Dunja Dreesens

162 (pseudo innovation) keep emerging. Possibly illustrating that something new is more alluring and exciting than tinkering with and adhering to existing tool types. However, for change and implementation to take effect, a certain constancy of purpose and consistency is needed. Purposes and criteria of tool types Believing the issue of too many tool types available to healthcare professionals and patients, was not confined to the Netherlands, international experts were approached to participate in a two-day evidence-informed consensus meeting. The aim of this invitational meeting was to develop a conceptual framework categorizing the different tool types aimed directly at patients. The participants considered a framework including all tool types infeasible during a two-day meeting. The developed framework clarifies the purposes of the patient-directed tool types and indicates the core elements these tool types prototypically consist of. In this way, the framework can help tool developers, people who commission the development of these tools, patients and healthcare professionals to discern between the different tools, and to identify to which tool type it belongs, which purposes it serves and which core elements it should contain. As the framework was developed by a small group of experts, it is called a conceptual or working framework and it needs to be further tested and probed to check if it is usable and to make it more robust. Knowledge sources and tool types Besides having a closer look at the various tool types that convey knowledge, knowledge itself was looked at as well, as part of the work done by the G-I-N Working Group Appraising and Including Different (AID) Knowledge. Different knowledge sources exist but some seem to be favoured more than others. Evidence-based guidelines are supposed to search for, and explicitly consider, evidence from sources other than conventional clinical trials and their quantitative data. These different types of knowledge can be used and are needed in situations when for example evidence from RCTs is unavailable, impossible to obtain, contradictory or inappropriate. These sources can also be used in conjunction with RCTs to provide context, to assess relevance and to understand bias(es). Additionally, more complex forms of knowledge like experiential and contextual knowledge can help guideline developers to take an approach consistent with the intentions of early evidence-based medicine: the best evidence is not restricted to evidence from RCTs and meta-analyses. However, in the context of medicine and guideline production, integrating different types of knowledge continues to be underexplored and undertheorized. Paediatricians’ reflections on tool types The worlds ‘evidence-based medicine’, ‘shared decision-making’ and ‘tools’ can come up with a lot of ideas, theories and concepts of how to move knowledge into use in daily practice but how do healthcare professionals feel about these endeavours. In interviews, 15 paediatricians reflected on several strategies to enhance shared decision-making (SDM) in paediatric palliative care. The first one being the clinical practice guideline Palliative care for children that contains recommendations on shared decision-making. The other strategies were a modified guideline recommendation on pain relief to reflect available options and patient preferences, and patient decision aids. Not all paediatricians felt that guidelines could enhance SDM as they regarded Summary