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BMJ Qual Saf 20:228-236 doi:10.1136/bmjqs.2010.043257
  • Original research

Guideline adaptation: an approach to enhance efficiency in guideline development and improve utilisation

  1. The ADAPTE Collaboration*
  1. 1EA 4129 - Santé, Individu, Société, Centre Léon Bérard Université Lyon 1, Lyon, France
  2. 2Dutch Institute for Healthcare Improvement, CBO, Utrecht, The Netherlands
  3. 3IQ healthcare, Radboud University Nijmegen medical Centre, Nijmegen, The Netherlands
  4. 4Institute of social and preventive medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
  5. 5Program in Evidence-based Care, Cancer Care Ontario; McMaster University, Hamilton, Canada;
  6. 6Cancer Control Guidelines Action Group, Canadian Partnership against Cancer, Toronto, Canada
  7. 7British Columbia Cancer Agency, Vancouver Island Centre, Canada
  8. 8School of Nursing, University of Ottawa, Canada
  9. 9Canadian Institutes of Health Research, Ottawa, Canada
  10. 10School of Nursing, Queen's University, Kingston, Canada
  11. 11Direction de la lutte contre le cancer, Ministère de la santé et des services sociaux, Québec, Canada
  12. 12Centre intégré de lutte contre le cancer, Hôpital Charles Lemoyne; Université de Sherbrooke, Canada
  13. 13Haute Autorité de Santé, Service des Recommandations Professionnelles, Paris, France
  1. Correspondence to Dr Béatrice Fervers, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; fervers{at}lyon.fnclcc.fr
  1. Contributors All authors and members of the ADAPTE collaboration have contributed substantially to the preparation of this manuscript and the development of the ideas contained in it, participated in at least one meeting, and gave final approval of the version to be published. BF and JL led the process. BB and RV were responsible for data collection and analysis. BF and JSB developed the first draft of the paper. BB, MB, GB, IDG, MBH, LP and RV helped write the final draft. BF and BB are guarantors of the article and accept full responsibility for the paper and controlled the decision to publish.

  • Accepted 21 July 2010
  • Published Online First 5 January 2011

Abstract

Background Developing and updating high-quality guidelines requires substantial time and resources. To reduce duplication of effort and enhance efficiency, we developed a process for guideline adaptation and assessed initial perceptions of its feasibility and usefulness.

Methods Based on preliminary developments and empirical studies, a series of meetings with guideline experts were organised to define a process for guideline adaptation (ADAPTE) and to develop a manual and a toolkit made available on a website (http://www.adapte.org). Potential users, guideline developers and implementers, were invited to register and to complete a questionnaire evaluating their perception about the proposed process.

Results The ADAPTE process consists of three phases (set-up, adaptation, finalisation), 9 modules and 24 steps. The adaptation phase involves identifying specific clinical questions, searching for, retrieving and assessing available guidelines, and preparing the draft adapted guideline. Among 330 registered individuals (46 countries), 144 completed the questionnaire. A majority found the ADAPTE process clear (78%), comprehensive (69%) and feasible (60%), and the manual useful (79%). However, 21% found the ADAPTE process complex. 44% feared that they will not find appropriate and high-quality source guidelines.

Discussion A comprehensive framework for guideline adaptation has been developed to meet the challenges of timely guideline development and implementation. The ADAPTE process generated important interest among guideline developers and implementers. The majority perceived the ADAPTE process to be feasible, useful and leading to improved methodological rigour and guideline quality. However, some de novo development might be needed if no high quality guideline exists for a given topic.

Footnotes

  • The Members of the ADAPTE Collaboration who have contributed to this article include (in alphabetical order):

  • ▸ Melissa Brouwers, Program in Evidence-based Care, Cancer Care Ontario; McMaster University, Hamilton, Canada; Cancer Control Guidelines Action Group, Canadian Partnership against Cancer, Canada

  • ▸ George P. Browman, British Columbia Cancer Agency, Vancouver Island Centre; Cancer Guidelines Action Group, Canadian Partnership against Cancer, Canada

  • ▸ Jako S. Burgers, Dutch Institute for Healthcare Improvement, CBO, Utrecht, The Netherlands; IQ healthcare, Radboud University Nijmegen medical Centre, Nijmegen, The Netherlands

  • ▸ Bernard Burnand, Health Care Evaluation Unit and Clinical Epidemiology Centre, Institute of social and preventive medicine, Centre Hospitalier Universitaire Vaudois and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland

  • ▸ Béatrice Fervers, Fédération Nationale des Centres de Lutte Contre le Cancer; Centre Léon Bérard, Lyon, France; EA 4129 - Santé, Individu, Société, Lyon, France

  • ▸ Ian D. Graham, PhD School of Nursing, University of Ottawa, Canadian Institutes of Health Research, Ottawa, Canada; Cancer Control Guidelines Action Group, Canadian Partnership against Cancer, Canada

  • ▸ Margaret B. Harrison, PhD School of Nursing, Queen's University, Kingston, Canada; Cancer Control Guidelines Action Group, Canadian Partnership against Cancer, Canada

  • ▸ Jean Latreille, Direction de la lutte contre le cancer, Ministère de la santé et des services sociaux, Québec; Centre intégré de lutte contre le cancer, Hôpital Charles Lemoyne; Université de Sherbrooke; Canadian Partnership against Cancer, Canada

  • ▸ Najoua Mlika-Cabanne, Haute Autorité de Santé, Service des Recommandations Professionnelles, Paris, France

  • ▸ Louise Paquet, Direction de la lutte contre le cancer; Ministère de la santé et des services sociaux, Québec; Canadian Partnership against Cancer, Canada

  • ▸ Magali Remy-Stockinger, Fédération Nationale des Centres de Lutte Contre le Cancer; Centre Léon Bérard, Lyon, France

  • ▸ Anita Simon, Alberta Cancer Board, Calgary, Canada

  • ▸ Joan Vlayen, Catholic University of Leuven, Leuven, Belgium

  • ▸ Louise Zitzelsberger, Cancer Guidelines Action Group, Canadian Partnership against Cancer; Ottawa Health Research Institute, Canada

  • Funding Other Funders: 59th and 60th ‘Commissions permanentes de coopération franco-québécoise (CPCFQ)’ 2003–2006, 'Direction de la lutte contre le cancer', Ministère de la santé et des services sociaux, Québec, Canada; Ligue Nationale contre le Cancer, France; Région Rhône-Alpes, France; Health Canada and The Canadian Partnership against Cancer; Fédération Nationale des Centres de Lutte Contre le Cancer, France; France-Switzerland collaborative fund (PAI G. de Stael); Haute Autorité de Santé, France.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the This study has received approval according to French procedures for this type of research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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