Discussion
cancer, chronic disease
CANCER, CHRONIC DISEASE
Effective approaches for cancer and chronic disease prevention are required for improved health outcomes and sustainability of the healthcare system [The BETTER WISE trial was an ambitious mixed methods project that aimed to evaluate prevention and screening outcomes 12-months after the intervention including sustainability at 24-months in both the general population and cancer survivors. The project also involved knowledge synthesis of high-level guidelines to develop the resources and the BETTER WISE toolkit used by the PP [The BETTER approach has demonstrated to be an effective approach to CCDPS in multidisciplinary team settings [The limitations of this study include the following: 1) inability to implement the study as planned due to the COVID-19 pandemic, resulting in lack of access to prevention and screening resources and change from in-person to virtual or telephone visits; 2) changes in the ability of the sites to provide ongoing committed PP resources due to a need to re-allocate services and resources to address the COVID-19 pandemic; and 3) patients dropping-out and missing data. Also, because participating PCPs were nested in a site, and some patients within a single clinical site received the intervention while others did not, there remained a risk of contamination. However, we perceived this risk to be low based on our previous experience with the BETTER trial [Suggestions for future studies include assessment of virtual preventive visits. In our study, virtual visits did not mitigate against the downstream system impacts of COVID; however they may be effective in a multidisciplinary approach where COVID-related system closures or redeployments are not in place. In support of this, our pre-COVID per-protocol analysis demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies [