Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews

Abstract

ObjectiveThis study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks.DesignA qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants’ views and experiences about adaptation process.SettingNine guideline development organisations from seven countries.ParticipantsGuideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees’ list.ResultsWe conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process.ConclusionsAdaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.

Determinants of regulatory compliance in health and social care services: a systematic review using the Consolidated Framework for Implementation Research

“…There was an expectation on behalf of the authors that a larger number of qualitative studies would be found. There is an extensive field of qualitative enquiry on the implementation of other aspects of quality in health and social care such as clinical guidelines (242, 243) , quality improvement initiatives (244, 245) , patient feedback (246, 247) , and professional regulation. (248) Moreover, the regulation and compliance literature is replete with qualitative studies of organisational responses to regulation, yet very few examine organisations working in health and social care.…”

Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research

“…There was an expectation on behalf of the authors that a larger number of qualitative studies would be found. There is an extensive field of qualitative enquiry on the implementation of other aspects of quality in health and social care such as clinical guidelines [ 244 , 245 ], quality improvement initiatives [ 246 , 247 ], patient feedback [ 248 , 249 ], and professional regulation [ 250 ]. Moreover, the regulation and compliance literature is replete with qualitative studies of organisational responses to regulation, yet very few examine organisations working in health and social care [ 236 ].…”

Guia de adaptação e implementação de diretrizes baseadas em evidências. Segunda edição

“…Existem diferentes modelos de adaptação de diretrizes, como ADAPTE (62), GRADE-ADOLOPMENT (63,64), o modelo do Royal College of Nursing (RCN) (65), RAPADAPTE (66), Dynamed (67) e o Systematic Guideline Review Method (68). Cada um apresenta uma abordagem com 8 a 12 etapas, com diferentes ferramentas e níveis de complexidade, a fim de identificar a confiabilidade das diretrizes que serviram de base para a adaptação e como os juízos de valor que levaram à formulação das recomendações podem ser aplicados a novas diretrizes adaptadas (6,69).…”