A wiki for cancer treatment guidelines

What are clinical practice guidelines?

“Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances’ (Field and Lohr, 1992).

Content is based on a systematic review of clinical evidence - the main source for evidence-based care.

Working party

formation

Systematic literature review

Evidence assessment

Production of guideline

draft

Public consultation

NHMRC Process (NHMRC = National Health and Medical Research Council)

Review Independent review Peer review

Submission to NHMRC

Potential changes!

Publication

Dissemination

Same procedure after 5 years!!!!

Approval

Problems with written guidelines

Hand-searching the literature is expensive

and time consuming

Cut off date required –> You can’t include any new studies!!!

Problems with written guidelines

Complicated templates to appraise literature

Rômulo Carnielhttp://www.flickr.com/photos/35840698@N05/5557202991/lightbox/

The review of the review of the review of the review

Exhausted clinical experts!

Problems with written guidelines

Out of d

ate

Problems with written guidelines

Impact?

General problem Storage of previous knowledge?

A wiki to develop and disseminate clinical practice guidelines

Better & cheaper literature search, citation and critical appraisal handling

Up-to-date, living guidelines (iterative publishing

possible)

Lots of people doing a little bit each

Stakeholder engagement

Transparency

Flexible, scalable & affordable

A wiki to develop and publish guidelines

2) Develop clinical questions

3) Develop search strategy, search the literature & feed into wiki

4) Critically appraise and summarise the literature on the wiki

5) Assess body of evidence, formulate recommendations, write content

6) “Wiki-fication” of content& dissemination

Ongoing literature feed

Ongoing appraisal of

literature

Ongoing content updates

Content additions

where needed

Ongoing commenting

1) Establish WP party and guideline objectives

The new way

Literature harvesting

Literature harvesting

Guideline development Critical appraisal of literature

The wiki critical appraisal form

Body of evidence table

Authors develop content,

Evidence summaries and recommendations

Example: Electronic guideline

Summary of recommendations

Guideline flowchart

Commenting on guidelines

Public consultation - Comment

Public consultation – Submit new evidence

The 3 sources where papers come from:

1) Automatic electronic alerts of new papers

2) The small group of authors whose expertise is the chunk, will feed in

3) The larger public, including professional bodies, external experts, health professionals, consumers, alerts

Updating a guideline chunk

Updating a guideline chunk The group responsible for a chunk is a standing

committee Responsible to address comments Whenever a new paper appears in their work

space they analyse it and decide whether it contained new information that would alter the guideline and change the chunk accordingly and in a timely manner

A chunk can be changed/updated without affecting the rest of the guidelines

Audit trail Each guideline content page lists a serious of

appendices to provide transparency about recommendation grading and body of evidence

User can also access pending evidence that hasn’t yet been incorporated

Guideline dissemination, implementation and evaluation

Developing e-learning modules Detailed web analytics

Screenshot Spaced Education Online Module

Spaced Education e-learning modules

Web analytics How people are navigating the site

Next steps Custom-designed skin, improved UI

Next steps

Generation Y need reward The obvious:

– Authorship of a chunk would be recorded and possibly attract CME points?

– Chunk authors could be authorised to be able to use the literature reviews to write review articles for journals

What else?

Incentives for our volunteers

The next level?

Acknowledgement Prof Ian Olver, CEO Cancer Council Australia Christine Vuletich, Manager - Clinical Guidelines Network Alisha Dorrigan, Project Officer Alice Winter-Irving, Project Officer Endometrial and lung cancer working party

Technical support Andrew Garrett, Lead Developer

Dr Bob Jansen, IT Consultant

Mediawiki skin

Redwerks (web design agency)

Website: wiki.cancer.org.au/australia