Guideline organizations' guidance documents paper 6: adaptation of practice guidelines

Developing high-quality practice guidelines is resource-intensive, leading many guideline-producing organizations to adapt existing recommendations. The objective of this paper is to describe processes for adapting practice guidelines of guideline-producing organizations as described in their guidance documents on guideline development.

We conducted a descriptive summary. Using multiple sources, we compiled a list of guideline-producing organizations and then searched for their publicly available guidance documents on guideline development (eg, handbooks). We included organizations addressing adaptation in their guidance documents. Teams of two authors assessed eligibility and abstracted data in duplicate and independently. We synthesized data in both textual and tabular formats.

Of 133 identified guideline-producing organizations with guidance documents on guideline development, 23 (17%) addressed adaptation. The most frequently addressed aspects of the adaptation process were (1) developing an adaptation plan (91%); (2) the factors considered for modifying source recommendations (91%), including acceptability of the intervention (52%), resource considerations (48%), values and preferences (43%), and applicability of the intervention (40%); (3) assessing the source guidelines (83%), with the three main criteria used being quality (65%), currency (65%), and relevance (39%); and (4) using source recommendations (78%). None of the organizations described a detailed approach for how to explain discordance of recommendations between different source guidelines, and which one to use.

Although this study provides insight into different aspects of the adaptation process, most organizations do not address these aspects in a comprehensive or detailed way. Clearer guidance and checklists are needed to support organizations in conducting efficient and context-specific adaptation efforts.