A wiki for cancer treatment guidelines - Jutta von Dinklage


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Presentation to NSW KM Forum, Sept 2011.

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  • Evidence-based guidelines: We want guideline based on best available evidence, don’t want to miss relevant papers, so we are looking improving the literature search process and sustainabilityMore decentralised model: We still have a working party and management committee that oversees a guideline, but in our new model we are splitting guidelines into chunks of information and each chunk is taken care of by an author who nominates two co-authors to help him/her update the chunk and resolve conflict
  • A wiki for cancer treatment guidelines - Jutta von Dinklage

    1. 1. A wiki for cancer treatment guidelines<br />
    2. 2. What are clinical practice guidelines?<br />“Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances’ (Field and Lohr, 1992).<br />Content is based on a systematic review of clinical evidence - the main source for evidence-based care.<br />
    3. 3. NHMRC Process (NHMRC = National Health and Medical Research Council)<br />Publication <br />Dissemination<br />Public consultation<br />Review<br />Independent review<br />Peer review<br />Submission to NHMRC <br />Potential changes!<br />Approval<br />Same procedure after 5 years!!!!<br />
    4. 4. Problems with written guidelines<br />Hand-searching the literature is expensive and time consuming<br /><ul><li>Cut off date required –> You can’t include any new studies!!!</li></li></ul><li>Problems with written guidelines<br />Complicated templates to appraise literature<br />RômuloCarniel<br />http://www.flickr.com/photos/35840698@N05/5557202991/lightbox/<br />
    5. 5. The review of the review of the review of the review<br />Exhausted clinical experts!<br />
    6. 6. Problems with written guidelines<br />Out of date<br />
    7. 7. Problems with written guidelines<br />Impact?<br />
    8. 8. General problem<br />Storage of previous knowledge?<br />
    9. 9. A wiki to develop and disseminate clinical practice guidelines<br />Better & cheaper literature search, citation and critical appraisal handling<br />Up-to-date, living guidelines (iterative publishing possible)<br />Lots of people doing a little bit each<br />Stakeholder engagement<br />Transparency<br />Flexible, scalable & affordable<br />
    10. 10. A wiki to develop and publish guidelines<br />
    11. 11. The new way<br />6) “Wiki-fication” of content<br />& dissemination<br />1) Establish WP party and guideline objectives<br />
    12. 12. Literature harvesting<br />
    13. 13. Literature harvesting<br />
    14. 14. Guideline development Critical appraisal of literature<br />
    15. 15. The wiki critical appraisal form<br />
    16. 16. Body of evidence table<br />
    17. 17. Authors develop content,<br />
    18. 18. Evidence summaries and recommendations<br />
    19. 19. Example: Electronic guideline<br />
    20. 20. Summary of recommendations<br />
    21. 21. Guideline flowchart<br />
    22. 22. Commenting on guidelines<br />
    23. 23. Public consultation - Comment<br />
    24. 24. Public consultation – Submit new evidence<br />
    25. 25. Updating a guideline chunk<br />The 3 sources where papers come from:<br />1) Automatic electronic alerts of new papers<br />2) The small group of authors whose expertise is the chunk, will feed in <br />3) The larger public, including professional bodies, external experts, health professionals, consumers, alerts<br />
    26. 26. Updating a guideline chunk<br />The group responsible for a chunk is a standing committee<br />Responsible to address comments<br />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<br />A chunk can be changed/updated without affecting the rest of the guidelines<br />
    27. 27. Audit trail<br />Each guideline content page lists a serious of appendices to provide transparency about recommendation grading and body of evidence<br />User can also access pending evidence that hasn’t yet been incorporated <br />
    28. 28. Guideline dissemination, implementation and evaluation<br />Developing e-learning modules<br />Detailed web analytics<br />
    29. 29. Spaced Education e-learning modules<br />Screenshot Spaced Education Online Module <br />
    30. 30. Web analytics <br />How people are navigating the site<br />
    31. 31. Next steps<br />Custom-designed skin, improved UI<br />
    32. 32. Next steps<br />Incentives for our volunteers<br />Generation Y need reward <br />The obvious:<br />Authorship of a chunk would be recorded and possibly attract CME points?<br />Chunk authors could be authorised to be able to use the literature reviews to write review articles for journals <br />What else?<br />
    33. 33. The next level?<br />
    34. 34. Acknowledgement<br />Prof Ian Olver, CEO Cancer Council Australia<br />Christine Vuletich, Manager - Clinical Guidelines Network<br />Alisha Dorrigan, Project Officer<br />Alice Winter-Irving, Project Officer<br />Endometrial and lung cancer working party<br />Technical support<br />Andrew Garrett, Lead Developer<br />Dr Bob Jansen, IT Consultant<br />Mediawiki skin<br />Redwerks (web design agency)<br />Website: wiki.cancer.org.au/australia<br />