Dunja Dreesens

164 need to be better positioned, by having governmental agencies fund a more diverse palette of studies such as research on patient preferences and implementation, and by following up on governmental reports that looked into the psychology of deciding, choice and behaviour and how this affects the decision-making in healthcare practice. Strengths and limitations No thesis can go without a critical reflection on the used research methods. This thesis consists of predominant qualitative research as the research was exploratory in nature. First, it tried to achieve an improved understanding of perspectives, experiences, opinions, attitudes concerning translation of knowledge. Second, it looked into the use of knowledge tool types. Third, the comprehension of the needs of healthcare professionals was examined when using these tool types. And last, it tried to reach consensus on (developing) criteria and purposes of these tool types. Strengths and limitations of qualitative research relate to credibility, transferability and dependability. To increase credibility several approaches were used, such as involving participants as much as possible by sharing results and outcomes and by member checking and independent coding by three authors. Transferability is regarded as limited, mainly because the research was largely executed with tool types used in the Netherlands and a Dutch clinical practice guideline. However, methods and outcomes can be used in international settings and other guidelines as well. Qualitative research is characterised by fluid structures, which change because of incoming and available data. Therefore, to improve dependability, for each study the approach and/or method chosen and the changes therein, if any, were exhaustively described. Furthermore, the SRQR or COREQ checklists were applied for all the studies in this thesis, except chapter five. Conclusion It has become clear that healthcare professionals and patients are inundated with (loosely defined) tools. A first step to limit the number of tool types and agree on their definitions has been achieved in the Netherlands. The next step is more robust adherence to maintain a certain level of consistency of the available tool types. Pseudo innovation of tool types needs to be avoided. Furthermore, the current knowledge tools do not always use all the knowledge sources that are available. Awareness of this is growing and efforts are underway to include and appraise these other knowledge sources. Different approaches in health care, such as SDM and EBM, exist to achieve optimal patient care. These approaches should combine their efforts more. Strategies to achieve this have been proposed and tentative steps have been taken. One strategy suggests integrating tools used in EBM and SDM or to use these tools more in concordance. Further recommendations for practice, policy and further research are described in detail at the end of the general discussion. Summary