Clinical Practice Guideline for End-of-Life Care in Patients with Cancer: A Modified ADAPTE Process

Abstract

PurposeThis study seeks to adapt a guideline for end-of-life care in patients with cancer to be used by healthcare teams.MethodsThis methodological study was conducted by modifying the ADAPTE process and adding to it a qualitative study and consensus ratings by a multidisciplinary panel of experts. A qualitative study was thus performed to identify the end-of-life needs of patients with cancer. Then, the source guidelines and the results of the qualitative study were used to draft the initial version of the guideline, with 85 adaptation recommendations. A multidisciplinary panel of healthcare experts performed the external review of the recommendations based on the four criteria of relatedness, comprehensibility, usefulness, and feasibility and scored them on a scale of 1-9. The mean score of each recommendation was calculated, and the recommendations were classified into three categories: Appropriate (mean score of 7-9), uncertain (mean score of 4-6.99), and inappropriate (mean score of 1-3.99).ResultsAll the recommendations were approved, as they all had a mean score of 7 or higher, and were then categorized into 11 dimensions: Communication management; participatory and evidence-based decision-making management; pain management; dyspnea management; nausea and vomiting management; anorexia and cachexia management; constipation management; death rattle management; management of delirium, anxiety, and restlessness; hydration management; and pharmacological considerations.ConclusionThe adaptation of the guideline for end-of-life care in patients with cancer in Iran was performed by modifying the ADAPTE process with the participation of multidisciplinary stakeholders and based on the local needs.

Clinical practice guideline adaptation for risk-based caries management in 18- 55 years old Iranian adults

“…The same model was administered for adaptation in the previous adaptation studies in medical and dental elds (37,(40)(41)(42). The included guidelines were appraised in the present study using AGREE II.…”

“…To nalize the recommendations, two-round ranking and decision-making according to the RAND-UCLA appropriateness method was applied (33), which was similar to the methods used by Lee et al as the "ADAPTE process and Delphi consensus" (41) and by Irajpour et al as the "modi ed ADAPTE" (40). By contrast, in a study by Anuwar et al (37), the recommendations were nalized by receiving feedback from external reviewers and addressing them in the development committee.…”