scholarly journals Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053587
Author(s):  
Yang Song ◽  
Monica Ballesteros ◽  
Jing Li ◽  
Laura Martínez García ◽  
Ena Niño de Guzmán ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Clinical Guidelines ◽  
De Novo ◽  
Guideline Development ◽  
International Standards ◽  
Adaptation Process ◽  
Implementation Barriers ◽  
Framework Analysis ◽  
Guideline Adaptation ◽  
Semistructured Interviews

ObjectiveThis study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks.DesignA qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants’ views and experiences about adaptation process.SettingNine guideline development organisations from seven countries.ParticipantsGuideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees’ list.ResultsWe conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process.ConclusionsAdaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.

Perspectives on the Value of American Society of Clinical Oncology Clinical Guidelines as Reported by Oncologists and Health Maintenance Organizations

2003 ◽  
Vol 21 (5) ◽  
pp. 937-941 ◽  
Author(s):  
Charles L. Bennett ◽  
Mark R. Somerfield ◽  
David G. Pfister ◽  
Cecilia Tomori ◽  
Sofia Yakren ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Guideline Development ◽  
Health Maintenance Organizations ◽  
National Committee ◽  
Implementation Barriers ◽  
Services Research ◽  
Health Maintenance ◽  
Healthcare Settings ◽  
Academic Practices ◽  
American Society

Purpose: Although the American Society of Clinical Onoclogy’s (ASCO) Health Services Research (HSR) committee activities have primarily focused on clinical guideline development, little is known about the value placed on these guidelines by the desired end users. ASCO members and Health Maintenance Organizations (HMOs) were surveyed on the value and implementation of ASCO guidelines. In this article, we summarize our findings. Methods: ASCO members (n = 1500) were queried about whether they had read ASCO’s first four clinical guidelines and technology assessment; whether they agreed with the recommendations; whether they used guidelines in clinical practice; and how guidelines had affected reimbursement. HMOs (n = 131) were queried on how they identify, implement, and value the first four ASCO clinical guidelines. Results: The membership survey indicated that ASCO guidelines were read more often by physicians in private healthcare settings compared with physicians in academic practices (P < .02). Disagreement rates were low for all guidelines (range, 1% to 7%). One quarter of respondents reported that the guidelines were difficult to find and difficult to apply to the practice setting, and approximately one tenth of respondents indicated that the guidelines were difficult to evaluate, interpret, or read. The HMO survey indicated that one third of HMOs reported use of ASCO guidelines, with higher rates of usage by larger HMOs and by those with higher National Committee on Quality Assurance (NCQA) ratings. Respondent HMOs valued guidelines for various purposes and used multiple methods of guideline identification and implementation. Conclusion: ASCO guidelines are generally highly supported by physicians and HMOs. Additional studies are needed to identify implementation barriers and to see whether guidelines have resulted in improvements in healthcare.

Guideline Adaptation: An Appealing Alternative to De Novo Guideline Development

2008 ◽  
Vol 148 (7) ◽  
pp. 563 ◽  
Author(s):  
Beatrice Fervers ◽  
Magali Remy-Stockinger ◽  
Ian D. Graham ◽  
Bernard Burnand ◽  
Margaret Harrison ◽  
...  
Keyword(s):  
De Novo ◽  
Guideline Development ◽  
Guideline Adaptation

Guideline Adaptation: An Appealing Alternative to De Novo Guideline Development

2008 ◽  
Vol 148 (7) ◽  
pp. 564
Author(s):  
Valerie A. Palda ◽  
Ian D. Graham ◽  
Dave Davis ◽  
Jako Burgers ◽  
Melissa Brouwers ◽  
...  
Keyword(s):  
De Novo ◽  
Guideline Development ◽  
Guideline Adaptation

scholarly journals How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024995 ◽  
Author(s):  
Christopher Robert Vernazza ◽  
Greig Taylor ◽  
Cam Donaldson ◽  
Joanne Gray ◽  
Richard Holmes ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Qualitative Study ◽  
Priority Setting ◽  
Framework Analysis ◽  
Dental Services ◽  
Key Stakeholders ◽  
Final Sample ◽  
Semistructured Interviews ◽  
Service Resource ◽  
Relevant Role

ObjectivesTo understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service.DesignQualitative study using semistructured interviews and a Framework analysis.SettingNational Health Service dentistry commissioning teams within subregional offices in England.ParticipantsAll 31 individuals holding the relevant role (dental lead commissioner in subregional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample.ResultsThree major themes arose. First, ‘Methods of priority setting and barriers to explicit approaches’ was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, ‘Relationships with key stakeholders and advisors’ were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, ‘Tensions between national and local responsibilities’ were illustrated, where there was confusion about where power and autonomy lay.ConclusionsCommissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting.

scholarly journals ‘You see the empty bed which means it’s either a transplant or a death’: a qualitative study exploring the impact of death in the haemodialysis community

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046537
Author(s):  
Sheera Sutherland ◽  
Kirsty E Durley ◽  
Kirsty Gillies ◽  
Margaret Glogowska ◽  
Daniel S Lasserson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Clinical Setting ◽  
Support Services ◽  
Research Team ◽  
Central Importance ◽  
Semistructured Interviews ◽  
Age Range ◽  
The Impact ◽  
Community Patients

ObjectiveTo explore the impact of the death of a patient in the haemodialysis unit on fellow patients.MethodsWe interviewed patients on dialysis in a tertiary dialysis centre using semistructured interviews. We purposively sampled patients who had experienced the death of a fellow patient. After interviews were transcribed, they were thematically analysed by independent members of the research team using inductive analysis. Input from the team during analysis ensured the rigour and quality of the findings.Results10 participants completed the interviews (6 females and 4 males with an age range of 42–88 years). The four core themes that emerged from the interviews included: (1) patients’ relationship to haemodialysis, (2) how patients define the haemodialysis community, (3) patients’ views on death and bereavement and (4) patients’ expectations around death in the dialysis community. Patients noticed avoidance behaviour by staff in relation to discussing death in the unit and would prefer a culture of open acknowledgement.ConclusionStaff acknowledgement of death is of central importance to patients on haemodialysis who feel that the staff are part of their community. This should guide the development of appropriate bereavement support services and a framework that promotes the provision of guidance for staff and patients in this unique clinical setting. However, the authors acknowledge the homogenous sample recruited in a single setting may limit the transferability of the study. Further work is needed to understand diverse patient and nurse experiences and perceptions when sharing the knowledge of a patient’s death and how they react to loss.

scholarly journals Young adults’ perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044777
Author(s):  
Susanne Lundin ◽  
Marina Jonsson ◽  
Carl-Fredrik Wahlgren ◽  
Emma Johansson ◽  
Anna Bergstrom ◽  
...  
Keyword(s):  
Young Adults ◽  
Atopic Dermatitis ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Transition Process ◽  
Population Based ◽  
Self Management ◽  
School Age ◽  
Perceived Availability ◽  
Semistructured Interviews

ObjectivesLearning to take control of one’s health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults’ perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.DesignA qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.ParticipantsYoung adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.ResultsDespite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults’ possibilities to take full control of their AD care.ConclusionsYoung adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

scholarly journals Understanding the Occupational Adaptation Process and Well-Being of Older Adults in Magallanes (Chile): A Qualitative Study

2019 ◽  
Vol 16 (19) ◽  
pp. 3640 ◽  
Author(s):  
Palma ­Candia ◽  
Hueso­Montoro ◽  
Martí-García ◽  
Fernández-Alcántara ◽  
Campos-Calderón ◽  
...  
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Well Being ◽  
Self Esteem ◽  
Adaptation Process ◽  
Occupational Adaptation ◽  
Use Of Time ◽  
Low Levels ◽  
Interpretative Approach ◽  
Depth Interviews

Background: Aging and longevity are important topics nowadays. Purpose: To describe how older adults perform the occupational adaptation process in the extreme region of Magallanes (Chile), and to identify the factors that might contribute to successful occupational adaptation and well-being. Method: Qualitative study, with a phenomenological interpretative approach. In-depth interviews were carried out with 16 older adults, with high or low levels of well-being, assessed with the Ryff Scale. An inductive content analysis according to Elo and Kyngäs was performed. Findings: Resilience, self-esteem and interdependence with significant others are key elements that promote well-being. Participants develop strategies to minimize the effects of environmental factors. The occupation’s function in terms of socialization, use of time, and social participation is revealed as a conditioning factor of occupational adaptation. Implications: Interventions with older people to achieve a successful occupational adaptation process must take into consideration the commitment to meaningful activities.

scholarly journals Long COVID and the role of physical activity: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047632
Author(s):  
Helen Humphreys ◽  
Laura Kilby ◽  
Nik Kudiersky ◽  
Robert Copeland
Keyword(s):  
Physical Activity ◽  
Qualitative Study ◽  
Lived Experience ◽  
Well Being ◽  
Telephone Interviews ◽  
Semistructured Interviews ◽  
The Usa ◽  
The Uk ◽  
Insight Into

ObjectivesTo explore the lived experience of long COVID with particular focus on the role of physical activity.DesignQualitative study using semistructured interviews.Participants18 people living with long COVID (9 men, 9 women; aged between 18–74 years; 10 white British, 3 white Other, 3 Asian, 1 black, 1 mixed ethnicity) recruited via a UK-based research interest database for people with long COVID.SettingTelephone interviews with 17 participants living in the UK and 1 participant living in the USA.ResultsFour themes were generated. Theme 1 describes how participants struggled with drastically reduced physical function, compounded by the cognitive and psychological effects of long COVID. Theme 2 highlights challenges associated with finding and interpreting advice about physical activity that was appropriately tailored. Theme 3 describes individual approaches to managing symptoms including fatigue and ‘brain fog’ while trying to resume and maintain activities of daily living and other forms of exercise. Theme 4 illustrates the battle with self-concept to accept reduced function (even temporarily) and the fear of permanent reduction in physical and cognitive ability.ConclusionsThis study provides insight into the challenges of managing physical activity alongside the extended symptoms associated with long COVID. Findings highlight the need for greater clarity and tailoring of physical activity-related advice for people with long COVID and improved support to resume activities important to individual well-being.

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