a wiki for cancer treatment guidelines - jutta von dinklage
DESCRIPTION
Presentation to NSW KM Forum, Sept 2011.TRANSCRIPT
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
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