Wiki technoligy can become a new, modern, fast and cost-effective way of producing evidence based guidelines for cancer care.

Clinical practice guidelines are a useful tool for promoting evidence based medical practice. They require a complete review of the available literature and usually are written by a team of experts in a field and disseminated widely for comment. Levels of evidence range from the strongest where meta-analyses of randomised trials exist, to the weakest where there is little data but a consensus of expert opinion is recorded.

The challenges of producing such guidelines are the time and cost of their production and the rapidity at which they are outdated because of the rapid emergence of new evidence.

One potential solution is to use a Wiki platform to produce guidelines.

Guidelines on a Wiki site could be continually updated as new data becomes available and is suggested for inclusion by those posting comments. The bibliography could be hyperlinked back to the source papers. Further to just relying on health professionals to identify new publications in an area, an electronic search of the literature on a particular topic could be regularly downloaded to the site for comment. A Wiki could be used to create new guidelines or update existing guidelines.

A current project is planned linking the Office of Postgraduate Medical Education of the University of Sydney (OPME), the Collaboration for Cancer Outcomes Research and Evaluation (CCORE), and the Australian Cancer Network (ACN) of Cancer Council Australia (CCA) as part of the Cancer Learning Website project and aims to test the use of a Wiki platform for cancer treatment guidelines. 

Draft chapters of the brain tumour guidelines will be placed on a Wiki site. It will be possible to evaluate two different methodologies for conducting the site. The site would have an administrator to monitor the comment threads and an expert committee led by a moderator to judge the site content. One method allows open access to commenting and altering the guidelines. The other would restrict the ability to alter guidelines to the expert group from the comments received about new evidence.

It is likely that the comment threads of health professional and consumers would be separated to allow easier analysis. The responses elicited on the Wiki site could be compared to responses received when the text of the guidelines was circulated by more conventional means to stakeholder groups.

The accuracy of electronic searching and relying on experts to identify new papers could be compared to more rigorous systematic searching.

The Wiki site allows postings of the history of updates and has the capability to conduct polls or surveys. There is also the option of membership or registration to a particular guideline site.

Such a site will still rely on the goodwill of the professionals and consumers, who now sit on guideline committees, but the process may make it easier to participate at time of their choosing. The ideal, here, is a large number of individuals each being responsible for the ongoing update of a small section of the guidelines.

Ian Olver graduated from the University of Melbourne in 1976 being awarded an MD in 1991 for a project on clinical trial methodology. He completed a PhD from Monash University in bioethics in 1997, exploring life and death issues. He trained in medical oncology at Peter MacCallum Cancer Institute, the Alfred Hospital in Melbourne and the University of Maryland Cancer Centre. He worked for 6 years at the Peter MacCallum Cancer Institute and then moved to Adelaide becoming the Clinical Director, Royal Adelaide Hospital Cancer Centre and the first Cancer Council SA Professor of Cancer Care at the University of Adelaide. In May 2006 he was appointed CEO Cancer Council Australia and a Clinical Professor in the Department of Medicine at the University of Sydney.