title: Adaptation of clinical guidelines: literature review and proposition for a framework and procedure.
abstract: OBJECTIVE
  The development and updating of high-quality clinical practice guidelines require substantial resources. Many guideline programmes throughout the world are using similar strategies to achieve similar goals, resulting in many guidelines on the same topic. One method of using resources more efficiently and avoiding unnecessary duplication of effort would be to adapt existing guidelines. The aim was to review the literature on adaptation of guidelines and to propose a systematic approach for adaptation of guidelines.
  
  
  METHODS
  We selected and reviewed reports describing the methods and results of adaptation of guidelines from those found by searching Medline, Internet, and reference lists of relevant papers. On the basis of this review and our experience in guideline development, we proposed a conceptual framework and procedure for adaptation of guidelines.
  
  
  RESULTS
  Adaptation of guidelines is performed either as an alternative to de novo guideline development or to improve guideline implementation through local tailoring of an international or national guideline. However, no validated process for the adaptation of guidelines produced in one cultural and organizational setting for use in another (i.e. trans-contextual adaptation) was found in the literature. The proposed procedure is a stepwise approach to trans-contextual adaptation, including searching for existing guidelines, quality appraisal, detailed analysis of the coherence between the evidence and the recommendations, and adaptation of the recommendations to the target context of use, taking into account the organization of the health care system and cultural context.
  
  
  CONCLUSIONS
  Trans-contextual adaptation of guidelines is increasingly being considered as an alternative to de novo guideline development. The proposed approach should be validated and evaluated to determine if it can reduce duplication of effort and inefficient use of resources, although guaranteeing a high-quality product, compared with de novo development.
authors.affiliation: Unité d'évaluation des soins, Iumsp, Hospices-Chuv, Lausanne, Switzerland. fervers@lyon.fnclcc.fr
authors.forename: Béatrice
authors.initials: B
authors.lastname: Fervers
authors.forename: Jako S
authors.initials: JS
authors.lastname: Burgers
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Haugh
authors.forename: Jean
authors.initials: J
authors.lastname: Latreille
authors.forename: Najoua
authors.initials: N
authors.lastname: Mlika-Cabanne
authors.forename: Louise
authors.initials: L
authors.lastname: Paquet
authors.forename: Martin
authors.initials: M
authors.lastname: Coulombe
authors.forename: Mireille
authors.initials: M
authors.lastname: Poirier
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
mesh_terms: D004059:Diffusion of Innovation; D005060:Europe; D017410:Practice Guidelines as Topic / Q000592:standards*