Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation

Schünemann, Holger J; Fretheim, Atle; Oxman, Andrew D

Decisions during local adaptation processes should be transparent and follow procedures that are similar to those used in developing the guidelines, including reporting the key factors that influence any modifications. Two fairly similar approaches have recently appeared that produced frameworks for identifying candidate guidelines for local adaptation. The Practice Guideline Evaluation and Adaptation Cycle (PGEAC) is a 10 step approach (figure 2) [17, 41, 42] . Graham and colleagues describe three alternatives in the PGEAC approach: (a) adopt one guideline with all its recommendations; (b) adopt one guideline, endorsing some of its recommendations but not endorsing recommendations that lack strong evidence or cannot be implemented or adapted locally; or (c) take the best recommendations from each of the guidelines and adapt them for inclusion of the new guideline [17] . If recommendations are modified the rationale for changes should be explicitly stated in the resulting local guideline document.