Dunja Dreesens

130 Tools and knowledge The following section provides a somewhat deeper reflection on the main issues encountered, as well as comparisons with the current literature while returning to the concerns as described in the (worlds of the) introduction of this thesis. As there are many issues relevant to the uptake of knowledge and the use of tools, I focus on four overarching issues. Be more precise and stick to it One way of coping with the vast and expanding knowledge body (in 2007 11 new systematic reviews each day, nowadays 82 systematic reviews according to KSR Evidence) in health care is to develop tools. Tools that assist knowledge translation and support evidence-informed (shared) decision making, in short knowledge tools. These tools synthesize and interpret knowledge and in this way help to get research from ‘bench to bedside’ (73), or as it is called in the domain of knowledge translation (KT) in health care: ‘moving knowledge to use’ (292). And while we are very conscious and deliberate regarding the ‘defining and interpretation’ of evidence, for example when developing clinical practice guidelines (297, 298), we seem to be more careless when it comes to defining and explaining knowledge tools. A multitude of tool types is available to clinicians and patients, and they are mostly ill defined. There is no common shared terminology, which is key for development, implementation and use of these tools, which in turn might impede knowledge translation in health care. Not a lot of similar research has been found on defining tool types at a (inter)national level and limiting the number of tool types, but there have been several appeals to reduce the number of tool types with the aim to increase clarity and use, and so improve quality of health care and to be more vigilant about defining tools (70, 112). Stiggelbout (88) did so in 2010 when reviewing the definition and classification of patient decision aids and Blume did so in 2016 when looking at external demands, among which knowledge tools hospitals have to comply with in order to deliver high quality and safe care (80, 299). Already in 1992, Norma Lange made an acute observation when explaining the trouble if we cannot define things; if we cannot define it, we cannot control it, practice it, teach it, finance it, or put in into practice (112). Stakeholders reaching consensus on a national level on a core set of tool types and their definitions in the Netherlands was a promising first step. Several Dutch tool developers even decided to use or adopt the core set and to assign funding only to developing tool types belonging to this core set. However, real life practice proved (as expected) to be more wilful. For example, one of the stakeholders involved in the consensus procedure felt it necessary to re-do the exercise of defining the tool types for the benefit of their own organisation’s rank and file acceptance (300, 301). Furthermore, it seems that with an expanding knowledge base, the tool box keeps expanding as well. New tool types are still emerging, or they appear to be. The National Health Care Institute is for example working on a tool type called ‘care tree’ (107), which in essence is a digital decision tree. Another example is the ‘quality standard’. In the Delphi study it was considered an umbrella term for tool types such as clinical practice guidelines and care standards, and it Chapter 7