Table 3 Processes for identification and evaluation of source material by adaptation frameworks

Practice guidelines evaluation and adaptation cycle (PGEAC) [36]

Select a clinical question based on:

• The prevalence of the condition or its associated burden

• Concerns about large variations in practice or care gaps,

• Costs associated with different practices

US National Guideline Clearinghouse and guideline repositories, as well as guideline developers and PubMed [36]

AGREE

N/A

If more than one guideline is being considered, a “content analysis” of the recommendations in each guideline is conducted by clinicians experienced in the content area. A table is used to compare the recommendations in each guideline and the level of evidence supporting each recommendation

N/A

N/A

Systematic guideline review (SGR) [37]

Not specified by the framework. Chronic Heart Disease was the topic already chosen for the review.

MEDLINE, The Cochrane Library, DARE, and HSTAT [37]

AGREE

For each clinical question extract data into evidence tables including: recommendations, evidence levels, grading, critical appraisal of evidence, and cited sources.

Recommendations within the guidelines are evaluated for whether they are supported by valid study results

N/A

Systematic reviews cited by the source guidelines are re-evaluated, along with clinical studies of an appropriate design when secondary publications did not provide the desired evidence

ADAPTE [16]

Topic chosen before the adaptation process. Research questions determined by the guideline committee in the patient population, intervention, professional/patients (audience of the guideline), outcomes, and healthcare setting (PIPOH) format [16]

26 guideline internet sites including the Cochrane Library, guideline repositories, government agencies and cancer clinical societies [39]

AGREE,

Assess guideline currency, content and consistency

Construct recommendation matrices with a list of recommendations and their respective source guidelines to allow comparison of the recommendations

Assess acceptability (i.e., whether the recommendations should be put into practice) and applicability (i.e., whether an organization or group is able to put the recommendation into practice).

Assess consistency between the evidence cited by the guidelines and the respective recommendations.

N/A

N/A

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

Knowledge gaps of the local practitioners were assessed along with a systematic review of the literature on knowledge gaps among various primary case groups

Search developed by research team in collaboration with experienced medical librarians (28)

AGREE modified by the research team

Evidence inventory tables are used by the research team to extract data from source guidelines and present all the information required for the guideline development group in 1 document. Discordant recommendations are highlighted

Not assessed, evidence cited in the source guidelines to support the recommendations is listed.

N/A

N/A

CAN-IMPLEMENT from ADAPTE [30, 38]

Topic chosen before the adaptation process. Research questions determined by the guideline committee in the Patient population, Intervention, Professional/patients (audience of the guideline), Outcomes; and Healthcare setting (PIPOH) format [30]

Guideline clearinghouses, country-specific databases, relevant specialty societies and web sites of organizations developing guidelines. MEDLINE, Google, AltaVista, and Yahoo [38]

AGREE II assess guideline currency, content, and consistency between evidence and recommendations [40]

Construct a table or “matrix” which compares similar recommendations across multiple guidelines and displays relative levels of evidence

Acceptability and Applicability of recommendations; consistency between the developers’ selected evidence, interpretation, and resulting recommendations

N/A

N/A

SNAP-IT by GRADE [28]

Guideline topic requested by the local health authorities

N/A

N/A

A designated chapter editor assessed each chapter and decided whether to adopt or adapt the recommendation.

The chapter editors then follow a predefined taxonomy to decide whether to adopt, adapt or develop a new recommendation.

N/A

If the panel decided to exclude or modify a recommendation, a more extensive reassessment of the underlying evidence is conducted.

Adapted ADAPTE [32]

Determined by the guideline committee in the Patient population, Intervention, Professional/patients, Outcomes; and Healthcare setting (PIPOH) format [32])

Seven CPG resources prioritized from the original 26-long list in ADAPTE and “DynaMed”, BMJ Best Practice and PubMed [32]

AGREE II

Construct a list of recommendations and their respective source guidelines to allow comparison of the recommendations

Assessment done when tailoring more than one guideline that includes selecting some, not all, recommendations from different source guidelines. Consistency between the evidence cited by the guidelines and the respective recommendations is assessed.

N/A

N/A

GRADE-ADOLOPMENT [19]

Guideline topic selected by the local health authorities

N/A

N/A

Take recommendations from existing guidelines that used the GRADE approach and had publicly available evidence summaries in the form of GRADE Summary of Findings (SoFs) tables or evidence profiles (EPs)

Assess each recommendation in EtD tables. The EtDs included the summary of evidence about the benefits and harms of the intervention option(s) and information about the importance of the problem (e.g., baseline risk), patients’ values and preferences, resource use, costs, feasibility, acceptability, and potential impact on health equity of recommending specific intervention options in the context and affected stakeholders

Evidence syntheses related to the existing recommendations were searched for; including systematic reviews and HTAs.

Systematic reviews are updated if the source systematic reviews are older than 3 months and the results fed into the EtD tables. The quality of the evidence was rated using GRADE