Background: De novo guideline development is labour intensive, costly and often unnecessarily repetitive. The RAPADAPTE approach reduces these concerns but can be challenging if the foundational guidelines being adapted do not match the framework for the guideline being developed.

Objectives: To expedite guideline adaptation and development by using the PICO elements, to both to clarify the existing recommendations in foundational guidelines and to formulate the precise questions to establish a guideline framework for the new Bahrain Breast Cancer guideline.

Methods: 90 clinical recommendations in the foundational Costa Rican breast cancer guideline were translated into English and expanded by expressing Population and Intervention pairings. Sorting the 90 recommendations by Population/Intervention pairings identified areas for convergence and divergence of recommendations. Mapping of these pairings to DynaMed Plus was used to further model a clinical approach to concept organiSation, and facilitate evidence identification and appraisal for guideline development. Adding Comparators increased clarity and precision for communications across guideline developers to define the scope of the recommendations. Adding Outcomes increased clarity and precision for the focus when evaluating evidence to formulate the recommendations.

Results: The guideline scope was expanded to 125 recommendations. 21 population classifications and 85 intervention classifications were coded and easily sorted in Excel to produce a clinically relevant framework which was used to shape the content and scope of the guideline.

Conclusions: PICO-based organisation of the guideline framework provided precise understandings of the 125 recommendations to be developed, and facilitated identification of direct links to the corresponding sections of DynaMed Plus where comprehensive and critically appraised evidence is available to facilitate guideline development.