Dunja Dreesens

126 for the clinical practice guideline Palliative Care for Children it would have been more helpful if the guideline would have made clear how to practice shared decision-making instead of just recommending it. Modified guideline recommendations, in such a way that they prompted asking for or clarified patient preferences were in majority regarded as useful strategies to enhance shared decision-making. Which was also the case for providing patient decisions aids together with the guideline. SDM does not concern just non-treatment related decisions but also treatment related decisions. Strengths & limitations For the research in this thesis, I have chosen a predominant qualitative research approach. This was done for several reasons. First of all, the research is of an exploratory nature and a better, detailed understanding of a complex issue, requiring inductive and deductive reasoning was needed. Moreover, quantitative methods and statistical analyses seemed not to fit the research questions (264). On the one hand, I was after improved understanding of perspectives, experiences, opinions, attitudes concerning the use and translation of knowledge, knowledge tool types, and comprehension of the needs of healthcare professionals when using these tool types. On the other hand, I tried to reach consensus on (developing) criteria and purposes of these tool types. First, I will reflect on the different studies described in this thesis, the various methods and settings used suitable for a policy oriented thesis that also looks at the primary process in the end. However, related to qualitative research certain strengths and limitations should be mentioned. These will be addressed when reflecting respectively on credibility, transferability and dependability of the research per chapter and overall for the thesis. Credibility refers to the believability and trustworthiness of the findings. In qualitative research, the richness of data is important and that participants feel the findings are credible and accurate. Transferability is about the generalizability of the data. Dependability concerns the consistency with which the findings can be repeated and will result in similar findings. It is also interlinked with the chosen research method (294). The terms ‘credibility’, ‘transferability’ and ‘dependability’ are also known respectively as ‘internal validity’, ‘external validity’ and ‘reliability’ and these terms can be loosely matched respectively with the terms ‘validity’, ‘generalizability’, ‘reliability’ and ‘replication’ which are more common in quantitative research (295). We tried to accomplish the credibility, transferability and dependability via several approaches. Credibility To achieve credibility a number of approaches were used. Regarding the scoping review (chapter 2; Dutch chaos case) a broad range of different organisations were included to ensure a good overview of the Dutch situation concerning the availability of knowledge tools. Furthermore, an iterative approach was used to reveal possible additional new sources to be considered. The findings were spot-checked twice independently by the co-authors. A scoping review is not as thorough as a systematic review, combined with the restriction to curative and palliative care, this could mean that some tool types were missed. The aim however was to prove the hypothesis that there existed numerous knowledge tool types in the Netherlands and not to achieve an exhaustive overview of these tools. Chapter 7