Article type
Abstract
"Background: To meet global needs for clinical practice guidelines (CPGs), consideration of varying implementation contexts is required. In resource limited settings, evidence to support traditional CPG development is often lacking.
Objective: We tested a novel pragmatic method to adapt existing guidelines for the Adapted Resource and Implementation Application (ARIA Guide) using a case study of supportive care recommendations for childhood cancers.
Methods: We developed and tested a five-step process: 1) Systematic search for existing guidelines; 2) Critical appraisal using AGREE II instrument; 3) Synthesis of recommendations; 4) Content Review; 5) Context Review. Only evidence-based CPGs were eligible for inclusion and underwent independent appraisal by two trained reviewers. CPGs receiving scores ≥5 for overall assessment and rigor of development were abstracted. If conflicting recommendations were identified, both advanced to content review. If no CPGs were identified, recommendations from cooperative group clinical trial protocols were abstracted. A panel of subject matter experts (content panel) including a pediatric oncologist, nurse and pharmacist reviewed synthesized recommendations for comprehensiveness, clarity, and accuracy and highlighted areas requiring adaptation. A context panel evaluated feasibility and appropriateness of recommendations to settings like theirs and provided specific feedback on adaptations needed during a minimum of two survey rounds. Adapted recommendations were recirculated to the panel for evaluation of acceptability prior to finalization. Context panels were assembled through professional societies/organizations targeting the population of interest and intentionally balanced gender, setting resource level and clinical experience while including representation from all World Health Organization regions.
Results: 132 healthcare workers from 50 countries currently participate in development of supportive care guidelines through the ARIA Guide . To date, we have trained 36 healthcare workers to systematically screen and critically appraise guidelines. 21 topics are currently under development; 11 in evidence review, 8 in content review, and 2 in context review.
Conclusions: Our pragmatic model to adapt recommendations from existing CPGs is feasible and promotes evidence-based practice while incorporating modifications to facilitate high quality care for patients across variably-resourced settings. This approach builds on prior adaptation models by tailoring recommendations to contextualize evidence for local impact, and develops global capacity in evidence synthesis.
"
Objective: We tested a novel pragmatic method to adapt existing guidelines for the Adapted Resource and Implementation Application (ARIA Guide) using a case study of supportive care recommendations for childhood cancers.
Methods: We developed and tested a five-step process: 1) Systematic search for existing guidelines; 2) Critical appraisal using AGREE II instrument; 3) Synthesis of recommendations; 4) Content Review; 5) Context Review. Only evidence-based CPGs were eligible for inclusion and underwent independent appraisal by two trained reviewers. CPGs receiving scores ≥5 for overall assessment and rigor of development were abstracted. If conflicting recommendations were identified, both advanced to content review. If no CPGs were identified, recommendations from cooperative group clinical trial protocols were abstracted. A panel of subject matter experts (content panel) including a pediatric oncologist, nurse and pharmacist reviewed synthesized recommendations for comprehensiveness, clarity, and accuracy and highlighted areas requiring adaptation. A context panel evaluated feasibility and appropriateness of recommendations to settings like theirs and provided specific feedback on adaptations needed during a minimum of two survey rounds. Adapted recommendations were recirculated to the panel for evaluation of acceptability prior to finalization. Context panels were assembled through professional societies/organizations targeting the population of interest and intentionally balanced gender, setting resource level and clinical experience while including representation from all World Health Organization regions.
Results: 132 healthcare workers from 50 countries currently participate in development of supportive care guidelines through the ARIA Guide . To date, we have trained 36 healthcare workers to systematically screen and critically appraise guidelines. 21 topics are currently under development; 11 in evidence review, 8 in content review, and 2 in context review.
Conclusions: Our pragmatic model to adapt recommendations from existing CPGs is feasible and promotes evidence-based practice while incorporating modifications to facilitate high quality care for patients across variably-resourced settings. This approach builds on prior adaptation models by tailoring recommendations to contextualize evidence for local impact, and develops global capacity in evidence synthesis.
"