Draft Implementation Plan for the Renewed Canadian Task Force on Preventive Health Care

• Open call for topics: Pan-Canadian Public Health Network (PHN), provincial screening programs, and quality councils will participate
• PHN will participate in prioritization of short-listed topics

Note: details of the Topic Selection Process, including criteria for topic selection and prioritization, will be available in the recommendation 6 implementation plan

PTs will be consulted on:

• Relevance of the key questions and Populations, Interventions, Comparisons, Outcomes (PICOs) to their population, healthcare system, and end-users
• Equity considerations using the PROGRESS-PLUS framework
• Is topic relevant to a PT program or service, or to individual primary care providers
• Barriers and enablers of a recommendation on the topic
• Feasibility, acceptability, costs and equity considerations of a recommendation using the GRADE FACE survey
• Types of knowledge translation (KT) tools that would be relevant
• Suggestions of guidelines to adapt or adopt.

Feedback will be considered by the Task Force to:

• Adjust the systematic review protocol
• Inform the guideline's evidence to decision framework (EtD) and implementation considerations in the guideline
• Inform the development of KT tools
• Inform the guideline dissemination plan

PTs will be consulted on:

• Whether the feasibility and implementation considerations are missing (see Step 2)
• Draft guideline dissemination plan
• Clarity of the recommendation(s)
• Potential indicators to assess the guideline's impact and implementation

PTs will be consulted on:

• KT tools options
• Does the design ensure accessibility, equity, and inclusiveness
• Inform whether any of the tools could be or need to be integrated into existing systems
• Other questions, as-needed basis

PTs consulted on:

• Topic-dependent strategies and indicators
• Additional questions about feasibility, barriers and enablers of recommendations uptake after recommendations are issued

This evaluation will occur annually for guidelines released in the past 1 to 5 years. Specific guidelines included in the annual evaluation will be selected by the Secretariat and the Task Force Chair.

• Topic intake form to include a question on the health equity impact of the topic.
  • Question: Is there the potential for a guideline on this topic to improve health equity for equity-denied populations? For example, are there disparities in the burden of disease, access to health services, or the health outcomes resulting from those health services across different population groups?
• Consideration of health equity (using above question) in the initial assessment of topic impact. The initial assessment of topic impact is used to inform development of topic short list.
• Consideration of health equity (using above question and the PROGRESS-PLUS framework) in topic briefs for short listed topics. The topic briefs are used to inform selection of topics to initiate in the Delphi process.

• Open call for topics email to be sent to Pan-Canadian Public Health Network (PHN), provincial screening programs, and quality councils.
• Topic short list and accompanying briefs to be shared with PHN for feedback to inform prioritization of short-listed topics.

• Members of the public can submit a topic using a form provided on the External Advisory Body (EAB) page on Canada.ca.
• Open call for topics process for every topic selection cycle. Email to be sent to key interest holders including but not limited to organizations representing equity-denied communities, Indigenous partners, patient advisory networks, primary care professionals, and medical specialists.
• Public advisory input will be sought from a public advisory network similar to Task Force Public Advisors Network (TF-PAN). The network should be comprised of diverse members of the public, including individuals from equity-denied communities.
• Input on the short-listed topics will be sought through a prioritization exercise.

• Consideration in the topic brief (used to inform selection of topics to initiate in the Delphi process):
  • Does the topic complement the suite of Task Force guidelines?
    • E.g., Lack of or limited Task Force guidance (e.g., mental health)
    • E.g., Companion topic to a completed or in-progress Task Force guideline (e.g., Vitamin D and Fragility Fractures)

• Topics to be selected every two years allowing for an annual workplan over two-year horizon. Workplan will be reviewed yearly to reassess priorities and timelines for in-progress guidelines. Workplan may be adjusted to reflect the reassessment.
  • A two-year horizon was selected to avoid placing an undue burden on interest holders (provinces, public advisory network) by limiting the volume of topic briefs under concurrent review.

• To ensure a balanced view of patient perspectives.
• Selected candidates should represent diverse perspectives, different lived experience and should not duplicate viewpoints, ensuring a broad range of insights.

To select those who can provide different perspectives, ideally representing the views of:

• Eligible or near-eligible for health service interventions, e.g., screening (either have been or have not been), but do not have the condition.
• Lived experience of the condition, i.e., diagnosed with the condition (either screen-detected or not) or family members/friends/unpaid caregivers of people with the condition.
• Experienced negative outcomes associated with the intervention.

• Clearly defining roles provides transparency

• To be identified as non-Task Force members of the working group (WG).
• All WG members, including patient partners, will vote or come to consensus on all substantive decisions at the WG level. This includes:
  • Determining the key questions of the guideline
  • Rating outcomes
  • Setting minimally important difference thresholds
  • Making judgements on GRADE Evidence-to-Decision (EtD) framework domains:
    • magnitude of desirable effects (benefits)
    • magnitude of undesirable effects (harms)
    • certainty of the evidence
    • patient values and preferences
    • the overall balance of effects
  • Contextual factors such as:
    • Feasibility
    • Equity
    • Acceptability
    • Resource use (as appropriate)
  • Draft recommendations
    • Strength and direction of guideline recommendations
    • Note: The Task Force approves the draft and final recommendations.

• A diversified strategy can help reach communities that experience greater equity barriers

• Expand recruitment strategy
  • Posting via social media
  • Posting open call on website for individuals relevant to the guideline topic to participate as patient partners
  • Posting an open call on the website for organizations relevant to the guideline topic to be consulted during interest holder engagement
    • Organizations may choose to disseminate recruitment information received to their harder-to-reach communities
• Open calls start as soon as a topic is selected.
• Survey questionnaires and interview to begin before guideline initiation so patients are onboarded by WG kickoff meeting.

• Establishing a standard across all Task Force guidelines ensure consistency

• Recruit at least two patient partners per guideline WG.

• Additional training can provide equal footing for patient partners allowing for more meaningful engagement. It also provides opportunities for those from equity seeking communities to participate and provide input

• Continue to provide overview of the guideline development process and related methods.
• Direct to appropriate or relevant online resources as needed for more in-depth training.
• Emphasize that each individual is expected to represent the perspectives of the population they represent, rather than personal preferences.

• The WG chair should effectively manage group dynamics to ensure that all opinions are fairly considered

• Task Force members will receive equity training to ensure that the views of patient partners are given fair consideration (e.g., training on unconscious bias, importance of incorporating the patient perspectives into guideline development).

• Identifying specific required skills (e.g., communication) and asset skills (e.g., experience with guideline development) can increase meaningful engagement

• Continue with interviews for prospective candidates.
• Survey/interview questions to be drafted at later time.

• While emotional support for patient partners is important, this may fall outside the capability of PHAC.

• Create and offer opportunities for new members to meet an experienced (e.g., participated in previous WG) patient or public member 'buddy' to allow them to discuss their role and any concerns.

• Having a Public Advisory Panel in a similar manner as Task Force Public Advisors Network (TF-PAN).

TF-PAN

• Having a Public Advisory Panel in a similar manner as TF-PAN.
• Standardize engaging Public Advisory Panel to review key messages and clarity of recommendation of the guideline as a minimum across all guideline groups.

Interest holder consultations

• Continue with current practice.
• Consider expanding recruitment by posting open call on website for specific guideline seeking organizations interested in being consulted during interest holder engagement.
• Ensure groups representing underrepresented and equity-deserving populations are included in those invited to participate.

• Having a Public Advisory Panel in a similar manner as TF-PAN.
• Standardize engaging Public Advisory Panel to do usability testing of KT tools (e.g., wording, clarity) as a minimum across all guideline groups.
• This can be done at the same time as draft guideline review.

Minimum required expertise, knowledge or experience in:

• disease prevention and health promotion of children, youth, and/or adults
• guideline production and dissemination
• systematic reviews, their methodology and their application to clinical decision-making and/or policy

Lived/living experience, a background in primary care or preventive medicine, and expertise in health disparities, health equity, ethics (public health ethics, research ethics, bioethics), or health economics will be considered an asset.

• Members of the Task Force are recruited through ​an open nomination process.
• A Selection Committee composed of the Task Force Chair, one PHAC representative, the Director General, Center for Health Promotion and Chronic Disease Prevention, PHAC, and one delegate each from the College of Family Physicians of Canada (CFPC), the Royal College of Physicians and Surgeons of Canada, the Canadian Nurses Association, and the Nurse Practitioner Association of Canada reviews the qualifications of each application and makes recommendations.
• PHAC appoints new members who serve at the discretion of the Vice President, Health Promotion and Chronic Disease Prevention Branch, PHAC.

• Subject matter experts (SMEs) to be identified as non-Task Force members of the working group (WG).
• All WG members, including SMEs, will vote or come to consensus on all substantive decisions at the WG level. This includes:
  • Determining the key questions of the guideline
  • Rating outcomes
  • Setting minimally important difference thresholds
  • Making judgements on GRADE Evidence-to-Decision (EtD) framework domains:
    • magnitude of desirable effects (benefits)
    • magnitude of undesirable effects (harms)
    • certainty of the evidence
    • patient values and preferences
    • the overall balance of effects
  • Contextual factors such as:
    • Feasibility
    • Equity
    • Acceptability
    • Resource use (as appropriate)
  • Draft recommendations
    • Strength and direction of guideline recommendations
    • Note: The Task Force approves the draft and final recommendations.

• Expand recruitment strategy
  • Posting via social media
  • Posting open call online for experts in key areas
  • Leveraging the PHAC expert roster
• Key area identification and open call to start immediately following topic selection.
• Surveys and interviews to begin before guideline initiation so SMEs can be onboarded prior to kickoff meeting.

The Task Force has an existing mechanism to include SMEs with a limited number of disclosed and managed conflicts that clearly distinguishes between financial, intellectual, and non-financial conflicts of interests (COI), and for transparently posting this information publicly.

• Prioritize SME onboarding prior to kickoff meeting.
• SMEs attend WG meetings as full WG members
• Vote or come to consensus on all substantive decisions at the WG level. This includes:
  • Determining the key questions of the guideline
  • Rating outcomes
  • Setting minimally important difference thresholds
  • Making judgements on GRADE Evidence-to-Decision (EtD) framework domains:
    • magnitude of desirable effects (benefits)
    • magnitude of undesirable effects (harms)
    • certainty of the evidence
    • patient values and preferences
    • the overall balance of effects
  • Contextual factors such as:
    • Feasibility
    • Equity
    • Acceptability
    • Resource use (as appropriate)
  • Draft recommendations
    • Strength and direction of guideline recommendations
    • Note: The Task Force approves the draft and final recommendations.
• Serve as full participants on WG discussions.
• Review key documents for accuracy.

• As part of the WG, SMEs will vote or come to consensus on all substantive decisions at the WG level. This includes:
  • Determining the key questions of the guideline
  • Rating outcomes
  • Setting minimally important difference thresholds
  • Making judgements on GRADE Evidence-to-Decision (EtD) framework domains:
    • magnitude of desirable effects (benefits)
    • magnitude of undesirable effects (harms)
    • certainty of the evidence
    • patient values and preferences
    • the overall balance of effects
  • Contextual factors such as:
    • Feasibility
    • Equity
    • Acceptability
    • Resource use (as appropriate)
  • Draft recommendations
    • Strength and direction of guideline recommendations
    • Note: The Task Force approves the draft and final recommendations.

• Summary on protocol: overall Task Force judgement on each outcome rating with a brief description of input received from SMEs.
• Summary on EtD framework: overall Task Force judgement on each domain with a brief description on input received from SMEs.

• Continue to list SMEs under 'acknowledgements'.
• SMEs who meet the International Committee of Medical Journal Editors (ICMJE) criteria to be offered guideline authorship (pending decision to name individual authors versus publishing under the Task Force, with no individuals named).

• Broaden eligibility to include a mix of academic and practitioner SMEs.

• Continue to provide overview of Task Force guideline development process and related methods.
• Direct to appropriate or relevant online resources as needed for more in-depth training (e.g., INGUIDE – certified guideline panel member course).

• WG members will receive equity training to ensure that the views of all members are given fair consideration. This may include, for example, training on unconscious bias and on the importance of incorporating all perspectives (including the SME and patient perspective) into guideline development.

• No change needed from current COI policy. Definitions will remain clearly outlined in the COI policy.

Members on a guideline working group (WG), including Task Force External Advisory Body (EAB) members, SMEs, and patient/public partners:

• All WG members, including SMEs and patient/public partners, on WGs have full voting rights on the WG (e.g., outcomes, thresholds, magnitude of benefits and harms, strength and direction of recommendations)
• Efforts will be made to recruit WG members without COI. At most, only a small minority (i.e., 1 to 3) of the WG members may have limited non-financial COI (i.e., not so serious as to impact the credibility of input).
• WG members with non-financial COI may participate in WG voting as long as the COI are not so serious as to impact the credibility of input.
• Those with financial or more serious non-financial COI do not participate in the WG or other aspects of decision-making (i.e., they recuse themselves).

• Require minimal intellectual or non-financial interests for Task Force members

• PHAC will require disclosures of interests before joining and may not appoint a prospective members to the Task Force if there are COI or other interests that could impair the integrity of the Task Force, including any significant financial interests.

Note: It may not be possible to say a priori that Task Force members will never have financial interests due to the broad nature of the topics covered by the Task Force.

Task Force EAB members

• Efforts will be made to recruit Task Force members without COI. At most, only a small minority (i.e., 1 to 3) of Task Force members may have limited non-financial COI (i.e., not so serious as to impact the credibility of input) related to a given guideline topic.
• Task Force members with non-financial COI may participate in WG voting as long as the COI are not so serious as to impact the credibility of input.
• Task Force members with non-financial COI related to the topic do not participate in the approval of draft and final recommendations.
• Task Force members with financial or more serious non-financial COI do not participate in the WG or other aspects of decision-making (i.e., they recuse themselves).

• Public Terms of Reference document to point to COI policy which will also be publicly posted.

• Member disclosures to be made public on PHAC website as per EAB Policy.
• Similar to current approach, for each guideline, include relevant interests disclosed and any COIs identified, reasons for including individuals with COIs in the guideline process, and how COIs were managed in published guideline documents (recognizing format of published guidelines and where they will be published is to be determined). This includes for SMEs and patients/public members that are engaged on WGs.

• Full involvement

• No change needed from current COI policy (PDF) for Task Force EAB members.

SMEs and Patient/public partners

• SME and patient partners on WGs participate in the WG's voting (e.g., outcomes, thresholds, magnitude of benefits and harms, strength and direction of recommendations)

• Limited involvement

Members of the guideline WG including, Task Force EAB members, SMEs, and patient/public partners:

• Efforts will be made to recruit WG members without non-financial COI. At most, only a small minority (i.e., 1 to 3) of WG members may have limited non-financial COI (i.e., not so serious as to impact the credibility of input).
• WG members with non-financial COI may participate in WG voting if the non-financial COI are not so serious as to impact the credibility of input.

Task Force EAB members

• Efforts will be made to recruit Task Force members without non-financial COI. At most, only a small minority (i.e., 1 to 3) of the Task Force members may have limited non-financial COI (i.e., not so serious as to impact the credibility of input) related to a given guideline topic.
• Task Force members with non-financial COI may participate in WG voting as long as the COI are not so serious as to impact the credibility of input.
• Task Force members with non-financial COI related to the topic may take part in discussions of the full Task Force on a given topic but they do not participate in the approval of draft and final recommendations.

• No involvement (complete exclusion)

• No change needed from current COI policy (PDF) for Task Force EAB members.

SMEs and Patient/public partners

• Prospective individuals with financial COI and more serious non-financial COI are not eligible to participate as SMEs or patient partners.

An External Advisory Body to PHAC.

No more than 15 members, including a Chair and Vice Chair