Dunja Dreesens

135 (ISEHC) and International Shared Decision-making (ISDM) (327) can be considered as signs that EBM and SDM, and their tools are connecting. Be inclusive, not exclusive It has been said several times already, knowledge in health care keeps accumulating and it is almost impossible to keep abreast of the research evidence in health care. Tools are being developed to help cope with the vast amount of knowledge, but these tools do not consider all knowledge sources. And as the previous section pointed out, it is not always that easy to include other sources of knowledge (patient preferences) as means are scarce and ‘how to’ remains elusive. The development of clinical practice guidelines has profited immensely from evidence-based medicine, but as was described in the introduction and by the GIN working group AID Knowledge the focus in EBM has been skewed towards research evidence (26, 308, 328) and within this body of knowledge, randomised clinical trials are the dominant type of knowledge. Attention to this imbalance has been called by others as well. Not just because relying on one knowledge source, is short-selling the other knowledge sources, but also because they are some flaws within that particular knowledge source (28, 74). Figure 2: Research waste and ‘evidence-biased’ medicine (adapted from Chalmers et al, 2009; Moher et al, 2016; Burgers, 2016) Describing those flaws in 2009, Chalmers et al made it clear that there is a ‘chain of knowledge’ and each link has its flaws, leading them to conclude that there is research waste and that by relying too much on flawed knowledge leads to ‘evidence-biased’ medicine (see figure 2). Chapter 7