title: Adaptation of trustworthy guidelines developed using the GRADE methodology: a novel five-step process.
abstract: BACKGROUND
  Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting.
  
  
  METHODS
  Informed by the ADAPTE framework, we developed a five-step adaptation process customized to guidelines developed using GRADE: (1) planning, (2) initial assessment of the recommendations, (3) modification, (4) publication, and (5) evaluation. We developed a taxonomy for describing how and why recommendations from the parent guideline were modified and applied a mixed-methods case study design for evaluation of the process.
  
  
  RESULTS
  We published the adapted guideline in November 2013 in a novel multilayered format. The taxonomy for adaptation facilitated transparency of the modification process for both the guideline developers and the end users. We excluded 30 and modified 131 of the 333 original recommendations according to the taxonomy and developed eight new recommendations. Unforeseen obstacles related to acquiring a licensing agreement and procuring a publisher resulted in a 9-month delay. We propose modifications of the adaptation process to overcome these obstacles in the future.
  
  
  CONCLUSIONS
  This case study demonstrates the feasibility of a novel guideline adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodologic efficiency of guideline adaptation.
authors.affiliation: Department of Internal Medicine, Innlandet Hospital Trust Gjøvik, Institute for Health and Society, University of Oslo, Oslo, Norway; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: annettekrist@gmail.com.
authors.forename: Annette
authors.initials: A
authors.lastname: Kristiansen
authors.affiliation: Department of Internal Medicine, Innlandet Hospital Trust Gjøvik, Institute for Health and Society, University of Oslo, Oslo, Norway; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Linn
authors.initials: L
authors.lastname: Brandt
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Agoritsas
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: Department of Internal Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
authors.affiliation: Department of Surgery, Bærum Hospital, Vestre Viken Hospital, Drammen, Norway.
authors.forename: Johan
authors.initials: J
authors.lastname: Bondi
authors.affiliation: Department of Hematology, Oslo University Hospital, Oslo, Norway.
authors.forename: Anders E
authors.initials: AE
authors.lastname: Dahm
authors.affiliation: Department of Physical Medicine and Rehabilitation, Department of Pain Management and Research, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway.
authors.forename: Lars-Petter
authors.initials: LP
authors.lastname: Granan
authors.affiliation: Division of Emergencies and Critical Care, Department of Cardiology B, Oslo University Hospital, Oslo, Norway.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Halvorsen
authors.affiliation: Department of Hematology, Oslo University Hospital, Oslo, Norway.
authors.forename: Pål-Andre
authors.initials: PA
authors.lastname: Holme
authors.affiliation: Department of Internal Medicine, Innlandet Hospital Trust Gjøvik, Institute for Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Flem Jacobsen
authors.affiliation: Department of Hematology, Oslo University Hospital, Oslo, Norway; Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
authors.forename: Eva-Marie
authors.initials: EM
authors.lastname: Jacobsen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Neumann
authors.affiliation: Faculty of Medicine, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway.
authors.forename: Per Morten
authors.initials: PM
authors.lastname: Sandset
authors.affiliation: Center for Vascular Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Torunn
authors.initials: T
authors.lastname: Sætre
authors.affiliation: Department of Medical Research, Bærum Hospital, Vestre Viken Hospital, Drammen, Norway.
authors.forename: Arnljot
authors.initials: A
authors.lastname: Tveit
authors.affiliation: Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital, Drammen, Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Vartdal
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Internal Medicine, Innlandet Hospital Trust Gjøvik, Institute for Health and Society, University of Oslo, Oslo, Norway; Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Per Olav
authors.initials: PO
authors.lastname: Vandvik
mesh_terms: D019317:Evidence-Based Medicine / Q000379:methods*; D005240:Feasibility Studies; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009664:Norway; D017410:Practice Guidelines as Topic / Q000592:standards*; D011642:Publications; D012307:Risk Factors; D012955:Societies, Medical; D013927:Thrombosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents