Background

The ADAPTE Manual and Resource Toolkit has been developed by the ADAPTE Collaboration.

The ADAPTE Collaboration

The ADAPTE Collaboration is an international collaboration of researchers, guideline developers, and guideline implementers who aim to promote the development and use of clinical practice guidelines through the adaptation of existing guidelines. The group’s main endeavour is to develop and validate a generic adaptation process that will foster valid and high-quality adapted guidelines as well as the users’ sense of ownership of the adapted guideline.

Following the development of the ADAPTE Manual and Resource Toolkit and their evaluation, main goals of the ADAPTE Collaboration, the group asked for G-I-N to ensure the continuity of the work in the area.

History

The ADAPTE Collaboration was born of two independent groups focussing on guideline adaptation: the ADAPTE group and the Practice Guideline Evaluation and Adaptation Cycle (PGEAC). Based on the similarity of their concepts and underlying principles and their commonality in process, the two groups decided to join forces and become the current ADAPTE Collaboration.

At the 2005 Guidelines International Network Meeting in Lyon, Béatrice Fervers and Ian Graham, representing both groups, presented a plenary session on guideline adaptation that demonstrated the compatibility of the two approaches.

The ADAPTE group

The ADAPTE group was initiated during a collaborative project involving the French National Federation of Comprehensive Cancer Centres (FNCLCC) and the Department of Cancer Control of the Québec Ministry of Health and Social Services. The initial aim of the project was the adaptation of cancer guidelines developed in France (Standards, Options, Recommendations [SOR]) to the context of cancer care in Québec. To achieve this aim and in response to the increasing interest in guideline adaptation, the group developed a structured framework for the adaptation of clinical practice guidelines as an alternative to de novo guideline development (1). The framework builds on the observation that cultural and organisational differences between and within countries can lead to legitimate variations in recommendations, even when the evidence base is the same. The adaptation of guidelines produced in one cultural and organizational setting for use in another has been called “trans-contextual adaptation.”

The process development was based on the expertise of the Group members and their experiences in different contexts with guideline development and adaptation. The former group involved guideline developers, clinicians, and health services researchers from France (FNCLCC and the French National Authority for Health [HAS]), Canada (Department of Cancer Control Québec), Switzerland (Health Care Evaluation Unit and Clinical Epidemiology Centre (IUSMP); University of Lausanne), and the Netherlands (Dutch Institute for Healthcare Improvement [CBO]).

The ADAPTE process respects evidence-based principles for guideline development and takes into consideration the organisational and cultural context to ensure relevance for local practice. The framework has received input from the scientific board of the SOR programme and a group of 16 oncologists and pharmacists from Québec and has been modified to reflect these comments. The SOR programme and the HAS in France started using the process, and initial experience within the SOR programme showed that guideline adaptation might lead to a reduced length of time for guideline development and that experts appreciated using the process.

Practice Guideline Evaluation and Adaptation Cycle (PGEAC)

Graham and Harrison initially developed the Practice Guideline Evaluation and Adaptation Cycle (PGEAC) for a project that involved creating a regional protocol for the community care of leg ulcers (2,3). The interdisciplinary group that they were working with did not have the resources to develop a clinical practice guideline from inception but wanted to be evidence based in their approach, and so they elected to adapt existing guidelines for local use. The steps used by the PGEAC were intended to guide the process of adapting guidelines and to ensure the adaptation process was as pragmatic and rigorous as possible. Each step of the cycle was based on existing research, when available. A number of groups have since used the framework to adapt guidelines for local, regional, and national use. The Department of Obstetrics at the Ottawa Hospital has used it to develop its protocol for the management of the second stage of labour (4). Nurses have used the framework to adapt gestational diabetes guidelines to the local context of aboriginal peoples. The PGEAC has influenced the guideline development process adopted by the Registered Nurses Association of Ontario (5,6). The framework has also been used by the Stroke Canada Optimization of Rehabilitation through Evidence (SCORE) Project to develop recommendations for upper and lower extremities and risk assessment post-stroke (7).

The PGEAC has also been the focus of a study funded by the Canadian Institutes of Health Research. This study involved forming national panels and studying their use of the PGEAC for developing recommendations for two cancer screening practices (8). The framework has also been used by the Canadian Strategy for Cancer Control Clinical Practice Guideline Action Group to produce guidance on the management of painful bony metastases (9). In addition, in collaboration with the Canadian Strategy for Cancer Control, the Society of Gynecologic Oncologists of Canada has used the process to develop recommendations for the treatment of ovarian cancer (10). All of these experiences with the PGEAC were used to further refine the framework (11,12). In addition to being positively received in the practice community (13), the PGEAC was recently validated by a pre-post study of the implementation of a community care leg ulcer protocol (14,15). The study revealed that, following implementation of the adapted protocol, healing rates increased from 23% in the pre-implementation period to 59% in the post-implementation period.

References

1. Fervers B, Burgers JS, Haugh MC, Latreille J, Mlika-Cabanne N, Paquet L, et al. Adaptation of clinical guidelines: literature review and proposition for a framework and procedure. Int J Qual Health Care. 2006;18(3):167-76.
2. Graham ID, Lorimer K, Harrison MB, Pierscianowski T, for the Leg Ulcer Protocol Tasks Force, Leg Ulcer Protocol Task Force Working Group, et al. Evaluating the quality and content of international clinical practice guidelines for leg ulcers: preparing for Canadian adaptation. Can Assoc Enterostom Ther J. 2000;19(3):15-31.
3. Graham ID, Harrison MB, Lorimer K, Piercianowski T, Friedberg E, Buchanan M, et al. Adapting national and international leg ulcer practice guidelines for local use: the Ontario leg ulcer community care protocol. Adv Skin Wound Care. 2005;18(6):307-18.
4. Sprague A, Oppenheimer L, McCabe L, Brownlee J, Graham ID, Davies B. The Ottawa Hospital's clinical practice guideline for the second stage of labour. J Obstet Gynaecol Can. 2006;28(9):769-79.
5. Graham ID, Harrison MB, Brouwers M, Davies BL, Dunn S. Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations. J Obstet Gynecol Neonatal Nurs. 2002;31(5):599-611.
6. MacLeod FE, Harrison MB, Graham ID. The process of developing best practice guidelines for nurses in Ontario: risk assessment and prevention of pressure ulcers. Ostomy Wound Manage. 2002;48(10):30-8.
7. Canadian Stroke Strategy Best Practices and Standards Working Group (BPS-WG). The Canadian Stroke Strategy: Canadian best practices recommendations for stroke care [monograph on the Internet]. 2006. Available from:
   http://www.canadianstrokestrategy.ca/...StrokeStrategyManual.pdf
8. Zitzelsberger L, Graham ID. Guideline adaptation: reflections on using the practice guidelines evaluation and adaptation cycle with four groups. Unpublished 2007.
9. Syme A, Zitzelsberger L, Graham I. Clinical practice guidelines for metastatic bone pain: application of a national process to bring evidence into practice. UICC World Cancer Congress. 2006 Jul 9-12; Washington (DC).
10. Elit L, Johnson M, Brouwers M, Fung-Kee-Fung M, Browman G, Graham ID. Promoting best gynecologic oncology practice: a role for the Society of Gynecologic Oncologists of Canada. Curr Oncol. 2006;13(1):1-5.
11. Graham ID, Harrison MB, Brouwers M. Evaluating and adapting practice guidelines for local use: a conceptual framework. In: Pickering S, Thompson J, editors. Clinical governance in practice. London: Harcourt, 2003: 213-229.
12. Graham ID, Harrison MB. EBN users' guide: evaluation and adaptation of clinical practice guidelines. Evid Based Nurs. 2005;8:68-72.
13. Reed P. Evidence-based practice. J Obstet Gynecol Neonatal Nurs. 2003;32(1):10.
14. Harrison MB, Graham ID, Lorimer K, Friedberg E, Pierscianowski T, Brandys T. Leg-ulcer care in the community, before and after implementation of an evidence-based service. Can Med Assoc J. 2005;172(11):1447-52.
15. Graham ID, Harrison MB, Cerniuk B, Bauer S. A community-researcher alliance to improve chronic wound care [monograph on the Internet]. 2006 Mar 17. Available from: http://www.cihr-irsc.gc.ca/e/30669.html

Members of the ADAPTE Collaboration

Melissa Brouwers*, PhD		Program in Evidence-based Care, Cancer Care Ontario, McMaster University; Cancer Guidelines Action Group, Canadian Partnership against Cancer - Hamilton, Canada
George Browman*, MD		British Columbia Cancer Agency, Vancouver Island Centre; Cancer Guidelines Action Group, Canadian Partnership against Cancer
Jako Burgers*, MD, PhD		Dutch Institute for Healthcare Improvement, CBO – Utrecht, The Netherlands
Bernard Burnand*, MD, MPH		Health Care Evaluation Unit and Clinical Epidemiology Centre, IUMSP; DUMSC Hospices, CHUV and Faculty of Biology and Medicine, University of Lausanne – Lausanne, Switzerland
Béatrice Fervers*, MD, MSc		Fédération des centres de lutte contre le cancer; Centre Léon Bérard – Lyon, France
Ian D. Graham*, PhD		School of Nursing, University of Ottawa, Canadian Institutes of Health Research; Cancer Guidelines Action Group, Canadian Partnership against Cancer - Ottawa, Canada
Margaret B. Harrison*, RN, PhD		School of Nursing, Queen’s University; Cancer Guidelines Action Group, Canadian Partnership Against Cancer – Kingston, Canada
Jean Latreille*, MDM, FRCP(C)		Direction de la lutte contre le cancer, Ministère de la santé et des services sociaux, Québec; Centre intégré de lutte contre le cancer, Hôpital Charles Lemoyne; Université de Sherbrooke; Cancer Guidelines Action Group, Canadian Partnership against Cancer – Longeuil, Québec
Najoua Mlika-Cabanne*, MD, PhD		Haute autorité de santé, Service des Recommandations Professionnelles – Paris, France
Louise Paquet*, MSc		Direction de la lutte contre le cancer; Ministère de la santé et des services sociaux, Québec; Cancer Guidelines Action Group, Canadian Partnership against Cancer – Montréal, Canada
Raghu Rajan		McGill University Hospital Centre, Comité d’évolution de la pratique en oncologie – Montréal, Canada
Magali Remy-Stockinger		Fédération des centres de lutte contre le cancer; Centre Léon Bérard – Lyon, France
Anita Simon, PhD		Alberta Cancer Board, Knowledge Management Team – Calgary, Canada
Joan Vlayen		Catholic University of Leuven – Leuven, Belgium
Louise Zitzelsberger*, PhD		Cancer Guidelines Action Group, Canadian Partnership against Cancer– Ottawa, Canada
* Founding members