Developing clinical guidelines for the management of menopausal symptoms in breast cancer survivors: process evaluation

Introduction: In Ireland, the risk of a women developing breast cancer is 1 in 9. For hormone responsive breast cancer, the risk of re-occurrence is reduced by anti-hormone therapy. However, the treatment induces menopausal symptoms that are often severe and adversely impact on quality of life and treatment adherence. This project adopts a guideline adaptation approach to develop clinical guidelines for the management of menopausal symptoms in breast cancer survivors in North East Ireland. Guideline adaptation involves identifying standards from existing clinical practice guidelines and contextualising them into an adapted guideline for local context. Guideline adaptation frameworks offer a systematic way of approaching adaptation to improve transparency, methodological rigor, and the quality of the adapted guideline (1). This paper provides a process evaluation on the value and utility of the guideline adaptation framework CAN-IMPLEMENT © (2, 3). Methods: This case study design utilised a collaborative participatory model within the CAN-IMPLEMENT © Framework.. Stakeholder engagement included patients, policymakers, researchers and healthcare professionals from medical oncology, cancer nursing, pharmacy and community. An evaluation was conducted with the Guideline Development Group. Data collection included documentary meeting notes, individual interviews and a validation evaluation forum. Findings: CAN-IMPLEMENT was evaluated as a rigorous, systematic method that provided novice guideline developers with methodological and practice assistance in both guideline adaptation and implementation planning. The AGREE II tool for appraisal and evaluation of existing international clinical guidelines was evaluated as a positive feature of the framework.  The framework was limited in providing tools to support implementation planning. The facilitating strategies for multidisciplinary collaboration embedded within CAN-IMPLEMENT was considered a favourable feature of the framework as it facilitated strong stakeholder engagement to facilitate the complex multi-faceted process of guideline adaptation. Conclusions: CAN-IMPLEMENT provides transparency and methodological rigor for the development of a quality adapted guideline. The collaborative approach fosters engagement and empowerment of patients and healthcare communities to become equal partners in care. Discussions: A guideline adaptation framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs and implementation into account. Stakeholder engagement is a potent mechanism to develop capacity building among the local healthcare community. Lessons learned: Developing a guideline without adequate consideration of local context implementation hinders the uptake and adoption of existing high quality guidelines.  CAN-IMPLEMENT is a valuable framework to address this challenge and has application potential across any healthcare environ. Limitations: This process evaluation was a single case study representing a cancer health service region in Ireland. The evaluation was based on self-reports rather than a formal framework evaluation tool. Suggestions for future research: This evaluation could be augmented by other evaluation studies of CAN-IMPLEMENT.  References: 1- Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implementation Science. 2018;13(1):72. 2- Harrison MB, Graham ID, van den Hoek J, Dogherty EJ, Carley ME, Angus V. Guideline adaptation and implementation planning: a prospective observational study. Implementation Science. 2013;8(1):49. 3- Cancer CPA. Canadian Partnership Against Cancer Toronto CAN-IMPLEMENT]. Available from: https://www.partnershipagainstcancer.ca/can-implement/