The current knowledge on the adaptation of clinical practice guidelines: a scoping review

Article type
Authors
Akl E1, Alonso-Coello P2, Amer Y3, Darzi A4, Schünemann H4, Song Y5, Wang R6, Zhang Y4, Zhu S5
1Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada ; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
2Iberoamerican Cochrane Centre (CCIb) - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
3Pediatrics Department and Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), São Paulo, Brazil
4Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
5School of Medicine, The Chinese University of Hong Kong, Shenzhen, Shenzhen, China
6Children's Hospital of Fudan University, Shanghai, China
Abstract
Background
Guideline adaptation allows for developing trustworthy recommendations using rigorous processes while limiting the intensive use of resources. New approaches and experiences continually emerge to improve the adaption process. The adaptation methods have yet to be standardized, and how the existing adaptation approaches have been used is unclear.

Objective
To map and analyze adaptation approaches through a scoping review, addressing the following:
1. What are the definitions and rationales for guideline adaptation?
2. What are the key strategies for adaptation?
3. How have the adaptation approaches been used?
4. What are the barriers and facilitators of adaptation approaches?

Methods
We conducted a scoping review following The University of Adelaide Joanna Briggs Institute Scoping Review Network Resources and adhering to PRISMA Extension for Scoping Reviews for reporting. We searched MEDLINE and EMBASE until March 2023 and conducted forwarded citations in Scopus, Google Scholar, and Web of Science. We included individual adaptation approaches used by different settings and identified corresponding adapted guidelines that reflect the application of each adaptation approach. We will further consult experts to collect more adaptation approaches within the Guideline International Network adaptation working group.

Results
We identified 33 adaptation approaches published from 2000 to 2023. Half of them were developed by high-income countries (51%), with major objectives to properly use available resources, avoid duplications, and save time and resources. We yielded 1264 additional records through a citation search and are finalizing data analysis. The ADAPTE, GRADE-ADOLOPMENT, and CAN-IMPLEMENT are the most cited approaches. We have linked the adapted guidelines and experiences paper to each adaptation approach to reflect their applications. We will report the findings in the Global Evidence Summit.

Discussion
The scoping review results clarify the current development status regarding guideline adaptation approaches. The final results will support the standardization of guideline adaptation methods and inform international methodological principles for guideline adaptation.