Trans-contextual adaptation of guidelines is increasingly being considered as an alternative to de novo guideline development. The proposed approach should be validated and evaluated to determine if it can reduce duplication of effort and inefficient use of resources, although guaranteeing a high-quality product, compared with de novo development.

Background The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patient's perspective is taken into consideration when such decisions are made.

Some healthcare organizations recommend adopting open visiting policies. These organisations are working towards the end goal of promoting the idea that patients and families can be true partners in care. An essential step in this culture shift involves openness to family presence and their engagement in the patient's care. Among other things, their recommendations are based on data from studies that assessed the impacts of different types of visiting policies on patients, families and healthcare staff. In order to inform and guide an organizational reflection on possible changes to our hospital center's visiting policies, our team undertook a systematic review that focussed on the advantages and disadvantages of open/flexible visiting policies, as perceived by patients, families and staff. Review articles and original articles were assessed and synthesized following a rigorous review process. Results of the reviewed studies suggest that flexible visiting policies lead to greater patient satisfaction with care and to positive impacts for both patients and families, and that these stakeholders have clear preferences for open/flexible policies. Nevertheless, policies including some guidelines to safeguard rest and sleep periods were deemed necessary by patients, rather than an unqualified open policy. Results also suggested that flexible visiting hours were not associated with an increased risk in hospital-acquired infections or septic complications in intensive care units (ICUs), where the majority of the reviewed studies were carried out. Authors recommended taking the specific context of care units into account when implementing new visiting policies, as needs may be different according to different health issues. Staff preferences over a model or the other were somewhat mixed. Some staff see the presence of families and visitors as an obstacle to the provision of care and a reason to fear increased workloads. In order to overcome this resistance, the importance of adequately preparing staff and supporting them throughout the policy change to ensure its success is highlighted.

Patient consultation was seen as having directly influenced the content of the HTA report while direct participation made it possible to rephrase some findings. This is one of few studies to assess the impact of patient involvement in HTA and more such studies are needed to identify the best ways to improve the input of such involvement.

The proposed framework was seen as a reference tool for making practitioners and health managers aware of the different mechanisms of user involvement in HTA and providing a structured way to classify and describe strategies. However, there is a need for more concrete instruments to guide practice and support decision making on specific strategies for user involvement in HTA at the local level.