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. 2016 Sep 13;9(1):442.
doi: 10.1186/s13104-016-2244-7.

To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development

Janine Margarita Dizon  1   2 , Shingai Machingaidze  3   4 , Karen Grimmer  5
Affiliations

To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development

Janine Margarita Dizon et al. BMC Res Notes. .

Abstract

Aim: Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context.

Results: The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply 'adopt' this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to 'contextualise' the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to 'adapt' the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.

Keywords: Clinical practice guidelines; Guideline adaptation; Guideline adoption; Guideline contextualisation; Guideline development.

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Figures

Fig. 1
Fig. 1
Suitcase analogy for adopt, adapt and contextualise
Fig. 2
Fig. 2
SAGE CPG developmnet framework
See this image and copyright information in PMC

References

    1. Schünemann R, Brożek H, Guyatt G, Oxman A. GRADE Handbook: handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. 2013.
    1. Vernooij RW, Sanabria AJ, Sola I, Alonso-Coello P, Martinez Garcia L. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks. Implement Sci. 2014;9:3. doi: 10.1186/1748-5908-9-3. - DOI - PMC - PubMed
    1. Johnston ME, Brouwers MC, Browman GP. Keeping cancer guidelines current: results of a comprehensive prospective literature monitoring strategy for twenty clinical practice guidelines. Int J Technol Assess Health Care. 2003;19(4):646–655. doi: 10.1017/S0266462303000606. - DOI - PubMed
    1. Graham ID, Harrison MB, Brouwers M, Davies BL, Dunn S. Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations. J Obstet Gynecol Neonatal Nurs. 2002;31(5):599–611. doi: 10.1111/j.1552-6909.2002.tb00086.x. - DOI - PubMed
    1. Fervers B, Burgers JS, Haugh MC, Latreille J, Mlika-Cabanne N, Paquet L, et al. Adaptation of clinical guidelines: literature review and proposition for a framework and procedure. Int J Qual Health Care. 2006;18(3):167–176. doi: 10.1093/intqhc/mzi108. - DOI - PubMed

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