Article Figures & Tables
Tables
- Table 1:
Canadian Task Force on Preventive Health Care guidelines and knowledge translation tools*
Guideline Guideline release date Associated knowledge translation tools Year(s) assessed (via interviews, surveys) Cancer screening guidelines Breast Cancer (13) November 2011 Patient algorithm
Patient FAQ
Risks & Benefits, Age 40–49
Risks & Benefits, Age 50–69
Risk & Benefits, Age 70–742014–2018 Breast Cancer (updated guideline) (14) December 2018 1000 Person Tool
1000 Person Tool, Age 40–49
1000 Person Tool, Age 50–59
1000 Person Tool, Age 60–69
1000 Person Tool, Age 70–74
Patient algorithm
Shared decision-making tool, Age 40–49
Shared decision-making tool, Age 50–59
Shared decision-making tool, Age 60–69
Shared decision-making tool, Age 70–742018–2020 Cervical Cancer (15) January 2013 Clinician algorithm
Clinician FAQ
Patient algorithm
Patient FAQ2014–2020 Prostate Cancer (16) November 2014 1000 Person Tool
Clinician FAQ
Infographic
Patient FAQ2014–2020 Colorectal Cancer (17) March 2016 Clinician recommendation table
Patient FAQ2016 Lung Cancer (18) April 2016 1000 Person Tool
Clinician FAQ2016 Esophageal Adenocarcinoma (19) July 2020 Clinician FAQ
Patient FAQ2020 Lifestyle and prevention guidelines Obesity in Children (20) April 2015 Clinician recommendation table 2015 Obesity in Adults (21) February 2015 Clinician algorithm
Clinician FAQ2015 Tobacco Smoking in Children and Adolescents (22) February 2017 Clinician FAQ 2017 Other guidelines Cognitive Impairment (23) January 2016 Clinician FAQ 2016 Developmental Delay (24) May 2016 Clinician FAQ 2016 Hepatitis C (25) April 2017 Clinician FAQ 2017 Asymptomatic Bacteriuria in Pregnancy (26) July 2018 Clinician FAQ 2018, 2019 Impaired Vision (27) May 2018 Clinician FAQ 2018 Asymptomatic Thyroid Dysfunction (28) November 2019 Clinician FAQ 2019, 2020 ↵* The 2011–2020 guidelines were evaluated between 2014 and 2020.
- Table 2:
Characteristics of participants in evaluations of Canadian Task Force on Preventive Health Care activities
Characteristic No. (%) of participants in survey
n = 1284*No. (%) of participants in interview
n = 183*Gender Male 351 (27.3) 64 (35.0) Female 855 (66.6) 116 (63.3) Nonbinary 17 (1.3) – Prefer not to say 116 (0.9) – Not reported 50 (3.9) 3 (1.6) Age, yr 20–39 731 (56.9) 89 (48.7) 40–59 407 (31.7) 38 (20.7) 60–79 80 (6.2) 7 (3.9) ≥ 80 0.0 0.0 Not reported 65 (5.1) 49 (26.8) Years of practice 1–10 783 (61.0) 121 (66.1) 11–20 182 (14.2) 28 (15.4) 21–30 140 (10.9) 22 (12.0) 31–40 80 (6.2) 10 (5.5) ≥ 40 12 (0.9) 2 (1.1) Not reported 87 (6.8) 0.0 Region Urban 749 (58.3) 93 (50.8) Suburban 191 (14.9) 14 (7.7) Rural 340 (26.5) 37 (20.3) Not reported 59 (4.2) 49 (26.8) Clinic type† Hospital-based 239 (18.6) 25 (13.7) Community-based 758 (59.0) 98 (53.6) Multidisciplinary clinic 347 (27.0) 60 (32.8) Not reported 80 (6.2) 49 (26.8) Number of clinicians† Single-practitioner clinic 72 (5.6) 4 (2.2) Multipractitioner clinic (physician group clinic or family health team) 582 (45.3) 86 (47.1) Not reported 630 (49.1) 49 (26.8) Province or territory† Ontario 606 (47.2) 83 (45.4) British Columbia 119 (9.3) 20 (11.0) Manitoba 86 (6.7) 10 (5.5) Saskatchewan 39 (3.0) 13 (7.1) Alberta 110 (8.6) 14 (7.7) Quebec 92 (7.2) 13 (7.1) Northwest Territories 8 (0.6) 13 (7.1) Nova Scotia 60 (4.7) 2 (1.1) New Brunswick 41 (3.2) 6 (3.3) Prince Edward Island 21 (1.6) 9 (5.0) Yukon 1 (0.1) 1 (0.5) Newfoundland and Labrador 30 (2.3) 2 (1.1) Not reported 73 (5.7) 2 (1.1) ↵* Surveys — 2020: n = 295; 2019: n = 263; 2018: n = 244; 2017: n = 198; 2016: n = 102; 2015: n = 127; 2014: n = 96. Interviews — 2020: n = 23; 2019: n = 23; 2018: n = 30; 2017: n = 29; 2016: n = 20; 2015: n = 26; 2014: n = 28.
↵† Number of participants within a category may not add up to the total number of participants because some primary care providers gave demographic characteristics for multiple clinics in which they work and some did not select certain options.
- Table 3:
Survey participants’ awareness of Canadian Task Force on Preventive Health Care guidelines*
Guideline Evaluation year 2014 2015 2016 2017 2018 2019 2020 Cancer screening guidelines (% surveyed who were aware of guideline) Breast cancer 85 89 91 90 75 – – Breast cancer — update NR NR NR NR 47 84 90 Cervical cancer 88 89 93 89 82 83 87 Prostate cancer 77 81 83 88 81 84 82 Lung cancer NR NR 49 – – – – Colorectal cancer NR NR 84 – – – – Esophageal adenocarcinoma NR NR NR NR NR NR 27 Mean awareness score across cancer screening guidelines, % 79.9 Lifestyle and prevention guidelines (% surveyed who were aware of guideline) Obesity in children NR 18 – – – – – Obesity in adults NR 22 – – – – – Tobacco smoking in children and adolescents NR NR NR 16 – – – Mean awareness score across lifestyle prevention guidelines, % 18.6 Other guidelines (% surveyed who were aware of guideline) Cognitive impairment NR NR 24 – – – – Developmental delay NR NR 24 – – – – Hepatitis C NR NR NR 38 Asymptomatic bacteriuria in pregnancy NR NR NR NR 33 48 – Asymptomatic thyroid dysfunction NR NR NR NR NR 62 44 Impaired vision NR NR NR NR 17 – – Mean awareness score across other task force guidelines, % 36.2 Note: NR = guideline not released, task force = Canadian Task Force on Preventive Health Care.
↵* “–” indicates guideline was not evaluated that year.
- Table 4:
Barriers and facilitators to implementation of Canadian Task Force on Preventive Health Care guideline
Perceived barrier Year barrier reported 2014 2015 2016 2017 2018 2019 2020 Misalignment of guideline with patient expectations and preferences X X X X X X X Misalignment of task force guideline with other provincial or specialty guidelines or unsure which guideline to follow or use X X X X X X Perceptions of evidence strength or lack of consensus among health care professionals about recommendation X X X X X X Time constraints to implement guideline or recommendation X X X X X Complexity of guideline or tool or lack of clarity on how to implement recommendation X X X X Lack of awareness of guideline or KT tools X X X X Misalignment of task force recommendation and provincial or territorial health care coverage or fee-for-service billing scheme X X X X Guideline out of date or not recently updated X Concern about overlooking a diagnosis X X Unintended outcomes of reduced screening X Patient understanding of the value of screening (perceptions often shaped by the media, social media) X X X X Lack of resources to facilitate screening (e.g., limited in Northern or remote communities) X X Perceived facilitator Year facilitator reported 2014 2015 2016 2017 2018 2019 2020 Electronic prompts, EMR reminders or mobile apps for patients X X X X X X Availability or awareness of updated guidelines or tools X X X X X Public or patient awareness of guideline recommendations X X X Consensus on recommendation among health care practitioners or colleagues X X X Financial incentive for screening X X Ease of guideline use X X X X Strength of guideline evidence X X X X Note: EMR = electronic medical record, KT = knowledge translation, task force = Canadian Task Force on Preventive Health Care.
- Table 5:
Sample illustrative quotes for barriers and facilitators to Canadian Task Force on Preventive Health Care Guideline implementation
Perceived barrier or facilitator Illustrative quote Perceived barrier Misalignment of guideline with patient expectations or preferences “So, when I have a discussion — even though it’s not a brand-new guideline for cervical cancer, they may have had a physician who’s just told them that they need an annual Pap test. So, when I try to re-educate the patient, I often find that … ‘Oh, there’s new evidence now, newer guidelines suggest that you only need to do it every 3 years as long as your Pap test results are normal,’ but patients are often [not] open to being re-educated. They often have their own perception about what is needed and can be adamant about getting that done — even if they don’t have a lot of deeper understanding about the implications of doing that testing.” — P004 (2020) Misalignment of task force guideline with other provincial or specialty guidelines “What would make it easier … if it corresponds with provincial recommendations, it will be easier to implement.” — P010 (2020) Perceptions of evidence strength or lack of consensus among health care professionals about recommendation “I know that there is a recommendation … it is weak. So I kind of defer to — in fairness, see what other physicians have been practising and their thoughts on it and see if that has played a role.” — P020 (2020) Time constraints to implement guideline or recommendation “When you only have such an amount of time with each of your patients, you don’t have the luxury of time to go into explaining everything as far as preventive medicine goes because in that same 15- to 20-minute appointment, they also need refills, a blood pressure check, their oxygen checked or their big toe looked at. You’re constantly trying to multitask while you’re talking to them and examining them about ‘are you up to date to on your colon screening, are you up to date on your breast cancer screening, your cervical cancer screening.’ Then, usually they’re never up to date on everything, so then you have to educate them on … ‘okay, will you book an appointment with Nurse XXX [name at 22:55], she’ll do your Pap for you.’ And you’ll have to explain to them how to book that and stuff like that.” — P007 (2020)
“I figure, they’re here, they’re undressed. It’ll take me 30 seconds. Why not just examine their breast? I’m using breast as an example because that’s the one thing that really threw us [recommendation was different from previous common practice]. So, yeah. It’s difficult and, frankly, the path of least resistance is to just do it. I can’t explain to them in 30 seconds why I shouldn’t do it” — P023 (2019)
“So [shared decision-making conversations] could be tricky because I think, you know, in a primary care setting, unfortunately we’re constantly seeing patients for acute issues, and … so the vast majority of these visits are focused on addressing their concerns acutely, and we try to squeeze in health prevention where there is time. So, it doesn’t usually leave a lot of time to focus on health prevention, to be honest.” — P011 (2019)Complexity of guideline or tool or lack of clarity on how to implement recommendation “Another aspect of it is the complexity of the guidelines, so if … I’d probably spend more time talking to my patients and have longer appointment times than the average family doctor. I really value the opportunity to explain things to my patients, so that we essentially agreed on plans for investigating or treatment. So, trying to explain the pros and cons of doing cancer screening in a 15-minute appointment when you’re also trying to cover all of their routine screening and maybe addressing a couple other complaints that the patient brought in to talk about that day, makes it difficult. So, the simpler guideline is, the easier it is to implement as well.” — P004 Lack of awareness of guideline or KT tools “I think the biggest barrier is just ... are people aware of it, right?” — P001 (2020)
“I think just awareness, right? Sometimes you forget. You get busy in your practice.” — P001 (2019)Guideline out of date or not recently updated “I just hope that the task force continues to use good-quality, up-to-date evidence for their guidelines.” — P005 (2017) Concern about overlooking a diagnosis “I think if you had a patient who had a very bad outcome when you followed a recommendation, that would make it hard. If, for example, I had a patient who I didn’t screen for prostate cancer who then had it, that would probably make me a little more anxious and I would remember that patient when I saw similar patients and I’d have an instinct to screen them more … if I felt that by changing my screening habits or by screening the way I was, I was missing people or I’d done someone harm by acting that way, I might change my practice.” — P020 (2018) Patient understanding of the value of screening (perceptions often shaped by the media, social media) “I think patients are just inundated with information to have their thyroid checked. So, sometimes I just give in.” — P005 (2020)
“Well, some patients are pretty persistent. They want their thyroid checked when they are having trouble losing weight, or even though we just had it done 6 months ago, it was normal. So, sometimes doing the education with them … sometimes, regrettably, we might order a test just to appease a patient.” — P001 (2019)
“Particularly with the PSA test, I have to say for the Canadian task force, [news provider; 8:08] and all the news media outlets are the worst there, because … I’ve been at the gym and I watch these urologists come on and say ‘every man should have a PSA’ and I sit there and I think ‘are you kidding? I’ve just finished explaining to all these men why they shouldn’t have a PSA and then the head of urology in the [association name; 8:28] says every man should get a PSA every single year. Don’t listen to anybody else.’ So, what are they doing? They’re listening to the news and then they’re coming in and insisting that they get a PSA every year.” — P021 (2018)Lack of resources to facilitate screening (e.g., limited in Northern or remote communities) “We have to take ... you know, we limited resources. So travel’s important. We have isolated communities. We have 11 official languages. We have, you know, technology sometimes can be a challenge and ... ultimately, does it benefit our patients?” — P019 (2018) Perceived facilitators Electronic prompts, EMR reminders or mobile apps for patients “When we actually do a complete physical with the patient and we have our template, at the end they have a screening part, you know just as a reminder to us, you know, screening for colon cancer, to make sure that this is up to date or mammogram, but I’ve never actually seen the lung cancer screening or the AAA screening on those templates … So, I find that even having those on those templates are kind of a reminder to be like, ‘Oh, does the patient fit this screening?’ and if so, we should probably do it. So, that’s probably one way that probably I could use them more and maybe I could even talk to my colleagues about including that on the templates, just so we remember to do that.” — P009 (2019) Public or patient awareness of guideline recommendations “Patients being aware of the guidelines. It’s really hard to have that conversation and convince them to not do those things, and I try to have those conversations, but sometimes it doesn’t go well, or let’s say the annual physical. They’re like ‘My doctor has always been doing this. Why aren’t you [doing] this,’ and then they think I’m a worse doctor for not doing it, and I try to talk to them and say, ‘hey, listen.’ It takes me longer to have this conversation than for me to just do those manoeuvres, or order the tests and be done with it, and then, they’re like ‘Maybe, but my doctor always did it.’ I think having that public perception and shifting that.” — P022 (2019) Consensus on recommendation among health care practitioners or colleagues “The more consensus there is, the more trust we have. So if 2 societies agree on a guideline, then I’m going to be implicitly more inclined to do that … like if you had ‘we recommend this and this and this’ and then you have ‘this also agrees with X and X society,’ that automatically ties in my trust in these societies, and the more consensus I see, the more trust I have with the guidelines.” — P016 (2018) Financial incentive for screening “I would say, to an extent, preventive care bonuses. Like … the ones that are for cervical cancer and for breast cancer and the FOBT; it’s a little bit easier to implement in the sense that you’re kind of keeping that in your mind and so there is some of that incentive to actually be focusing particularly on those at a re-visit.” — P004 (2019) Ease of guideline use “Also — and what’s fascinating is I found I trust guidelines more if the evidence is presented in and clear and understandable way.” — P007 (2018) Strength of guideline evidence “I personally think that the fact that it always comes with the level of evidence … what level of evidence it comes with. I find that makes it easier to implement because if it’s weak evidence, then I use more discretion, and if it’s strong evidence — if it’s a strong recommendation, I kind of use it more as something that I should really commit to doing. So, I think that the weakness or strength of the evidence helps me to implement it because it helps me with my decision-making process, whether or not I accept that guideline.” — P002 (2020) Note: EMR = electronic medical record, FOBT = fecal oculate blood test, KT = knowledge translation, Pap = Papanicolaou, PSA = prostate-specific antigen, task force = Canadian Task Force on Preventive Health Care.
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