Enhancing cancer care guideline development and implementation using formal guideline adaptation: methodology description

Introduction (comprising background and problem statement): Clinical Practice Guidelines (CPGs) assist healthcare practitioners and patients in making decisions about evidence informed interventions to manage specific health related circumstances. They act as a mechanism for a systematic integrated delivery of care. Despite the existence of high quality international CPGs, their adoption and implementation in practice remains low. This is a real concern for healthcare policy makers and guideline developers. Adapting existing CPGs for local use using formal guideline adaptation frameworks has been advanced as an efficient method to foster better implementation. Guideline adaptation involves identifying standards and recommendations from existing quality CPGs and then contextualising them into an adapted guideline that is implementable within the practice setting intended. The importance of scientific methods to inform this process is critical.  Description of policy context and objective: This paper provides a description of Guideline Adaptation methodology. The methodology described formed a study protocol that developed guidelines for the management of menopausal symptoms in breast cancer survivors within cancer services in North East Ireland. The methodology is underpinned by Implementation Science. Developed by the Canadian Partnership against Cancer, the CAN-IMPLEMENT programme © provides the overarching framework (1). The paper describes the methodology in three phases. The first phase focuses on the establishment of a participatory co-design model and involvement of patients, healthcare professionals and policy makers. The second phase describes the appraisal and evaluation of existing international clinical guidelines using the AGREE II instrument (2). The final phase focuses on guideline adaptation and implementation planning using the Consolidated Framework for Implementation Research (CFIR) (3) and Taxonomy of Implementation Strategies (4). Highlights (innovation, Impact and outcomes): This protocol provides an evidence informed guideline adaptation methodology using a collaborative model of co-design and co-production. The impact of the methodology is threefold in terms of outcomes. It enhances guideline development and implementation. It fosters networks and relationships where healthcare professionals and patients as equal partners address healthcare issues of concern. It promotes capacity building among healthcare stakeholders in guideline adaptation and implementation. Transferability: This protocol will inform other guideline groups in effective efficient methods for advancing the translation of CPGs into practice. This protocol could be applied to other settings as well as other clinical topics to strengthen the evidence on the adaption and implementation of CPGs. References: 1- 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. 2- Collaboration A. AGREE II Instrument and training resources.  2010. Available from: https://www.agreetrust.org/ 3- Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4. 4- Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science. 2015;10(1):21.