Dunja Dreesens

139 Recommendations & implications for research - It needs to be acknowledged that randomized clinical trials (RCT) and other dominant frequentist methods might be excellent for answering some questions in health care (in part), such a diagnostics and therapeutic interventions, and when developing guidelines but they do not fit all knowledge needs in health care, such as complex interventions, multimorbidity, organisation of care, the gender data gap, patient preferences, public health issues (e.g. pandemics), and healthcare policy and coverage decisions; other research methods need to be considered more and the different methods need to be combined. - To enhance the further use of knowledge, and the use of all knowledge sources more effort is needed in finding out how to include and appraise other knowledge sources and how to put these methodologies to use. This might mean that evidence-based medicine needs to look at other disciplines and domains, such as psychology, (youth) social care, behavioural sciences, communication and language sciences, IT and industrial design. Not just for knowledge creation, distribution and use, but also to learn how some of these domains include and appraise different kinds of knowledge. - The importance of and need for a common terminology was shared by international experts. To get more traction on the core set of tool types, the consensus procedure could be repeated on an international level. Also, to prevent ‘new’ tool types entering the Netherlands Recommendations & implications for policy - Funding organisations such as ZonMw should reconsider their funding policies. They should be more open to other kinds of research methods than RCTs, stimulate research into other areas such as patient preferences, patient experiences, organisation of care, implementation studies and evaluative research and stimulate cross-disciplinary research efforts. - To make health care really patient-centred, you have to start at the beginning by saving a proper seat for patients at the table that sets the research agenda. The Dutch Research Agenda (Nationale Wetenschapsagenda) was a promising first step. Though, I am curious how (well) it plays out for the questions submitted by patients and the general public. Increased funding of patient participation in knowledge translation and tool development, or broader to enable actual patient emancipation and become an equal partner, could be considered. Perhaps healthcare insurers could assume some kind of responsibility in putting patients more centre stage. - It is becoming increasingly clear that (medical) decision-making is not merely an objective and rational process, nor free from intrusion of emotions and behavioural and cognitive biases, whether it concerns patients, healthcare professionals or other stakeholders. We need to acknowledge that and deal with it (better). The Dutch government should follow up on the reports of the Netherlands Scientific Council for Government Policy (Wetenschappelijke Raad voor de Regering) on the psychology of deciding, choice and behaviour explaining the complex and sometimes erratic dynamics of human choice behaviour; for example in healthcare covering subjects such as limited rationality, unstable preferences, habits, and influences by the social and physical environment (344, 345), and see to it that it permeates to healthcare practice and research. Chapter 7