Dunja Dreesens

125 representatives such as patient coaches or patient organisations. The developed framework stated the purposes of these tool types and their core elements. The aim of this framework was to create clarity not only on what kind of patient-directed knowledge tool types exist but also which elements they prototypically should contain and to support tool developers and commissioners of tool development to decide when to develop which tool. The framework can also help healthcare professionals, patients and possibly policy advisors when to use which tool type. The framework needs further testing and probing by a larger group of stakeholders, which is why it was presented as a working framework. As was mentioned before, a knowledge tool distils, synthesizes and interprets the highest quality knowledge and research to serve knowledge translation and support (shared) decision- making. But do these tools consider and use all the knowledge sources available? Even though efforts are being made that clinical practice guidelines use different knowledge sources, there still seems to be a preference for scientific evidence. Furthermore, the hierarchy within scientific evidence seems to be very persistent; systematic reviews (SR) and randomized clinical trials (RCT) are often the preferred knowledge source. However, RCTs may be unavailable or not provide the most suitable knowledge. Therefore, the GIN Working Group Appraising and Including Different (AID) Knowledge attempted first to draw (more) attention to the different existing knowledge sources, the exclusion of some of these sources, or using them implicitly without acknowledging them. And second, the Working Group attempted to indicate how to use these different knowledge sources, and showing possible flaws when mainly SRs and RCTs are used when developing tools such as clinical practice guidelines. The working group did this during several consecutive workshops at the annual conferences of the Guidelines International Network (GIN). It resulted in presenting important epistemological 1 reasons to appraise and include a (wider) variety of different types of knowledge when developing guidelines. Appraising and integrating different knowledge will remain a challenge. However, the G-I-N Working Group AID Knowledge believes that much can be done to help guideline developers improve this. By appraising and including different types of knowledge in guideline development, guidelines will contribute to better inferences guiding decisions (chapter 5). To find out what the needs of healthcare professionals are regarding knowledge tools, paediatricians were asked to reflect on tool types and strategies that integrated clinical knowledge and shared decision-making (chapter 6). Paediatricians reviewed and assessed the Dutch clinical practice guideline Palliative Care for Children (2013), that has a separate chapter on shared decision-making including communication recommendations. Other tools and strategies were patient decision aids and altered recommendations on pain relief of the Palliative care for children guideline. The altered recommendations included patient preferences regarding pain relief. Most of the interviewed paediatricians indicated that clinical practice guidelines could enhance the practice of shared decision-making; and did not think that guidelines and shared decision-making were mutually exclusive. They also thought integrating shared decision-making in a guideline was of added value for guidelines in general. Although 1 Epistemology is the branch of philosophy concerned with the theory of knowledge (source https://en.wikipedia . org/wiki/Epistemology). The theory of knowledge and understanding, especially regarding its methods, validity, and scope, and the distinction between justified belief and opinion; (as a count noun) a particular theory of knowledge and understanding (source: Oxford English Dictionary). Date: 1 st August 2019. Chapter 7