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


RESULTS
The 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.
Faculty of Medicine and Health Sciences, Centre for Evidence-Based Health Care (CEBHC), Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa. dizonj@sun.ac.za.|Center for Health Research and Movement Science, College of Rehabilitation Sciences, University of Santo Tomas, 1018, Manila, Philippines. dizonj@sun.ac.za.
Janine Margarita
JM
Dizon
Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.|European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.
Shingai
S
Machingaidze
International Centre for Allied Health Evidence (iCAHE), City East Campus, University of South Australia, P4-18 North Terrace, Adelaide, 5000, Australia.
Karen
K
Grimmer
D003680:Deglutition Disorders / Q000175:diagnosis; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic
Clinical practice guidelines; Guideline adaptation; Guideline adoption; Guideline contextualisation; Guideline development