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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 a 2-day training workshop. 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.

Are the BETTER tools available in other languages?

Currently, the BETTER tools are only available in English.

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 does not 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 web-based application?

The web-based application is a secure online application for managing and distributing the BETTER Health Survey.

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 did the BETTER Research take place?

Urban areas including Toronto, Ontario and Edmonton, Alberta.

Rural and remote regions in Newfoundland and Labrador.

 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 screening algorithm?

A copy of the screening algorithm is provided in BETTER Prevention Practitioner Training.

What do patients think about the BETTER Program?

A part of the BETTER 2 trial included a qualitative arm which analyzed the feedback we received from patients.

Patient feedback showed that they valued personalized care and dedicated time to talk about screening and prevention.

We received no negative comments about the BETTER program. After the study was completed, patients expressed a desire for the program to continue.

What does BETTER training entail?

Training is a 2 day in-person workshop. In a small group setting, we 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 screening and prevention. The time spent in training could count towards 11 hours of continuing education.

How much does training cost?

There is no registration fee associated with training. It is free to attend (does not include travel and accommodations).

I have a large group interested in training. It is not feasible for us to travel. Do we have any options?

Contact the BETTER Institute. Depending on our scheduled training, we might be coming to your region and able to accommodate a local training session.

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 margaret.harder@wchospital.ca to receive an application form. Your application will be reviewed.

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