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What is the BETTER Approach?

The BETTER Approach focuses on prevention and screening of cancer, diabetes, heart disease and associated lifestyle factors (nutrition, exercise, smoking, and alcohol). Specifically, the approach identifies a new role in the primary care setting (the BETTER Prevention Practitioner™), which can be taken on by a clinician/allied health professional.

What is the BETTER Institute?

Our Mandate: To improve cancer and chronic disease prevention and screening for cardiovascular disease, diabetes, colorectal, breast, and cervical cancers and their associated lifestyle factors in patients 40-65 years of age.

Areas of Focus

  • Training of BETTER Prevention Practitioners™: hands-on training of healthcare professionals on the Prevention Practitioner role and BETTER approach.
  • Implementation Support: tailored implementation and adaptation support to primary care practices and organizations interested in adopting the BETTER approach.

This project has the potential to improve the health of Canadians through the introduction of a new model of care that integrates cancer and chronic disease prevention and screening into diverse primary care settings throughout Canada.

What does the BETTER Institute offer?

Training of BETTER Prevention Practitioners™: hands-on training of healthcare professionals on the Prevention Practitioner role and BETTER approach.

Implementation Support: tailored implementation and adaptation support to primary care practices and organizations interested in adopting the BETTER approach.

Where was the BETTER Program developed?

It was developed in Canada. The BETTER Trial began in two Canadian cities, Edmonton and Toronto.

Which chronic diseases do you screen for?
  • Cancer (breast, cervical, colorectal, lung), diabetes, and heart disease
  • We also take into consideration mental health
Which lifestyle factors do you address?

Smoking, alcohol, nutrition and physical activity

What is a BETTER Prevention Practitioner™?

Informed by the BETTER toolkit, the purpose of this skilled role is to work directly with patients to determine which cancer and chronic disease prevention and screening (CCDPS) actions they are eligible to receive, and through a process involving shared decision-making and S.M.A.R.T. (specific, measurable, attainable, realistic, time-based) goal setting, develop a unique, personalized BETTER Prevention Prescription™ with each patient.

Who can become a BETTER Prevention Practitioner™?

In the research studies the BETTER Prevention Practitioner™ were allied health professionals.

The role is versatile – we now have a wide range of BETTER Prevention Practitioner™ which include, RNs, RPNs, LPNs, NPs, RDs, Pharmacists, Physicians, and more.

How do I become a BETTER Prevention Practitioner™?

The BETTER Institute provides virtual training workshops over 2 or 3 days for a total of 11 hours of instruction. To find out when the sessions are held, visit the training page

How long is a visit with a Prevention Practitioner?

The visit is usually between 45 minutes to 1 hour.

We recommend beginning with 1-hour visits.

There are a number of variations of the BETTER Program. Some clinics have decided to have 45 minutes with the BETTER Prevention Practitioner™, with a 15-minute visit with their primary care provider before or after the BETTER Prevention Practitioner™ appointment. The length of the visit depends on the capacity of the individual clinic.

A BETTER Prevention Practitioner™ should ideally have at least one-half day a week devoted to BETTER Prevention Practitioner™ visits.

Note, this does not include the patient’s time to complete the survey.

How do I implement BETTER into my primary care setting?

Through the BETTER Institute, there may be potential to offer implementation support in order to help you integrate the program into your current workflow. If you are interested, please contact better@ualberta.ca.

Is the BETTER Program adaptable?

Yes! Clinics and practitioners have been adapting the BETTER Program to fit their needs. We understand each practice is different and encourage participants to adapt Classic BETTER into their setting.

How do I access the BETTER tools?

If your practice is working with the BETTER Implementation Lead, they can help to facilitate this process.

To request a copy of the BETTER tools, please contact us at better@ualberta.ca

Are the BETTER tools available in other languages?

The BETTER tools are currently available in English and French.

Can the BETTER tools be integrated into our Electronic Medical Record (EMR) system?

If your practice/organization has the IT capacity and resources to do this then, yes. The BETTER team is unable to provide IT support for EMR-related matters.

Can we add additional screening and prevention measures (such as immunization screening) to the Prevention Practitioner Visit?

Yes, you can add additional screening and prevention measures. However, the measures included in the BETTER Care Map are the ones that are supported by our evidence review. The BETTER team cannot provide recommendations or guideline support for any additional measures. For example, you could add immunization screening but your practice would need to determine the guidelines and scope associated with this additional screening.

What is the BETTER web-based application (or BETTER web-app)?

The BETTER Institute has developed the suite of BETTER Health Surveys as a secure electronic resource (i.e. the BETTER web-application or BETTER web-app) to help assess individuals’ risk for chronic diseases such as cancer, cardiovascular disease, and diabetes.

The BETTER web-app enables primary care settings and organizations implementing the BETTER Program to virtually distribute, collect and manage the BETTER Health Surveys. The surveys include questions derived from evidence-based, validated tools and expert recommendations, and are a central component of the Prevention Practitioner role as they collect information that is not often well documented in EMRs (e.g. family history, personal history, and lifestyle behaviours).

Individuals complete the BETTER Health Survey(s) electronically on a web browser. The BETTER web-app automatically develops a Survey Summary, which is a printer-friendly copy of each of the patient’s survey answers that can be downloaded or printed to file in the patient’s medical chart for future reference. The Web App also uses integrated logic to pre-populate portions of the BETTER Prevention Prescription.

If you are interested in learning more about the BETTER web-app, please contact us at better@ualberta.ca

Is there any research behind BETTER?

Yes, there have been numerous BETTER publications. The first publication was in 2011. For a list of all publications, go to here.

In the research studies, were the BETTER Prevention Practitioner™ physicians or allied health members?

Allied health professionals. The role is versatile – we now have a wide range of BETTER Prevention Practitioner™ which include, RNs, RPNs, LPNs, NPs, RDs, Pharmacists, Physicians, and more.

Where has BETTER Research activities taken place?

BETTER research studies have taken place in three Provinces in Canada: Alberta, Ontario, and Newfoundland and Labrador.

To learn more about the BETTER program of research, visit our evidence page .

 What was the study methodology for the BETTER trials?

Pragmatic two-way factorial cluster Randomized Control Trial (RCT).

A cluster randomized trial is a type of trial in which groups of subjects are randomized, rather than individual subjects – physicians’ practices were the unit of allocation and individual patients were the unit of analysis. Pragmatic trials take place in a setting where patients receive their usual care.

What are BETTER screening guidelines?

A large clinic practice guideline review was completed to create a screening algorithm to guide the work of a Prevention Practitioner. The guideline review process included provincial, Canadian and international guidelines.

How were the BETTER guidelines decided upon?

Clinical practice guidelines and tools were identified using a structured literature search, which included both indexed and grey literature. Two questions from the Agree II tool were used to screen the rigor of the guidelines. The full Agree II tool was used on the guideline after it passed the screen. A clinical working group was convened to review the guidelines and tools, with representatives from family medicine, nursing, nutrition and researchers. Subgroups reviewed the guidelines and tools for each topic and the larger group discussed and voted on which recommendations should be included. The guidelines that were selected were designed to be measurable, actionable and explicit.

What age group do the BETTER guidelines apply to?

40 to 65 years

I have patients under 40 or over 65 years old. Can this program be used for them?

The evidence review was conducted for patients between the ages of 40 and 65.

The BETTER Institute does not provide screening recommendations for patients under the age of 40 or over the age of 65. Your clinic would be responsible for any recommendations outside this age range.

How do I get a copy of the BETTER Care Map?

A copy of the screening algorithm is provided in BETTER Prevention Practitioner Training. To request a copy of the BETTER Care map contact us at better@ualberta.ca

What do patients think about the BETTER Program?

The BETTER 2 study included a qualitative evaluation which analyzed the feedback we received from patients.

Patient feedback showed that patients who received a visit with a Prevention Practitioner valued personalized care and dedicated time to talk about screening and prevention.

After the study was completed, patients expressed a desire for the program to continue and for preventative care to be a focus of the Canadian healthcare system.

What does BETTER training entail?

Training is provided virtually over the course of 2 or 3 days for a total of 11 hours of continuing education. In a small group setting, you will learn about the BETTER Prevention Practitioner™ role, review the BETTER research, use the BETTER Tool Kit, and practice behavior change techniques. We use a hands-on approach to learning, which includes case studies, discussions and videos. Though this training, you will gain specialized skills in chronic disease prevention and screening.

How much does training cost?

The fee for Prevention Practitioner Training is $400 per person.

Training may be provided at no cost if a trainee meets the following criteria:

  • They are a healthcare professional actively practicing within a primary care setting or are linked with primary care
  • They practice as a healthcare professional in Alberta, Manitoba, Ontario, New Brunswick, Newfoundland & Labrador, or Nova Scotia
  • They participate in a training session before September 30, 2021

If you have any questions or would like to learn more about our training fees, please contact us at better@ualberta.ca

I have a large group interested in training. What are our options?

All training sessions are capped at 8 participants. Depending on the size of your team, multiple training sessions may be needed.

Virtual training sessions listed on our website and which are indicated as OPEN can be attended by any healthcare professional, regardless of their location or practice team.

To explore potential options, including scheduling training sessions specifically for your team or the possible accommodation of a local in-person training session, please contact us at better@ualberta.ca

I work as a health care professional and am interested in bringing BETTER to my setting. Can I apply to attend training?

Yes! Visit the training page for open training dates. Email better@ualberta.ca to express interest and receive an application form.

We are already doing prevention in our clinic. Why do we need a BETTER Prevention Practitioner™?

The BETTER Prevention Practitioner™ role is designed to be a compliment to primary care providers and they work they are doing. It is designed promote interdisciplinary teamwork.

The Prevention Practitioner works in partnership with primary care providers. The Prevention Practitioner helps to collect detailed patient information, develop a personal rapport with a patient and makes referrals, which benefits the work of the primary care team and often saves the primary care provides valuable time.

How do I learn more?

Contact us! better@ualberta.ca