Andrea Darzi1, Elias A Abou-Jaoude2, Arnav Agarwal3, Chantal Lakis4, Wojtek Wiercioch3, Nancy Santesso3, Hneine Brax5, Fadi El-Jardali6, Holger J Schünemann7, Elie A Akl8. 1. AUB GRADE Center, Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon; Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. 2. School of Business, Canisius College, 2001 Main Street, Buffalo, NY 14208, USA. 3. Department of Clinical Epidemiology and Biostatistics, Cochrane GRADEing Methods Group and MacGRADE Centre, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. 4. Faculty of Medicine and Medical Sciences, University of Balamand, PO Box 166378, Youssef Sursok Street, Ashrafieh, Beirut 1100-2807, Lebanon. 5. Faculty of Medicine, Univeristé Saint Joseph, PO Box 11-5076, Damas street, Riad El Solh, Beirut 1107 2180, Lebanon. 6. Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon; Department of Clinical Epidemiology and Biostatistics, Cochrane GRADEing Methods Group and MacGRADE Centre, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada; Department of Health Management and Policy, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. 7. Department of Clinical Epidemiology and Biostatistics, Cochrane GRADEing Methods Group and MacGRADE Centre, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. 8. AUB GRADE Center, Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon; Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon; Department of Clinical Epidemiology and Biostatistics, Cochrane GRADEing Methods Group and MacGRADE Centre, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada; Department of Internal Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. Electronic address: ea32@aub.edu.lb.
Abstract
BACKGROUND AND OBJECTIVE: Our objective was to identify and describe published frameworks for adaptation of clinical, public health, and health services guidelines. METHODS: We included reports describing methods of adaptation of guidelines in sufficient detail to allow its reproducibility. We searched Medline and EMBASE databases. We also searched personal files, as well manuals and handbooks of organizations and professional societies that proposed methods of adaptation and adoption of guidelines. We followed standard systematic review methodology. RESULTS: Our search captured 12,021 citations, out of which we identified eight proposed methods of guidelines adaptation: ADAPTE, Adapted ADAPTE, Alberta Ambassador Program adaptation phase, GRADE-ADOLOPMENT, MAGIC, RAPADAPTE, Royal College of Nursing (RCN), and Systematic Guideline Review (SGR). The ADAPTE framework consists of a 24-step process to adapt guidelines to a local context taking into consideration the needs, priorities, legislation, policies, and resources. The Alexandria Center for Evidence-Based Clinical Practice Guidelines updated one of ADAPTE's tools, modified three tools, and added three new ones. In addition, they proposed optionally using three other tools. The Alberta Ambassador Program adaptation phase consists of 11 steps and focused on adapting good-quality guidelines for nonspecific low back pain into local context. GRADE-ADOLOPMENT is an eight-step process based on the GRADE Working Group's Evidence to Decision frameworks and applied in 22 guidelines in the context of national guideline development program. The MAGIC research program developed a five-step adaptation process, informed by ADAPTE and the GRADE approach in the context of adapting thrombosis guidelines. The RAPADAPTE framework consists of 12 steps based on ADAPTE and using synthesized evidence databases, retrospectively derived from the experience of producing a high-quality guideline for the treatment of breast cancer with limited resources in Costa Rica. The RCN outlines five key steps strategy for adaptation of guidelines to the local context. The SGR method consists of nine steps and takes into consideration both methodological gaps and context-specific normative issues in source guidelines. We identified through searching personal files two abandoned methods. CONCLUSION: We identified and described eight proposed frameworks for the adaptation of health-related guidelines. There is a need to evaluate these different frameworks to assess rigor, efficiency, and transparency of their proposed processes.
BACKGROUND AND OBJECTIVE: Our objective was to identify and describe published frameworks for adaptation of clinical, public health, and health services guidelines. METHODS: We included reports describing methods of adaptation of guidelines in sufficient detail to allow its reproducibility. We searched Medline and EMBASE databases. We also searched personal files, as well manuals and handbooks of organizations and professional societies that proposed methods of adaptation and adoption of guidelines. We followed standard systematic review methodology. RESULTS: Our search captured 12,021 citations, out of which we identified eight proposed methods of guidelines adaptation: ADAPTE, Adapted ADAPTE, Alberta Ambassador Program adaptation phase, GRADE-ADOLOPMENT, MAGIC, RAPADAPTE, Royal College of Nursing (RCN), and Systematic Guideline Review (SGR). The ADAPTE framework consists of a 24-step process to adapt guidelines to a local context taking into consideration the needs, priorities, legislation, policies, and resources. The Alexandria Center for Evidence-Based Clinical Practice Guidelines updated one of ADAPTE's tools, modified three tools, and added three new ones. In addition, they proposed optionally using three other tools. The Alberta Ambassador Program adaptation phase consists of 11 steps and focused on adapting good-quality guidelines for nonspecific low back pain into local context. GRADE-ADOLOPMENT is an eight-step process based on the GRADE Working Group's Evidence to Decision frameworks and applied in 22 guidelines in the context of national guideline development program. The MAGIC research program developed a five-step adaptation process, informed by ADAPTE and the GRADE approach in the context of adapting thrombosis guidelines. The RAPADAPTE framework consists of 12 steps based on ADAPTE and using synthesized evidence databases, retrospectively derived from the experience of producing a high-quality guideline for the treatment of breast cancer with limited resources in Costa Rica. The RCN outlines five key steps strategy for adaptation of guidelines to the local context. The SGR method consists of nine steps and takes into consideration both methodological gaps and context-specific normative issues in source guidelines. We identified through searching personal files two abandoned methods. CONCLUSION: We identified and described eight proposed frameworks for the adaptation of health-related guidelines. There is a need to evaluate these different frameworks to assess rigor, efficiency, and transparency of their proposed processes.
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