Initial evaluation of an internet- based wiki platform for cancer management guidelines ! Ian Olver AM CEO Cancer Council Australia
Problems with written guidelines ! • Out of date before ink dries because of new evidence constantly being published ! • Wide stakeholder consultation is important but adds to the delay ! • Hand searching the literature is expensive and time consuming ! • Paucity of data on impact !
What is a wiki? ! • Cancer Council Australia solution was to develop guidelines on a mediawiki platform ! • A wiki (swift in Hawaiian) is a website that allows the creation and editing of interlinked web pages via a web browser using a simplified mark-up language ! • It is a collaborative website - in this case closed so that only authors only can add content but anyone can comment !
Where do the new papers come from? ! We will start with hand searching but that is unsustainable for continuous updating ! What papers are likely to change a guideline? ! • Meta analyses and phase III studies (rarely phase II) ! • The 3 sources of papers to update are: ! • The authors of a section ! • The larger expert group and general public ! • Automatic electronic notification of new papers or hand search !
Topic leader notification on his/her user page ! Table%of%papers%that% need%to%be%appraised% Link%to%appraisal%form%
Evaluating each paper ! The section experts will evaluate each paper with a format like an annotated bibliography ! • Study type (phase I, II, III, IV, meta analysis) ! • Level of evidence I, II, III-1,III-2, III-3, IV) ! • Number of patients ! • Quality of evidence rating (high, medium, low) ! • Size of effect rating (1,2,3,4) ! • Relevance of evidence (1,2,3,4,5) ! • Economic Evaluation (Y/N) ! • Include/Reject (give reason) ! !
The wiki critical appraisal form ! Features:% 7%Popup%help%menu%for% every%form%field%
Body of evidence table !
Public consultation ! Features:)) In)a)simple)comment)box,)the)user)can) 1) comment)on)content;)or) 2) directly)no<fy)the)working)party)of) new)evidence)that)has)emerged)
Web Analytics How people navigate the site !
Lung Guidelines ! • 54 clinical questions and 22 authors ! • 1607 articles retrieved form the literature and 1770 critical appraisals ! ! • There were 156 comments in 9 weeks ! ! • There were 13,341 page views at 1.22 mins per view and 29.14 bounce rate !
Public Consultation ! In the endometrial guidelines there were; ! ! • 80 visitors per month (50.55 new visits) ! • 3.01 pages per visit ! • 4.21 visits per page ! • 50% bounce rate ! ! !
Lung Cancer !
Future Wiki ! • Could also link to a clinical trials database so that an investigator could see what practice is, what new papers there are and what trials are ongoing and identify the gaps as to plan the next trial ! • Link to detailed treatment guidelines (EviQ) ! ! • Add educational tools (e.g. Q-stream) !
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