The BETTER program for preventing cancer and chronic diseases

July 4, 2018

Learn more about the BETTER program for preventing cancer and chronic diseases through an interview with Dr. Eva Grunfeld, a video and a pamphlet

The Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) approach integrates evidence-based strategies to address cancer, diabetes, heart disease and associated modifiable risk factors in primary care. BETTER’s goal is to improve cancer and chronic disease prevention and screening by offering training on the application of up-to-date clinical tools that can be used with patients in a primary care setting.

BETTER’s approved three-year funding from the Partnership will support Canadians in up to seven provinces with a focus on training staff in primary care clinical settings serving rural, remote, and First Nations, Inuit and Métis populations.

We got in touch with Dr. Eva Grunfeld, co-creator and program lead of BETTER, to explain the program and its next phase.

What is the BETTER Program?
The World Health Organization (WHO) 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 about risk factors for cancer and other chronic diseases based on their lifestyle, as well as their personal medical and family history. The discussion would be augmented by evidence-based processes including motivational interviewing and goal setting. Patients are then provided with a personalized prevention prescription.

What is the new phase of BETTER?
In the first phase of BETTER in 2009, my colleague Dr. Donna Manca and I 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. The Eastern branch of the BETTER Training Institute will initially serve Ontario, Newfoundland and Labrador, New Brunswick and Nova Scotia.

The Western branch of the Institute will initially serve Alberta, British Columbia and Manitoba. The Institute is 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 hosts the new phase of BETTER and is the home of the Western branch of the BETTER Training Institute.

The Eastern branch is based at Women’s College Hospital in Toronto, with Dr. Aisha Lofters as the Medical Consultant. Dr. Manca as the Medical Director for the Training Institute with her colleague Carolina Fernandes serving as Executive Director. I am 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 beginning. The BETTER website has a full list of the people who have made the program possible and will be involved in its continuation over the next three years.

How will new funding help the program evolve in the coming years?
The funding for this new phase allows us to go from the research and evaluation phase into large-scale implementation. The $2.98 million funding from the Partnership allows us to open two Training Institute sites, which increases our capacity to train health professionals across Canada as Prevention Practitioners and to bring these new skills into their clinics.

The funding helps 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, well-being 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 for a focused visit with a trained prevention expert.

We want every Canadian to have a chance to develop a prevention prescription that’s realistic and personalized, 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.

Sign up for the BETTER program’s two-day Prevention Practitioner training.

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