Developing Wiki-Based Clinical Practice Guidelines for Cancer (#40)
Producing high quality oncology guidelines and maintain their currency with a constantly growing evidence base is a challenging undertaking. To overcome the limitations of physical publishing, enable continuous stakeholder consultation and evidence updates, the traditional guideline development process was translated to a dynamic online wiki environment.
All key steps of guideline development were converted and streamlined into an online process on the wiki. The literature search, evidence retrieval and screening process was developed and then completed online for the guidelines. The critical appraisals and key data for each retrieved paper were recorded on the wiki and summary evidence table automatically generated by the system. Evidence-based recommendations and guideline content were developed by the working group and uploaded to the wiki. The installation of an online commenting tool enabled online consultation and external stakeholders were invited to comment on the draft content. Web analytics were used to monitor usage.
To develop the lung cancer treatment guidelines, the initial evidence retrieval resulted in 2035 potentially relevant articles being forwarded for detailed methodological evaluation with another 571 added through other methods for 67 clinical questions. To fine-tune the initial draft content, the working party used the wiki to exchange 156 internal comments with another 38 external comments collated during an initial 30-day public consultation period. The guidelines were then disseminated electronically and evidence updates continue to be fed into the system. The writers remain engaged to appraise new papers and update the guideline as necessary.
A wiki-based guideline platform is a feasible solution to overcome many challenges in guideline development, particularly to keep track of the growing evidence-base. It provides an infrastructure for ongoing updates, including a detailed audit trail to maximise transparency. Online linkages to other resources and implementation tools can be easily integrated to increase uptake.