Dunja Dreesens

136 In 2014, a follow-up of the review was carried out to see how the research waste could be reduced. The subsequent recommendations to reduce waste were not just aimed at researchers but also at funders, regulators, journals and academic institutions (329-333). In 2016, Moher et al tried to establish if the recommendations from 2009 and 2014 were followed through (see figure 2). They noticed some “gratifying traction” but concluded more effort was still needed, repeating that stakeholders should interact more (334). Greenhalgh et al (328) and two Dutch governmental advisory boards reached similar conclusions (335, 336) and made a plea to return to ‘real evidence based medicine’. They were referring to the three pillars of EBM as defined by Sackett et al (26); restating that more attention needs to be paid to patient experience, the real life clinical encounter and context. Attempts are carried out to include different sources of knowledge while developing clinical practice guidelines (247, 337). And with effect; several NICE guidelines have been refocussed due to patient input (328). When Lukersmith et al tried to use different sources of knowledge developing a guideline, they experienced the difficulty in current guideline methodology to consider context and information from different sources of knowledge besides quantitative research. They therefore used the ICF (International Classification of Functioning, Disability and Health framework (WHO, 2001) to manage the complexity of using different sources of knowledge (312). To achieve optimal patient care, provide more effective healthcare services and strengthen the healthcare system, the use of all knowledge sources is necessary. Not using all sources is a kind of research waste as well. I concur with Askheim et al when they said: we need to “remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner’ (338). This means making tool developers (and other stakeholders) more aware of the availability of different knowledge sources, the possible flaws within the knowledge base and that it is pertinent to continue working on methods how to appraise and include different knowledge sources. We might take our cue from other disciplines, such as environmental sciences. To make their research findings more robust and trustworthy the IPCC (Intergovernmental Panel on Climate Change) involved other sciences and worked cross-disciplinary when developing their report on climate change and food shortages (339, 340). A case of consilience If one thing has become clear to me at the end of this thesis, is that a lot of domains, disciplines, expertise, parties and professionals are involved when it comes to knowledge translation and the tools developed to support knowledge translation and (shared) decision-making. However, most of these domains, disciplines, parties and professionals currently work in their own silos of the knowledge cycle. This knowledge cycle consists of: knowledge production; knowledge synthesis; tool development; dissemination and implementation of knowledge (tools) into practice; knowledge use; and evaluation of knowledge use and impact on healthcare and patient outcomes (292, 341). In order to achieve optimal (health) care, the different parts of the knowledge cycle and their ‘inhabitants’ need to be well connected, so that knowledge moves more fluently into practice. It also means that all knowledge sources should be considered, and we should not restrict ourselves to knowledge sources within medicine. You could say it is a case of consilience (342). The term was coined by William Whewell in the 19 th century. In his Chapter 7