Dunja Dreesens

27 Background Doctors have been signalling for years that they feel overburdened by information (18, 19, 74) and that they are suffering from ‘infobesity’ (16). Sackett indicated more than 20 years ago that it is impossible for doctors to stay abreast of the developments in their field (75). The already vast knowledge in health care is expanding daily – in 2010, 11 systematic reviews were published every day (14) – so that keeping up with developments is a challenge (15, 24). The development of so-called knowledge tools is intended to support clinicians (and patients) to keep pace and to improve their decision-making (76, 77). In addition to knowledge tool types such as evidence-based clinical practice guidelines (CPG), however, protocols, guidance, standards, clinical pathways and many other tool types have been developed over the years. With the rising importance of shared decision-making (61) and the increasing call for a patient revolution (66), further tool types have been added to the mix, including decision aids, question prompt lists and option grids (78, 79). Is the image of the clinician bogged down in information being replaced with one of the clinician bogged down in a myriad of knowledge tools (80)? This image is probably not exclusive to the Netherlands, as there appears to be a ’widespread view […] that work effectiveness is impaired by information overload’ (18, 19). Moreover, even though tool types such as CPGs, standards, pathways and decision aids are used in other countries as well (81-87), are all these tools really different in terms of content and purpose (76, 88)? Research into knowledge and decision support tools has been conducted within several countries. Such research, however, seems to focus on one tool type, for example clinical pathways (70, 89, 90), CPGs or patient decision aids (58, 88, 91). Research into clinical pathways yielded an overview of 84 similar tools adorned with different names. Another focus in this research was the use, methodology of development (92) and implementation (42) of these tools. To our knowledge, no overview exists at a national level of current knowledge and decision support tool types used by clinicians or patients. The objective of this review article is to identify the different types of knowledge and decision support tools which are available at a national level to clinicians and patients in the Netherlands and to gain insight in how these tool types are described or defined. We looked at it from a national policy perspective, concentrating on tool types developed by national organisations. For reasons of feasibility, we focused on Dutch national organisations that develop and implement these tools. A scoping review identifies the range and nature of existing knowledge tools by summarising what is there and might reveal if something is missing. The review therefore also serves as a basis for conducting further research and defining relevant research questions related to tools, knowledge use and translation. Chapter 2