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A wiki for cancer treatment guidelines<br />

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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 />

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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 />

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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 />

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The review of the review of the review of the review<br />Exhausted clinical experts!<br />

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Problems with written guidelines<br />Out of date<br />

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Problems with written guidelines<br />Impact?<br />

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General problem<br />Storage of previous knowledge?<br />

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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 />

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A wiki to develop and publish guidelines<br />

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The new way<br />6) “Wiki-fication” of content<br />& dissemination<br />1) Establish WP party and guideline objectives<br />

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Literature harvesting<br />

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Literature harvesting<br />

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Guideline development Critical appraisal of literature<br />

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The wiki critical appraisal form<br />

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Body of evidence table<br />

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Authors develop content,<br />

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Evidence summaries and recommendations<br />

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Example: Electronic guideline<br />

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Summary of recommendations<br />

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Guideline flowchart<br />

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Commenting on guidelines<br />

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Public consultation - Comment<br />

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Public consultation – Submit new evidence<br />

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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 />

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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 />

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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 />

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Guideline dissemination, implementation and evaluation<br />Developing e-learning modules<br />Detailed web analytics<br />

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Spaced Education e-learning modules<br />Screenshot Spaced Education Online Module <br />

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Web analytics <br />How people are navigating the site<br />

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Next steps<br />Custom-designed skin, improved UI<br />

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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 />

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The next level?<br />

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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 />