Dunja Dreesens

137 book Philosophy of the Inductive Sciences, he used it to discuss the unification of knowledge between the different branches of learning (343). I think the concept can be applied not just to knowledge but to knowledge translation and knowledge tools as well. With the unification of all the domains, disciplines, parties and professionals involved in knowledge translation and tool development, we might create a more sound and solid knowledge base, develop better tools for knowledge translation and (shared) decision-making, and improve the use of knowledge in healthcare practice. Conclusions I set out to achieve that tools are no longer developed without a clear definition, that there exists a common terminology when referring to tool types, to make better use of the different knowledge sources available, and finally provide healthcare professionals and patients, and possibly other users such as policy advisors and insurers, with a set of pragmatic tools that cover their needs in knowledge translation and decision support. It has become clear that healthcare professionals and patients are inundated with tools, but a first step to limit the number of tools and to agree on their definitions has been achieved in the Netherlands. More robust adherence is the next step and to maintain a certain level of consistency of available tool types, pseudo innovation of tool types needs to be avoided. Clarifying which purposes patient-directed knowledge tools serve and which core elements they should contain can further help tool developers, people who commission the development of these tools, patients and healthcare professionals to discern between the different tools available. It became clear that not all knowledge sources are used when developing knowledge tools, particularly clinical practical guidelines. But the disregard of knowledge sources such as more patient-driven empirical data on the patient perspective (e.g. qualitative data on patients’ experiences with side-effects of treatment, with quality of care, or on patient preferences) and the main use of ‘classical’ doctor-driven research evidence (i.e. clinical epidemiological, quantitative research evidence) has been one of the main critiques of evidence-based medicine lately. Not just because patient preferences, clinical practice and context are still relatively underexposed, but also because the dominant knowledge source used has some flaws. Awareness of this is growing and efforts such as GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) are underway to include and appraise other knowledge sources and to address the flagged flaws in certain knowledge sources. Another way to bring the best scientific evidence and patient preferences more closely together could be achieved by connecting the evidence-based medicine approach with the approach of shared decision-making. Several strategies to achieve this have been proposed and tentative steps have been taken. One strategy concerns the training and education of healthcare professionals integrating EBM and SDM. Other strategies suggest integrating tools used in EBM and SDM or to use these tools more in concordance. Although not a straightforward method on how to integrate SDM in guidelines is available yet, more guidelines contain ‘open’ recommendations describing (treatment) trade-offs and (treatment) alternatives and provide more detailed guidance on how to decide with the patient on the patient’s care. Another consideration is to provide tools amalgamated with specific guideline recommendations that enhance SDM, such as patient decision aids. Chapter 7