic disease prevention strategies by training health professionals as Prevention Practitioners. Over the next three years, the Eastern branch of the “BETTER Training Institute” will open to initially serve Ontario, Newfoundland and Labrador, New Brunswick and Nova Scotia. The Western branch of the Institute will open to initially serve Alberta, British Columbia and Manitoba. The Institute will be responsible for training health practitioners from a range of disciplines in the Prevention Practitioner role, and to provide consulting services to individual primary care practices, physician groups and primary care organizations interested in adopting the BETTER approach.

Who will be involved in the new phase of BETTER?

The University of Alberta in Edmonton will host the new phase of BETTER and is the home of the Western branch of the BETTER Training Institute. The Eastern branch will be based at Women’s College Hospital in Toronto, with Dr. Aisha Lofters as the Medical Consultant. Dr. Manca will be the Medical Director for the Training Institute with her colleague Carolina Fernandes serving as Executive Director. I will be the Chief Scientific Advisor for the Training Institute.  There have been many other individuals, organizations and health care facilities involved in the program since its inception 10 years ago. A full list of those who have made the program possible and will be involved in its continuation over the next three years is available on the BETTER website.

How will this new funding help the program evolve in the coming years?

The funding for this new phase will allow us to go from the research and evaluation phase into large-scale implementation. The new $2.98 million funding from the Partnership allows us to open two sites for the Training Institute, which will increase our capacity to train health professionals across Canada to be Prevention Practitioners and bring these new skills into their clinics. The funding also will help us pursue the longer-term goal of making the BETTER Training Institute self-sustaining through a cost recovery model. In the next 10 years, we envision the Institute attracting other types of health care providers. While our focus is on the primary care setting, we realize that the BETTER approach is very adaptable to other health care settings and practices and want to use the coming years to grow the program and determine the best approach to broadening the curriculum to other health care providers. We are currently testing the effectiveness of the BETTER approach in the public health setting and for cancer survivors.

From a patient standpoint, what does the new phase of BETTER mean?

The purpose of BETTER is to move away from a health system modelled on disease management by providing an opportunity for Canadians to focus on disease prevention, wellbeing, and improving their overall health. Our vision is that every individual, regardless of where they live and what primary care setting they are in, has the opportunity to have a focused visit with a trained prevention expert. We want every Canadian to have a chance to develop a realistic, personalized prevention prescription and we want to have health practitioners assist patients in goal setting and achieving their health targets. Prevention is the future of a sustainable health system in Canada and BETTER will play a role in empowering Canadians to take charge of their health and reduce their chances of developing cancer and other chronic diseases.

What have been your personal experiences leading the BETTER Program?

I wrote the original proposal for BETTER in 2008 and it has been incredible to see it develop over the years. It’s been quite the journey to see the application of the evidence into creating the program, to see the development of the training for Prevention Practitioners, and to now see the creation of the BETTER Training Institute. This, along with the collaborations that have built up the program and the energy and efforts of my colleagues, has made it one of the most rewarding pursuits of my career. When I was writing the original proposal, it felt like I was writing a play. I now feel a little like a playwright seeing their play come to life with real people making real what they had put down on paper.

To learn more about the BETTER program, visit: www.better-program.ca.

Dr. Eva Grunfeld is a program lead of BETTER and the Giblon professor and vice-chair (research) of the Department of Family and Community Medicine at the University of Toronto. She is also clinician scientist and Director of Knowledge Translation Research, Health Services Research Program at the Ontario Institute for Cancer Research.