Dunja Dreesens

138 Recommendations and implications The results of this thesis may contribute to a better insight into tool development and the use of knowledge while connecting different approaches in health care which aim to improve quality of care. The recommendations and implications will be described separately for practice, research and policy. One recommendation however relates to all three: in favour of improved knowledge use the cycle of development, implementation and evaluation of knowledge tool types should be followed through. Meaning that once a tool type is developed, implementation strategies should be in place to see to the use of these tools, and after a while the implementation and use of the tools should be measured and evaluated. Then it can be decided if the tool needs changing (or dispensed with), or that the implementation strategies need adjustment, before deciding new tools should be introduced, however fancy they sound or look. Adherence to the PDCA- cycle (plan do check act), quality cycle, knowledge circle or whatever its name, is paramount to avoid wasting resources in tool development and limiting the effect of the tools in knowledge translation. Recommendations & implications for practice - To achieve a common tool terminology and avoid ‘new’ tool types from emerging, the core set of tool types needs to be disseminated further by the stakeholders to their rank and file. Also, the involved stakeholders should agree on next steps on how to stick to the agreed core set of tool types, implement it and evaluate and maintain it. Tool types such as clinical practice guidelines and patient decision aids have an ‘expiration date’. This should also be the case with the established core set of tool types, because definitions can change as well as the needs for tools. - Furthermore, the framework of patient-directed knowledge tools should be put to the test to see whether it does help tool developers choose the right tool and helps clarify the different kinds of patient-directed tools for commissioners of tools and users. - Guideline working groups together with tool developers should be more brave and experiment with formulating recommendations that include patient preferences and/or viable treatment/care options available, to show the ambiguity of the available evidence and admit that the perception of optimal patient care is in the eye of the beholder and therefore a subjective matter. Perhaps they should invite other disciplines to the table as well, such as implementation experts, behavioural scientists, and ethicists. The Dutch College of General Practitioners is one of the few tool developers in the Netherlands to employ implementation experts and involve them when developing clinical practice guidelines. - Evidence-based medicine training should be integrated with shared decision-making and communication skills training, as the Dutch Federation of Medical Specialists is trying to do for example. However, not just for the new generation of healthcare professionals but also the older generations should receive this training. In this way, healthcare professionals are trained to use the available knowledge to their advantage whilst translating it to the patient’s unique characteristics and preferences. And enabling them to discuss the patient preferences with that patient. - Chapter 7