To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development

Abstract

AimDeveloping new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context.ResultsThe first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply ‘adopt’ this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to ‘contextualise’ the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to ‘adapt’ the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare: a systematic review

“…It is therefore an option that future CPGs on CMSP highlights preference or context sensitive recommendations [39]; and link these recommendations to context applicable implementation strategies, since context factors may play a vital role in applicability. An example of signposting context sensitive recommendations, is illustrated in the novel concept of CPG contextualization, whereby context and practice points are produced and linked to relevant context sensitive recommendations [23, 40]. The inclusion of context and practice points is thought to enhance CPG the application of recommendations in practice.…”

South African Guidelines Excellence (SAGE): Adopt, adapt, or contextualise?

“…CPG adoption is a method where CPGs produced elsewhere are used as is, and directly implemented into practice. [17] Countries with the same patient types, health systems and resources should be able to adopt and implement such CPG recommendations.…”

“…CPG contextualisation is a method where recommendations from CPGs produced elsewhere can be adopted; however, additional information is required to address local contexts. [17][18] Current good-quality CPGs for many conditions, such as chronic pain, should be applicable to patients in most settings. The challenge is to contextualise (localise the evidence to fit local contexts), [19] e.g.…”

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary health care: A systematic review

“…It is therefore an option that future CPGs on CMSP highlights preference or context sensitive recommendations [39]; and link these recommendations to context applicable implementation strategies, since context factors may play a vital role in applicability. An example of signposting context sensitive recommendations, is illustrated in the novel concept of CPG contextualization, whereby context and practice points are produced and linked to relevant context sensitive recommendations [23,40]. The inclusion of context and practice points is thought to enhance CPG the application of recommendations in practice.…”