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Purpose: The BETTER WISE (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care for Wellness of Cancer Survivors and Patients) intervention is an evidence-based approach to prevention and screening for cancers and chronic diseases in primary care that also includes comprehensive follow-up for breast, prostate and colorectal cancer survivors. We describe the process of harmonizing cancer survivorship guidelines to create a BETTER WISE cancer surveillance algorithm and describe both the quantitative and qualitative findings for BETTER WISE participants who were breast, prostate or colorectal cancer survivors. We describe the results in the context of the COVID-19 pandemic. Methods: We reviewed high-quality survivorship guidelines to create a cancer surveillance algorithm. We conducted a cluster randomized trial in three Canadian provinces with two composite index outcome measured 12 months after baseline, and also collected qualitative feedback on the intervention. Results: There were 80 cancer survivors for whom we had baseline and follow-up data. Differences between the composite indices in the two study arms were not statistically significant, although a post hoc analysis suggested the COVID-19 pandemic was a key factor in these results. Qualitative finding suggested that participants and stakeholders generally viewed BETTER WISE positively and emphasized the effects of the pandemic. Conclusions and implications for cancer survivors: BETTER WISE shows promise for providing an evidence-based, patient-centred, comprehensive approach to prevention, screening and cancer surveillance for cancer survivors in the primary care setting. Trial registration: ISRCTN21333761. Registered on December 19, 2016, . [ABSTRACT FROM AUTHOR]

Background: The original 'BETTER' (Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care) approach consisted of a prevention-focused visit between participants aged 40–65 years and a "Prevention Practitioner" (PP), who empowered the participant to set achievable prevention and screening goals for cancers and chronic diseases. BETTER was successfully adapted for economically deprived communities (BETTER HEALTH) in Canada. Our objective was to conduct a review of guidelines in preparation for adapting the 'BETTER HEALTH' approach for younger adults aged 18–39 years living with lower income, a group known to have earlier mortality due to a higher prevalence of preventable chronic diseases than their peers with higher income. Methods: We searched multiple electronic databases and grey literature for clinical practice guidelines on prevention/screening and included those that met the following criteria: published in English from 2008–2020 in Canada or any of the following countries (Australia, Ireland, New Zealand, Scotland, United States and England); and addressed prevention or screening. We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and extracted data (publication details, recommendations, and Quality/Level of evidence as reported by authors) from sources with overall scores of 5 or higher. Final recommendations were compiled after harmonization with input from diverse stakeholders (co-investigators, PPs, and the Community Advisory Committee). Results: We included a total of 85 guidelines, and developed a final list of 42 recommendations for 18–39 year-olds across 21 topics. Specific recommendations fell under the following topics: cancers, cardiovascular disease, diabetes, obesity, lifestyle (alcohol; healthy nutrition/physical activity); healthy relationships and healthy sexuality, immunization, oral health, social determinants of health, and substance use. Conclusion: We identified evidence-based guidelines on individual-level prevention/screening actions for adults 18–39 years old and relevant for those living with lower income which will directly inform development and implementation of the BETTER LIFE intervention. [ABSTRACT FROM AUTHOR]

Context: BETTER WISE is a comprehensive and structured approach for cancer and chronic disease prevention and screening (CCDPS) that addresses cancer survivorship and screens for lifestyle risks and poverty in patients aged 40 to 65. Objective: To describe the impact, barriers and facilitators of BETTER WISE. Study design and Analysis: Qualitative study: 17 focus groups and 48 key informant interviews were conducted, transcribed and analyzed employing thematic analysis using a constant comparative method. Written feedback (585 feedback forms) from patients was also collected and analyzed. Setting: 13 primary care settings (urban, rural and remote) in Alberta, Ontario, and Newfoundland and Labrador, Canada. Participants: Primary care team members (N=132) including clinicians, managers and clerical staff participated in focus groups or one-on-one key informant telephone interviews. Additionally, patients submitted 585 written feedback forms. Intervention: 1,005 patients were invited for a one-hour visit with a "prevention practitioner" (PP), a member of the primary care team with training in CCDPS and the BETTER WISE approach. PPs met with patients one-on-one to provide them with an overview of their individual risk for chronic diseases, eligibility for screening, and assistance with lifestyle counselling. Results: Four main themes were identified: 1) Impact on patients: Patients appreciated the BETTER WISE approach and found it empowering. They caught health concerns that were overlooked and reported improved lifestyle changes; 2) Impact on primary care providers (PCPs): PPs reported improved teamwork, increased knowledge of CCDPS, and better relationships with patients and physicians; 3) The main barrier to implementation of BETTER WISE was the onset of the COVID-19 pandemic, which: i) changed prevention visits to phone visits, ii) put screening tests on hold, and iii) added hardship on patients and PCPs as focus shifted to emergencies, acute care, and COVID-19 screening and vaccinations; 4) Facilitators of the implementation of BETTER WISE included: i) buy-in from PPs, physicians, and patients, ii) good relationship and team culture within primary care teams, and iii) alignment with CCDPS activities already happening at the clinics. Conclusion: Despite the interruption of the COVID-19 pandemic, the participating primary care clinics completed the BETTER WISE study and the BETTER WISE approach had a positive impact on patients and PCPs. [ABSTRACT FROM AUTHOR]