Colorectal screening evidence & colonoscopy screening guidelines

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  • Welcome!Colorectal screening evidence & Colonoscopy screening guidelinesYou will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.


  • Poll Questions: ConsentParticipation in the webinar poll questions is voluntaryNames are not recorded and persons will not be identified in any wayParticipation in the anonymous polling questions is accepted as an indication of your consent to participate

    Benefits:Results inform improvement of the current and future webinarsEnable engagement; stimulate discussion. This session is intended for professional development. Some data may be used for program evaluation and research purposes (e.g., exploring opinion change)Results may also be used to inform the production of systematic reviews and overviews

    Risks: None beyond day-to-day living

  • After TodayThe PowerPoint presentation and audio recording will be made available

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  • Whats the evidence for the guidelines? Review evidence:Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: ctf phc-guidelines/2015-colorectal-cancer/systematic-review

    Screening guidelines:Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.

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  • The Health Evidence TeamMaureen Dobbins Scientific DirectorHeather HussonManagerSusannah WatsonProject CoordinatorStudents:Emily Belita(PhD candidate)

    Jennifer YostAssistant ProfessorOlivia MarquezResearch CoordinatorEmily SullyResearch AssistantLiz KamlerResearch AssistantZhi (Vivian) ChenResearch AssistantResearch Assistants:Marco CheungLina SherazyClaire HowarthRawan Farran

    **Need to update with new logo**heres a look at the teammany involved in the work to keep HE current and maintained


  • What is

    Health Evidence launched in 2005comprehensive registry of reviews evaluating the effectiveness of public health and health promotion interventionsprovide over 90,000 visitors per year access to over 4,600 quality-rated systematic reviewslinks to full text, plain language summaries, and podcasts (where available) One of main goals of Health Evidence, in addition to making evidence re: effectiveness of PH interventions more accessible, is to make it easier for professionals to use evidence in decision making



  • Why use you timeRelevant & current evidence Transparent processSupports for EIDM available Easy to use


  • A Model for Evidence-Informed Decision MakingNational Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). []

    Model for Evidence-Informed decision making in PH consists of 5 components visible in this diagramTraditionally public health practitioners and decision makers do consider evidence about community health issues and local context, existing resources, and community and political climate in making decisions about programs and policies however, it has become apparent that a considering evidence about research may be more challengingAs such the Health Evidence webinar series is designed to identify research evidence relevant to public health decisions


  • Stages in the process of Evidence-Informed Public HealthNational Collaborating Centre for Methods and Tools. Evidence-Informed Public Health. []

    The EIPH wheel illustrates the steps involved in evidence-informed practiceThe wheel is a guide for practitioners and decision makers to determine how to address a particular issue by systematically incorporating research evidence in the decision making processThere are 7 steps in the EIPH process that starts with:Clearly defining the problem;Searching the research literature;Appraising the evidence you find;Synthesizing or summarizing the research on your issue;Adapting and interpreting the findings to your local context;Implementing the evidence or appropriate intervention; andEvaluating your implementation efforts.We will hear today about how (presenter) has worked through the first 4 steps, in order to help with the decision makers with the remainder of the 7 steps


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  • Searchable Questions Think PICOSPopulation (situation)

    Intervention (exposure)

    Comparison (other group)




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  • Maria BacchusAssociate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care

    Donna Fitzpatrick-Lewis

    MSW, Senior Research Coordinator at the Effective Public Health Practice Project (EPHPP)


  • Putting Preventioninto PracticeCanadian Task Force on Preventive Health CareGroupe dtude canadien sur les soins de sant prventifs

    Recommendations on Screening for Colorectal Cancer 2016

    Canadian Task Force on Preventive Health Care (CTFPHC)

    Maria begins presentation *

  • CTFPHC Working Group Members**non-voting member


  • Overview of PresentationBackground on Colorectal Cancer

    Methods of the CTFPHC

    Recommendations and Key Findings

    Implement our Recommendations


    Questions and Answers



  • Background Canadian perspectiveColorectal cancer (CRC) is the second most common cause of cancer mortality in men and the third most common in women with a current lifetime probability of dying from this disease of 3.5% and 3.1% respectively

    The incidence and mortality of CRC are low until middle age, and rise rapidly thereafter

    It is estimated that 25,000 Canadians were diagnosed with CRC in 2015 and 9,300 died from the disease

    Most CRCs appear to arise from colonic polyps that develop slowly, some of which transform to cancers

    CRC screening programs aim to reduce deaths by detecting and removing polyps and/or early stage CRCs



  • Background - Guideline ObjectivesThe purpose of this guideline is to present recommendations for screening for CRC in asymptomatic adults aged 50 and older who are not at high risk for CRC and to update previous CTFPHC recommendations (2001)

    This guideline provides guidance for primary care practitioners on different screening tests, screening intervals and recommended ages to start and stop screening

    These guidelines do not apply to those with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, history of CRC in one or more first degree relatives, or adults with hereditary syndromes predisposing to CRC such as familial adenomatous polyposis or Lynch Syndrome*


  • Screening Tests for Colorectal Cancer Fecal occult blood testing (FOBT) Tests include guaiac fecal occult blood testing (gFOBT) and fecal immunochemical testing (FIT)The patient provides a stool sample that will be tested for blood that cannot be seen with the naked eye

    Endoscopies Tests include flexible sigmoidoscopy and colonoscopies A long flexible tube with a light and camera attached is inserted into the anus, rectum, and lower colon of the patient to look for polyps Before this procedure, patients will need to cleanse their bowels with enemas or laxatives



  • Methods of the CTFPHCIndependent panel of:Clinicians and methodologists Expertise in prevention, primary care, literature synthesis, and critical appraisalApplication of evidence to practice and policy

    Colorectal Cancer Working Group7 Task Force membersEstablish research questions and analytical framework



  • Methods of the CTFPHCMcMaster Evidence Review and Synthesis Centre (MERSC) Undertook a systematic review of the literature based on the analytical frameworkPrepared a systematic review of the evidence with GRADE tables Participated in working group and task force meetings Obtained expert opinions


    Donna begins presentation *

  • CTFPHC Review ProcessInternal review proces