Maintaining Evidence-Based Guidelines Online: Update on Nutritional Management of Patients with Head and Neck Cancer. (#34)
Aims: To update the evidence-based guidelines for nutritional management of patients with head and neck cancer originally published online in 2011 and to ensure currency of the best available evidence on a widely accessible and easily updated web-based wiki platform.
Methods: Ongoing literature searches identified new publications between July 2011 and July 2012. Traditional guideline development methodology was employed to critically appraise the literature according to the National Health and Medical Research Council (NHMRC) levels of evidence and the American Academy of Nutrition and Dietetics’ study design quality ratings. The body of evidence was assessed using NHMRC grades of recommendations addressing the existing 27 clinical questions. Technical support provided by Cancer Council Australia facilitated online collaboration with proposed updates posted in a closed domain for comment and approval by steering committee members prior to publication in the live domain.
Results: The update process yielded 24 studies for inclusion, adding to the 288 studies identified in the development phase. While high level evidence still exists for the benefit of nutrition intervention, most of the new studies were level III or IV and of neutral quality. Therefore, few changes were made to existing recommendation statements and uncertainty regarding best practice persists in some areas. New statements were added regarding the impact of developing treatment regimens, however, evidence is limited. Comparison of website usage between October 2011 and March 2013 demonstrated increased page views (2303 versus 37697); unique page views (1299 versus 23950) and number of countries accessing the guidelines (31 versus 61).
Conclusions: The updated guidelines continue to provide clinicians with access to evidence based recommendations for nutritional care of this patient group, aiming to influence practice internationally. The wiki platform has proven successful in ensuring content remains current through facilitating collaboration, rapid updates, version control and online consultation.