BackgroundAppropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.MethodsOur first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.ResultsThe update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.ConclusionThe new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.

BackgroundAppropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and colorectal cancers?MethodsA guideline panel was established as part of Cancer Care Ontario's Program in Evidence-based Care, and a systematic review of the published literature was conducted. It yielded three foundational systematic reviews and an existing guidance document. We conducted updates of these reviews and searched the literature published between 2004 and 2010. A draft guideline was written that went through two rounds of review. Revisions were made resulting in a final set of guideline recommendations.ResultsSixty-six new studies reflecting 74 comparisons met eligibility criteria. They were generally of poor to moderate quality. Using these and the foundational documents, the panel developed a draft guideline. The draft report was well received in the two rounds of review with mean quality scores above four (on a five-point scale) for each of the items. For most of the interventions considered, there was insufficient evidence to support or refute their effectiveness. However, client reminders, reduction of structural barriers, and provision of provider assessment and feedback were recommended interventions to increase screening for at least two of three cancer sites studied. The final guidelines also provide advice on how the recommendations can be used and future areas for research.ConclusionUsing established guideline development methodologies and the AGREE II as our methodological frameworks, we developed an implementation guideline to advise on interventions to increase the rate of breast, cervical and colorectal cancer screening. While advancements have been made in these areas of implementation science, more investigations are warranted.

Our findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.

306 Background: The Standards and Guidelines Evidence (SAGE) directory of cancer guidelines is a resource designed to facilitate evidence-based clinical practice, policy formation, and guideline adaptation, and reduce duplication in guideline development. Methods: Developed in 2008, SAGE is a publically available (www.cancerview.ca/sage), searchable database of English language cancer control guidelines and standards released since 2003. Qualifying guidelines in SAGE are rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. These ratings can be used to measure trends in guideline quality. SAGE also documents guideline development status, including current guidelines, guidelines in progress, those in need of an update and guidelines undergoing updates. Results: SAGE contains over 1,900 indexed records from 271 developer organizations spanning 27 countries and international jurisdictions. There is considerable variability in guideline quality both within and across guideline developers, and AGREE II quality domains of applicability and editorial independence are the poorest performing. SAGE has the ability to provide information on guideline topic gaps and overlap, demonstrating that the majority of guidelines target breast, lung, colorectal and prostate cancers, and focus on the treatment stage of the cancer control continuum. This provides a channel of communication amongst organizational groups and facilitates guideline development partnerships. Conclusions: The value-add of SAGE to mitigate inconsistencies in guideline quality is the appraisal component of its records. It is the ultimate goal that SAGE will continue to assist efforts to leverage positive change in the field of practice guidelines, patient care and system performance in cancer control.