Article Text


How to adapt existing evidence-based clinical practice guidelines: a case example with smoking cessation guidelines in Canada
  1. Peter Selby1,2,3,4,
  2. Katie Hunter1,5,
  3. Jess Rogers5,
  4. Kelly Lang-Robertson5,
  5. Sophie Soklaridis3,6,
  6. Virginia Chow1,
  7. Michèle Tremblay7,
  8. Denise Koubanioudakis7,
  9. Rosa Dragonetti1,
  10. Sarwar Hussain1,
  11. Laurie Zawertailo1,8
  1. 1 Centre for Addiction and Mental Health, Addictions Program, Toronto, Ontario, Canada
  2. 2 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  4. 4 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5 Centre for Effective Practice, Toronto, Ontario, Canada
  6. 6 Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  7. 7 Institut National de Santé Publique du Québec, Montreal, Québec, Canada
  8. 8 Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Peter Selby; peter.selby{at}


Objective To develop and encourage the adoption of clinical practice guidelines (CPGs) for smoking cessation in Canada by engaging stakeholders in the adaptation of existing high-quality CPGs using principles of the ADAPTE framework.

Methods An independent expert body in guideline review conducted a review and identified six existing CPGs, which met a priori criteria for quality and potential applicability to the local context. Summary statements were extracted and assigned a grade of recommendation and level of evidence by a second expert panel. Regional knowledge exchange brokers recruited additional stakeholders to build a multidisciplinary network of over 800 clinicians, researchers and decision-makers from across Canada. This interprofessional network and other stakeholders were offered various opportunities to provide input on the guideline both online and in person. We actively encouraged end-user input into the development and adaptation of the guidelines to ensure applicability to various practice settings and to promote adoption.

Results The final guideline contained 24 summary statements along with supporting clinical considerations, across six topic area sections. The guideline was adopted by various provincial/territorial and national government and non-governmental organisations.

Conclusions This method can be applied in other jurisdictions to adapt existing high-quality smoking cessation CPGs to the local context and to facilitate subsequent adoption by various stakeholders.

  • smoking cessation
  • clinical practice guideline
  • tobacco
  • healthcare provider
  • guideline implementation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors PS was the principal investigator and provided overall supervision of the project at all stages. PS, KH, JR, KL-R, VC, MT, DK, RD, SH and LZ each made substantial contributions to the guideline development concept and process. KH wrote the initial draft of the manuscript. PS, KH, JR, KL-R, SS, VC, MT, DK, RD, SH and LZ revised the manuscript critically for important intellectual content.

  • Funding Funding was provided by Health Canada (Drugs and Tobacco Initiatives Program).

  • Competing interests No pharmaceutical or tobacco industry funds were used or received in the development of these guidelines. During the course of the grant, PS received funding for ad hoc consulting for advisory boards, education and unrestricted research grants from manufacturers of smoking cessation medications including Pfizer, Johnson and Johnson, Nabi Pharmaceuticals via an arm’s length Data Safety and Monitoring Board, Novartis and Biovail. PS also received consulting fees from manufacturers of anti-addiction medications including Prempharm, Lundbeck and Sanofi Synthélabo. No funds for entertainment were accepted. VC reports grants from Drugs and Tobacco Initiatives Program, Health Canada, during the conduct of the study. LZ reports grants from Global Research Awards for Nicotine Dependence, and a grant from Pfizer Canada, outside the submitted work. The remaining authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.