Physician-Linked Correspondence Frequently Asked Questions

Yes, you can make a request to opt out of physician-linked correspondence for 1 or more of the screening programs at any time. You can call us at 1-866-662-9233 from Monday to Friday (8:30 a.m. to 5 p.m.) or email screenforlife@cancercare.on.ca.

If you opt out, your eligible patients will continue to receive correspondence for the program(s) that you have opted out of; however, the letters will not be sent on your behalf (i.e., will not include your name).

Download Opt-Out Form

Even if you do not enrol, your eligible patients will still receive correspondence; however, it will not be sent on your behalf (i.e., the letters will be generic).

To stop receiving invitations to participate, you can call 1-866-662-9233 from Monday to Friday (8:30 a.m. to 5 p.m.) or email screenforlife@cancercare.on.ca. If you email us, please provide your full name and College of Physicians and Surgeons of Ontario number.

There is no deadline. You can enrol in physician-linked correspondence at any time.

Once you have completed and submitted the consent form, you are considered enrolled in physician-linked correspondence. You can assume that your patients will be sent letters if they meet the requirements outlined in Which of my patients will be sent physician-linked correspondence? You can also call 1-866-662-9233 from Monday to Friday (8:30 a.m. to 5 p.m.) to confirm your enrolment. To maintain your confidentiality, we have an authentication process to confirm your identity before any information is provided.

A patient enrolment model (PEM) physician is determined by affiliation type B28 from the Corporate Provider Database indicating that they are a full-time member of their group. PEM physicians are typically members of Comprehensive Care Models, Family Health Groups, Family Health Networks and Family Health Organizations.

By consenting to participate in all 3 cancer screening programs, you will not need to re-enrol when physician-linked correspondence expands to the Ontario Breast Screening Program and Ontario Cervical Screening Program, which means that your patients will receive physician-linked letters for those programs in the future. You can opt out of 1 or more programs at any time.

No. ColonCancerCheck, the Ontario Breast Screening Program and the Ontario Cervical Cancer Screening Program are population-based, organized cancer screening programs and are set up so that all eligible Ontarians receive program correspondence. At this time, based on the results of a pilot study (explained in the next paragraph), we do not have a method in place allowing physicians to exclude patients from receiving correspondence or specify which correspondence they receive. This is something we will consider in future planning.

Physicians participating in a pilot study were asked to validate lists of their eligible patients to ensure that it was clinically appropriate to send them a mailed invitation for colorectal cancer screening. The electronic lists were 93% accurate for clinical information. In subsequent focus groups, validation of patient lists was explained and reviewed with participating physicians; as a part of this process, physicians were informed about the accuracy rate determined in the pilot. The pilot assessment confirmed that most participating physicians would opt not to validate their patient lists in future mailed invitation campaigns because they felt that the high accuracy rate was a sufficient tradeoff for the considerable work involved in reviewing the lists.[1]Reference 1 Close reference Tinmouth J, Ritvo P, McGregor E, Green J. September 2010. Perceptions of Patients and Physician Participants in Ontario’s ColonCancerCheck Primary Care Invitation Pilot: A Report Based on Findings from Family Physician Focus Groups Produced for Cancer Care Ontario and the ColonCancerCheck Program. OpenClose

Cancer Care Ontario sends cancer screening letters in accordance with our policies; however, we do not always have access to the same data that you do. The physician-linked letters include wording to encourage your patients to contact you if they feel they have received a letter in error (see the bottom of the first page of the letters). If you feel that any of your patients are being inappropriately invited to participate in 1 or more of our programs, you can tell them how to withdraw from correspondence for the programs of their choice. To do this, your patient would need to download and complete the Cancer Screening Program: Participant Information Form. Detailed instructions and contact information are provided on the form. For assistance, your patients can call 1-866-662-9233, Monday to Friday from 8:30 a.m. to 5 p.m.

No. Patients you see who are not enrolled to you will still receive ColonCancerCheck correspondence, but these letters will not include your name.

To remove a patient who should not be rostered to you, complete a Primary Care Request to Remove a Patient form #3624-84 available at the Ministry of Health website. Mail the original completed form to:

Ministry of Health, Enrolment Processing Unit, 49 Place d’Armes, PO Box 48, Kingston, ON K7L 5J3

No. The introduction of physician-linked correspondence has no impact on the timing of letters being sent to participants. The timing of the letters is based on a person’s date of birth or date of last screen, and letters are mailed on the same schedule whether or not they are sent on your behalf.

Cancer Care Ontario obtains address information from many data sources, including the Ministry of Health’s Registered Person Database, to determine the most appropriate address for correspondence. If any of your patients have not updated their address with ServiceOntario, please encourage them to do so. Information on how to do this is available at http://health.gov.on.ca/en/public/publications/ohip/address.aspx.

For the purposes of physician-linked correspondence, we cannot change your address in the system or the way your name appears on patient correspondence. We suggest you contact both the Ministry of Health and The College of Physicians and Surgeons of Ontario to update your name and contact information. It is important that you update your contact information with the ministry and the college because we use this information to authenticate you when you call:

• Ministry of Health (Service Support Contact within Primary Healthcare Branch): Call 1-800-262-6524
• College of Physicians and Surgeons of Ontario (CPSO): Call 1-800-268-7096, or change online by logging into your CPSO account or by completing the address change form found on the CPSO website and submitting by mail, email or fax.

We receive regular updates from these sources and the changes will be incorporated in future mailings. The email, phone number or fax number you provide on your consent form will be used to contact you regarding all matters related to physician-linked correspondence. Please make sure this information is also kept up to date with both the ministry and college.

Evidence shows a positive relationship between physician recommendation for screening and patient participation in colorectal cancer, breast cancer and cervical screening.

The ColonCancerCheck program conducted a 2-phase pilot to evaluate the feasibility and effectiveness of physician-linked correspondence. The first phase (n=102 volunteer physicians) compared the uptake of the guaiac-based fecal occult blood test (gFOBT) in screen-eligible patients who were mailed physician-linked invitation letters with the uptake of a matched, contemporaneous (i.e., occurring in the same time period) control group that was not invited by mail. Screening participation with gFOBT was higher in the group that received physician-linked letters (22%) than in the group that was not invited by mail (8%).^[1]Reference 1Close referenceUsing physician-linked mailed invitations in an organised colorectal cancer screening programme: effectiveness and factors associated with response. BMJ Open. 2014 Mar 12;4(3):e004494. doi: 10.1136/bmjopen-2013-004494OpenClose

The next phase specifically evaluated the impact of physician linkage. It compared the gFOBT uptake after physician-linked invitations or recall letters were sent to patients of 1,000 volunteer physicians participating in the pilot (January to March 2012) with gFOBT uptake after unlinked letters were sent to patients of the same group of physicians 1 year earlier (January to March 2011).^[2]Reference 2Close referenceMarrett L, Gao, J. Physician Linked Correspondence (PLC) Evaluation. Cancer Care Ontario. Internal Report. Dec 2012.OpenClose  Patients who received physician-linked invitation letters (16.9%) were more likely to return a gFOBT than patients who received unlinked letters (12.7%). Similarly, patients who received physician-linked recall letters (54.8%) were more likely to return a gFOBT than patients who received unlinked letters (47.6%). Selection bias may be playing a role in these findings. An evaluation of patients of non-participating physicians who received unlinked letters during the same 2 time periods suggested a 0.9% increase in gFOBT uptake, indicating that secular trends (i.e., long-term trends that are likely independent of the intervention) may have accounted for a small proportion of the improvement observed in this phase of the pilot.

Based on the results of the 2-phase pilot, Cancer Care Ontario implemented physician-linked correspondence in the ColonCancerCheck program.

The letters are similar to the 3 pilot letters (invitation, recall, recall reminder), but some minor changes have been made to align them with the messaging in our generic letters (those not including your name). We have also introduced an invitation reminder (refer to the question What will the correspondence sent to my patients look like? for more details).

Cancer Care Ontario will send ColonCancerCheck correspondence on your behalf to all eligible patients ages 50 to 74 who are enrolled to you and due for colorectal cancer screening.  We will not send correspondence to people who have been previously diagnosed with colorectal cancer, have withdrawn from receiving screening letters or do not have a valid mailing address registered with us.

The letters have been updated to reflect that the fecal immunochemical test is the recommended test for screening people at average risk of developing colorectal cancer.

Your eligible patients will receive the following ColonCancerCheck letters personalized with your name:

• Invitation letter – Sent to all patients ages 50 to 74 who are due for colorectal cancer screening, unless they have received an invitation, recall or reminder letter within the last 2 years.
• Recall letter – Sent to all past ColonCancerCheck program participants who submitted a ColonCancerCheck guaiac fecal occult blood test kit to a lab 2 years ago, and are due for screening again.
• Reminder letter for invitation or recall – Sent to all patients who received an invitation or recall letter 4 months earlier (unless their invitation or recall letter was undeliverable), but did not screen for colorectal cancer.

These letters are sent according to current colorectal cancer screening recommendations, which are subject to change.

ColonCancerCheck result and result reminder letters will continue to be sent, but not on your behalf.

Your patients may also be eligible for Cancer Care Ontario’s 2 other organized cancer screening programs: the Ontario Breast Screening Program (OBSP) and the Ontario Cervical Screening Program (OCSP). Because these programs do not currently have physician-linked correspondence, your patients will continue to receive correspondence without your name. When physician-linked correspondence is expanded to the OBSP and OCSP, your name will appear on correspondence for those programs. You may opt out of participating in physician-linked correspondence for 1 or more cancer screening programs at any time.

Physician-linked correspondence looks the same as the generic ColonCancerCheck letters that Cancer Care Ontario sends to all eligible Ontarians. The only difference is that instead of using generic language to encourage people to speak with their healthcare provider about cancer screening, physician-linked correspondence states that the letter is sent on your behalf and specifies your name. Select a sample letter to view the exact wording.

Invitation:

Invitation Sample (English) 

Invitation Sample (French)

Invitation Reminder:

Invitation Reminder Sample (English) 

Invitation Reminder Sample (French) 

Recall:

Recall Sample (English)

Recall Sample (French)

Recall Reminder:

Recall Reminder Sample (English)

Recall Reminder Sample (French)

When physician-linked correspondence expands to the Ontario Breast Screening Program (OBSP) and the Ontario Cervical Screening Program (OCSP), the letters we send to your patients will include similar wording (i.e., the letter will be sent on your behalf). 

We will give you details about this expansion before it takes place.

See Letters to the Public About Cancer Screening to view samples of current generic OBSP and OSCP letters.