Van Campe Fien, Chambaere Kenneth, Pivodic Lara, Gilissen Joni, Pesut Barb, Duggleby Wendy, Smets Tinne, Szczerbińska Katarzyna, Furlan de Brito Maja, Davies Andrew, Ferraris Davide, van der Plas Annicka, Scacciati Bianca, Van den Block Lieve
End-of-Life Care Research Group, Vrije Universiteit Brussel & Universiteit Gent, Brussels, Belgium.
Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium.
Palliat Med. 2025 Apr;39(4):460-472. doi: 10.1177/02692163251320507. Epub 2025 Mar 19.
Systematic adaptation of evidence-informed interventions is critical for effective transfer across settings. Public health palliative care interventions pose unique challenges because of their complexity and embedding in dynamic, real-life settings. The ADAPT guidance provides a comprehensive framework for systematically adapting evidence-informed health interventions, yet its application in public health palliative care remains unexplored.
Within the EU NAVIGATE project, this study describes the international adaptation process of a Canadian navigation program supporting older people with cancer experiencing declining health, for implementation in six European countries. It also reflects on the methodological insights gained from applying the ADAPT guidance in public health palliative care.
Using an iterative five-stage multi-method approach, we followed the ADAPT guidance and its recommended frameworks. Stage 1 assessed context-intervention fit and identified core and adaptable components of the original intervention. Stage 2 adapted implementation materials, while stage 3 involved a contextual analysis. Stage 4 focused on adapting the training for implementers, and stage 5 reviewed feasibility.
The ADAPT guidance proved flexible and useful, though systematic adaptation posed challenges due to the unique complexities of public health palliative care interventions. These included balancing intervention integrity with cultural sensitivities and local juridical regulations regarding end of life. Our process addressed these challenges through contextual assessments, identifying core components, engaging with original developers, and collaboration between local and international adaptation teams.
A systematic adaptation process, guided by the ADAPT guidance is feasible, but transferring public health palliative care interventions requires careful methodological, contextual, and conceptual considerations.
系统地调整基于证据的干预措施对于跨环境有效推广至关重要。公共卫生姑息治疗干预措施因其复杂性以及在动态现实环境中的嵌入性而带来独特挑战。ADAPT指南为系统地调整基于证据的卫生干预措施提供了一个全面框架，但其在公共卫生姑息治疗中的应用仍未得到探索。
在欧盟“导航”项目中，本研究描述了一项加拿大导航项目的国际调整过程，该项目为健康状况下降的老年癌症患者提供支持，以便在六个欧洲国家实施。它还反思了在公共卫生姑息治疗中应用ADAPT指南所获得的方法学见解。
我们采用迭代的五阶段多方法方法，遵循ADAPT指南及其推荐框架。第一阶段评估背景与干预的契合度，并确定原始干预措施的核心和可调整组成部分。第二阶段调整实施材料，第三阶段进行背景分析。第四阶段专注于调整对实施者的培训，第五阶段审查可行性。
事实证明，ADAPT指南灵活且有用，不过由于公共卫生姑息治疗干预措施的独特复杂性，系统调整带来了挑战。这些挑战包括在干预完整性与文化敏感性以及关于生命末期的当地法律法规之间取得平衡。我们的过程通过背景评估、确定核心组成部分、与原始开发者合作以及当地和国际调整团队之间的协作来应对这些挑战。
在ADAPT指南指导下的系统调整过程是可行的，但转移公共卫生姑息治疗干预措施需要仔细的方法学、背景和概念性考量。
