Dunja Dreesens

163 it a skill or attitude. Others, however, thought that guidelines in general could enhance shared decision-making in daily practice. In the case of the guideline Palliative care for children, however, they commented that the recommendations needed to focus more on how to practice SDM. When presented with a one option recommendation on pain relief and a multiple options recommendation on pain relief, most paediatricians preferred the latter, as it would open the discussion with the patient and/or its parents. Furthermore, most interviewed paediatricians felt that patient decisions aids were beneficial to patients, e.g. to ensure that all topics relevant to the patient are covered. For guidelines to enhance SDM, guideline developers could consider formulating more ‘open’ recommendations, especially in case of preference sensitive choices. Moreover, SDM should not be limited to non-treatment recommendations, should describe (treatment) trade-offs and (treatment) alternatives and provide more detailed guidance. Another consideration is to provide tools amalgamated with specific guideline recommendations to enhance shared decision-making, such as patient decision aids. A case of consilience Taking a step back and looking at the research findings some overarching issues could be discerned. If we want to help healthcare professionals and patients with making sense of all the knowledge and knowledge sources available to them, we should not inundate them with tools. And we need to be more vigilant about their definitions and implementation. More discipline by and collaboration between stakeholders is necessary for sustainability of the core set that was agreed on a national level. Furthermore, we need to combine and connect the EBM and SDM approaches to integrate research evidence and patient preferences better. That means developing tools that provide healthcare professionals and patients with answers to evidence-based questions and help them elicit and integrate patient preferences. Next to patient decision aids, clinical practice guidelines should be more preference-sensitive so that viable choices are not taken away from patients. 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 waste of research as well. This means making tool developers (and other stakeholders) more aware of the availability of different knowledge sources, the possible flaws within the predominantly used knowledge base and that it is pertinent to continue working on methods how to appraise and include different knowledge sources. To achieve all this an interdisciplinary and interprofessional approach is needed. The many domains, disciplines, expertise, parties and professionals involved in knowledge translation, (shared) decision-making and tool development should abandon their silos, combine their knowledge, compare methods. In addition, the different domains in health care such as cure, social care, occupational health, public health and long term care, could collaborate more frequently and learn from each other. And they might even look outside health care for other knowledge sources and how these other domains appraise and include the array of knowledge sources available. Getting knowledge used in daily practice is a case of consilience. The policy domain is a part of this as well and could contribute (more) by acknowledging that patients Summary