Methods of guideline adaptation: a review of guideline development guidance

Article type
Authors
El-Khoury R1, Noureldine M2, Abboud W3, Khabsa J1, SchĂĽnemann H4, Akl E5
1Clinical Research Institute, American University of Beirut Medical Center, Beirut
2Faculty of Medicine, Lebanese American University, Byblos
3Department of Internal Medicine, American University of Beirut, Beirut
4Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario; Department of Medicine, McMaster University, Ontario
5Clinical Research Institute, American University of Beirut Medical Center, Department of Internal Medicine, American University of Beirut, Beirut; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University
Abstract
Background: Guidelines are the cornerstone of high-quality evidence-based practice. Guidelines could be (1) developed from scratch, i.e., de novo; (2) adopted as is; or (3) adapted to the local setting taking into consideration contextual factors. Adapting guidelines accounts for contextual factors, while cutting on the required resources.

Objectives: The aim of the study was to systematically review guideline adaptation processes as described in guidance documents.

Methods: We included any publicly available documents, and peer reviewed articles by guideline producing organizations mentioning adaptation. We abstracted in duplicate and interpedently information on the characteristics of the organizations and of the adaptation process. We synthesized data narratively.

Preliminary Results: Out of 137 guideline producing organizations considered, 36 provided guidance on guideline adaptation (total of 48 documents). The majority of the documents were in English (52%) and were produced by national organizations (67%). 19% of the documents were completely dedicated to Adaptation and 50% referred to the ADAPTE-toolkit for adaptation. 27% of the documents addressed the consideration of equity and 29% assessed the baseline risk of the outcomes. Only 10% of the guidelines assessed the indirectness of the evidence.

Conclusions:The majority of the guideline adaption guidance documents do not assess the indirectness of the evidence, the baseline risk for the outcome or the equity while adapting a guidance document.

Patient or healthcare consumer involvement: Appropriate adaptation of guidelines should improve the quality of care, reduce variability in medical practices, and eventually improve patients’ outcomes.