Dunja Dreesens

22 The world of tools To deal with the vast accumulating knowledge, tools are being developed. Tools such as systematic reviews, evidence summaries and meta-analyses mean that healthcare professionals do no longer need to read and interpret all the articles and research themselves. To help them further, clinical practice guidelines are developed. This tool type not only distils and synthesises knowledge it also interprets it. To help inform, educate, engage and support the patient and healthcare professionals to use the knowledge during patient encounters (patient) decision aids are developed as tools. The previous paragraphs have already mentioned several different tool types. However, if you look at a random website of a health profession association or ask around, one encounters more tool types. That begs the questions: how many tool types to support knowledge translation and support (shared) decision-making are out there?; are they different tool types, or just clad with different names; what purposes do they serve?; do professionals and patients know all these tools exist, and if yes, how do they deal with all these tools or tool types? Research into the tool type ‘clinical pathway’ revealed 84 names for tools with a similar meaning (70). Research into patient decision aids showed similar results (58). Are we, trying to resolve the information and knowledge overload by swamping our healthcare professionals, and maybe even the patients nowadays, with all sorts of knowledge translation and decision support tool types? Another dimension of the tools is their development process and the criteria they must meet to be regarded as trustworthy. For the development of the tool types, CPGs and PDAs rules and international criteria are available (6, 59, 71). But how about the other tool types? Moreover, are the existing tool types interconnected with each other? The world of clinical practice From bench to bedside is a well-known phrase in health care. It refers to “the process by which the results of research done in the laboratory are directly used to develop new ways to treat patients” (72). It is mainly used in the biomedical domain, but the phrase could be expanded to the broader knowledge base and knowledge sources (73). Researchers, epidemiologists, administrative and policy workers, tool developers, and implementation experts mainly inhabit the worlds described above. Even though we acknowledge that healthcare professionals and patients should be more involved in setting research agendas, developing tools, and implementation strategies, the ones that are involved make up only a small proportion of the ones that are out in the real world. It is up to all those in the real world to try stay abreast of all the knowledge, and use it accordingly, with or without the help of tools. The latter being almost impossible. Despite all efforts, it still takes knowledge (‘bench’) a long time to reach practice (‘bedside’), as was mentioned before, and the use of available tools in daily practice is lagging. There still seems to be a gap between research, tools and practice. Aimand research questions How can we make all the knowledge in health care available to healthcare professionals and patients in a timely matter and in such a way that it is easy to digest and apply? Which tool types to translate knowledge and support (shared) decision-making do we need and are suitable? How do we develop them so that target users know that they can rely on them? Chapter 1