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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.
NHMRC Process (NHMRC = National Health and Medical Research Council) Publication  Dissemination Public consultation Review Independent review Peer review Submission to NHMRC  Potential changes! Approval Same procedure after 5 years!!!!
Problems with written guidelines Hand-searching the literature is expensive and time consuming ,[object Object],[object Object]
The review of the review of the review of the review Exhausted clinical experts!
Problems with written guidelines Out of date
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
The new way 6) “Wiki-fication” of content & dissemination 1) Establish WP party and guideline objectives
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
Updating a guideline chunk 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 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
Spaced Education e-learning modules Screenshot Spaced Education Online Module
Web analytics  How people are navigating the site
Next steps Custom-designed skin, improved UI
Next steps Incentives for our volunteers 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?
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
A wiki for cancer treatment guidelines - Jutta von Dinklage

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A wiki for cancer treatment guidelines - Jutta von Dinklage

  • 1. A wiki for cancer treatment guidelines
  • 2. 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.
  • 3. NHMRC Process (NHMRC = National Health and Medical Research Council) Publication Dissemination Public consultation Review Independent review Peer review Submission to NHMRC Potential changes! Approval Same procedure after 5 years!!!!
  • 4.
  • 5. The review of the review of the review of the review Exhausted clinical experts!
  • 6. Problems with written guidelines Out of date
  • 7. Problems with written guidelines Impact?
  • 8. General problem Storage of previous knowledge?
  • 9. 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
  • 10. A wiki to develop and publish guidelines
  • 11. The new way 6) “Wiki-fication” of content & dissemination 1) Establish WP party and guideline objectives
  • 14. Guideline development Critical appraisal of literature
  • 15. The wiki critical appraisal form
  • 18. Evidence summaries and recommendations
  • 24. Public consultation – Submit new evidence
  • 25. Updating a guideline chunk 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
  • 26. 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
  • 27. 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
  • 28. Guideline dissemination, implementation and evaluation Developing e-learning modules Detailed web analytics
  • 29. Spaced Education e-learning modules Screenshot Spaced Education Online Module
  • 30. Web analytics How people are navigating the site
  • 31. Next steps Custom-designed skin, improved UI
  • 32. Next steps Incentives for our volunteers 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?
  • 34. 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

Editor's Notes

  1. 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