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Table 2 Processes of adaptation suggested by published frameworks

From: The advantages and limitations of guideline adaptation frameworks

Framework (year published)

Author(s) (framework development group)

Committee structure

Methods and process summary

Updating of the adapted guideline

How adapted recommendations were constructed (e.g., consultation, consensus, EtD tables)

External peer review

Presentation and dissemination of the adapted guideline

Practice guideline evaluation and adaptation cycle (2005) [36]

Graham, I. D. Harrison, M. B.

A single local interdisciplinary20 guideline evaluation group comprising key stakeholders

• Identify a clinical area to promote best practice,

• Search and evaluate existing guidelines,

• Adopt or adapt the guideline for local use

Yes

Consensus in the guideline evaluation group

Yes, by local practitioners, other stakeholders, and organizational policy-makers for review and comment

Unclear, likely hardcopy documents

Systematic guideline review (2009) [37]

Muth, C. et al. (“Kompetenznetz Herzinsuffizienz” and the German Society for General Practice and Family Medicine (DEGAM))

Most steps conducted by the 5 authors

• Use multiple sources to search for guidelines

• Assess quality of the guidelines

• Collate recommendations from different guidelines into “evidence tables of a standardized format which included recommendation(s), evidence level(s), grading, critical appraisal of evidence, and cited sources”

No

Consensus by the authors

Yes, a multi-professional, interdisciplinary formal consensus process that included a patients’ representative and a pilot testing phase

Hardcopy documents

ADAPTE (2011) [16]

ADAPTE Collaboration (including Graham, I. D. Harrison, M. B.)

Dual committee structure consisting of the organizing committee and panel of guideline developers (usually content experts)

• Search for source guidelines

• Assess source guidelines

• Adapt source guideline

Yes

Consensus by the panel

Yes, by target users, consulted with relevant endorsement bodies and the developers of source guidelines

Hardcopy documents

The Alberta Ambassador Program (AAP) adaptation process (2011) [26]

Harstall, C. et al. (The Alberta

Ambassador Program)

Up to 6 committees with distinct responsibilities in the adaptation process

• Formulate the question from knowledge gaps in the adaptation context

• Literature search to identify relevant source guidelines.

• Assess source guidelines

• Adapt guideline written via monthly videoconferences of the Guideline Development Group

Yes “living” guideline that will be updated every 2 years

Consensus by the guideline development group

Yes, by clinical experts, methodologists, and potential guideline users who were not involved in its development

Targeted to local implementation facilitators. Including internet access to the guidelines

CAN-IMPLEMENT (2013) [30, 38]

Harrison, M. B. Graham, I. D. et al. (The Canadian Partnership Against Cancer)

2 or more committees including a steering committee and working panel(s)

• Similar steps to ADAPT

• Some steps of the adaptation process done simultaneously by different sub-committees of the guideline development group.

• A stronger focus on the implementation of guidelines after their adaptation

Yes

Consensus by the panel

Yes, by each stakeholder group affected by the recommendations

Adaptation only the first phase of the CAN-IMPLEMENT process. Phase 2 is development of training programs and interventions to implement new guideline. Phase 3 involves evaluation of the process and outcomes

SNAP-IT by GRADE (2014) [28]

Kristiansen, A. et al. (Canadian McMaster University GRADE group partnership with Norwegian Ministry of health)

Editorial committee, individual chapter editors

• Select one well established guideline which was deemed to be current, of high quality, and used GRADE (23)

• Choose recommendations within this guideline that they deem relevant in the adaption context to adopt/adapt

Dynamically update the recommendations at least every 3 months

One content expert and one methods expert on the editorial committee reviewed each chapter of the guideline to choose which recommendations to adopt and/adapt. The panel consulted with editors of the source guideline on content issues and when modifications were made.

Yes, by all relevant medical specialty organizations, local ministry of health and the source guideline development organization

Published in newly developed web authoring and publication platform (MAGIC), including offline access on smartphones and tablets

Adapted ADAPTE (2015) [32]

Amer, Y. S. Elzalabany, M. M. Omar, T. I. Ibrahim, A. G. Dowidar, N. L.

Dual committee structure consisting of the organizing committee and panel

Framework based on the work of ADAPTE collaboration and CAN-IMPLEMENT with modifications to increase the timeliness and clarity of the adaptation process

Yes

Consensus by the panel

Yes, same as ADAPTE

Hardcopy documents. The framework include some implementation tools which include professional and organizational interventions, monitoring and evaluation, and an action plan for dissemination

GRADE-ADOLOPMENT (2017) [19]

Schunemann, H. J et al. (Canadian McMaster University GRADE group partnership with Saudi Arabian Ministry of health)

Methodologist group from McMaster university. Guideline panels made up of local expert members from multidisciplinary backgrounds, including some patient representatives

• Local authorities choose the key clinical questions;

• Identify specific recommendations that address those questions.

• Choose source guidelines based on the GRADE approach and constructing EtD tables

• Revise and update these tables are to match the local context.

N/A This framework stops at the decision to either adopt, adapt the source recommendation/evidence, or start de novo development of a new guideline.

Evidence to decision (EtD) tables

N/A This framework stops at the decision to adopt, adapt the source recommendation/evidence or start de novo development of a new guideline.

Unclear, in the case described the adapted guidelines were made for the Kingdom of Saudi Arabia and dissemination was the responsibility of the local government

  1. Abbreviations: EtD evidence-to-decision, GRADE The Grading of Recommendations Assessment, Development and Evaluation, N/A not applicable