https://choosingwiselycanada.org/events/past/

Link to ‘Competing demands and opportunities in primary care’ https://www.cfp.ca/content/63/9/664

Please feel free to enter your questions or comments in the chat box.

TAIBU COMMUNITY HEALTH CENTRE: ACHIEVING INCREASED CANCER SCREENING IN PRIMARY CARE: https://www.allianceon.org/TAIBU-Community-Health-Centre-Achieving-increased-Cancer-Screening-Primary-Care

Primary Care Poverty Tool: https://cep.health/clinical-products/poverty-a-clinical-tool-for-primary-care-providers/?&region=6

Please feel free to enter your questions or comments in the chat box.

The problem is that the public has been educated for years and years about "better safe than sorry". My patients want screening, as they feel safer when doing so.

Going back to the equity issue in screening: how do you suggest to engage primary care practices to improve collection of socio-demographic data

Following provincial screening guidelines & targets, what's the likelihood of overscreening? (Late arriving, sorry if this was answered previously.)

How can we best integrate tenants of cultural sensitivity and cultural humility into concepts regarding the reduction of low-value screening?

Is this a bigger problem in the world of socialized medicine vs private medicine? Would be interested to know about screening rates in places like the US and how they compare (equity, frequency, population specifics, etc.).

Hello- I am an OHT Impact Fellow at the Middlesex London OHT. One of our collaborative quality improvement is increasing cancer screening in our OHT. While we aim to set our goal high (increasing screening), we also have some discussions on what the implication of an increased screening would be. For example, is our system ready to provide intervention/ management for those who are diagnosed? What can we do as an OHT? Any thoughts? Thanks

Having conversations with patients around possible/ potential harms of over screening or unnecessary screening will be of great value to patients who are mostly unaware at this point of potential harms

We must not lose sight of the fact that patients often request screening because of some health event - eg new sexual partner, strange appearance to their stool. We should always explore these to help patients make an educated decision.

Agree Cindy - there is as much an education piece for public (and clinicians) here as any other intervention for reduction in unnecessary use.

SDM demands a lot of statistical knowledge and Communication skills from the physician. Here in Sweden, I simply get an invitation to mammography, no info attached. Next invitation had only information about benefits of screening. I had to opt out actively. And opt our is psychologically more difficult than opt in. Problems med framing: benefits and risks are sometimes framed differently (absolute vs. relative risk reduction).

Agree Jason. A wonderful opportunity

https://www.cfp.ca/content/by/section/Prevention%20in%20Practice

Wondering if you have any thoughts or comments on how teams can help to support those patients that are unattached or not rostered to still receive their cancer screens when appropriate.

Thank you for your thoughts. Screening people is easy, but the next step is always a challenge :)

Sarah, I have pathways for colon cancer screening and normal-risk breast cancer screening for unattached patients that I can share in the cQIP CoP. There is a serious gap for cervical cancer screening in unattached patients. A lot of it used to be completed by Public Health Units' Sexual Health Clinics -- many of those clinics were suspended during the pandemic

Very few FHTs will conduct Pap tests for unattached patients. CHCs have tried to meet the demand for Pap testing among unattached patients, but resources are lacking

Harms to testing for pre-dementia seems quite odd and may create far more harms when we really are in the infancy of accurate diagnosis, treatment options for the more than 120+ types of dementia. This is especially true when there are barbaric treatment of those in LTC with chemical can physical restraints are the only measures uneducated staff utilize in stead of the current beneficial effect on those with dementia in real home environments. This applies to the majority who are imprisoned in LTC facilities for two years now.

guidelines need to be adjusted: lower prevalence of certain cancers (less lung cancer due to less smoking, hopefully less cervical cancer due to HPV-vacc). This reduces the PPC of the results of screening tests.

https://pubmed.ncbi.nlm.nih.gov/31637642/

Definitely feel now is a good time to re-examine how we deploy the health workforce to allow NPs, pharmacists etc to practice to the full extent of their training

I feel that there should be a live-updated web site that unattached patients can access in order to look up opportunities to be screened for cervical cancer in each region

Currently a patient advisor on colorectal screening using FIT vs FOBT to reduce the number of colonoscopies that may be used before FIT test to identify cancers which means the use of sim-lire means for the majority of patients will help physicians focus on those with clear signs of cancer.

https://www.selfmanagementontario.ca/

The Ontario Patient Self-Management program pivoted to on-line groups

McNallys offers scientific/medical talks including Choosing Wisely which are widely available through recorded videos but the one-on-one discussion are very valuable for learning and sharing in open forums

Thank you all very much

Re-upping the Competing interest article https://www.cfp.ca/content/63/9/664

Thank you very much

Excellent presentation- conversations- information! Thank you!

Target Shared Decision making!

Any chance we can get the slides and a recording?

Survey Link (English): https://www.surveymonkey.com/r/KKFB37HSurvey Link (French): https://fr.surveymonkey.com/r/KKQK3XD

Thank you all!

If you have any questions following this presentation, please email us at info@choosingwiselycanada.org.

https://choosingwiselycanada.org/cwc-2022/

Great informative presentation!

Thank you, very informative presentation and discussion today

Thank you!