Dunja Dreesens

184 and involvement of all national stakeholders, from patients to policymakers, with patient representatives in a co-leading role. We believe that the involvement of all stakeholders from the writing phase of the project proposal contributed to the successful collaboration. Another strength of the project is that the guidance was developed with prospective feasibility checks parallel to the nine ongoing development projects. The relevance of patient-directed knowledge tools being publicly available has also been acknowledged in the UK, with one of the main institutions developing guidelines committed to develop patient decision aids based on clinical guidelines 28 . The relevance of this process was recently underpinned by empirical evidence in the Netherlands. The Dutch College of General Practitioners launched a non-commercial public website in March 2012 that provides easy access to patient versions of guidelines. Since its launch, the website has grown to become one of the most visited Dutch healthcare websites. Healthcare usage in primary care seems to have decreased by 12% after the launch of the website 29 . We expect the criteria to evolve over time as they are further tested through developers using patient versions of guidelines and patient decision aids, as well as by adding new tools to the guidance. The next challenge will be the effective implementation of the guidance as a further step towards ensuring the development of high-quality, reliable and publicly available patient- directed knowledge tools with the support and acceptance of professional associations (and alliances), scientific associations and patients’ organisations. The main stakeholders (the Dutch Federation of Patients’ Organisations, the Dutch Association of Medical Specialists, the Dutch College of General Practitioners and the Dutch Nurses’ Association) continued in working together to translate the guidance into a web-based practical version, and to arrive at consensus on a sustainable model for the development, publication, governance and financing of patient decision aids. An important follow-up step is to crosslink this guidance to the guidance for developers of clinical practice guidelines 1 . Formal steps towards accreditation have not been taken yet, the question being whether this procedure is needed, and is warranted given the current level of evidence. In December 2016, the USA National Quality Forum released national standards for the certification of patient decision aids 30 . The certification criteria are meant to be used for ’complete’ patient decision aids, which are standalone, independent tools for patients facing a clinical decision. Our guidance, although not formulated along the lines of certification criteria, is highly comparable with the USA criteria in terms of content. The only USA criterion that we do not cover is that the patient decision aid should report readability levels. We believe that this study can be seen as an inspirational example for other countries that are facing the same challenges with regard to the development and governance of clinician- and patient-directed knowledge tools such as guidelines, guideline summaries, patient versions of guidelines and patient decision aids. Valorisation chapter