Dunja Dreesens

38 appear to speak a common language regarding knowledge tools in the Netherlands, using terms that sound and look alike. However, because these terms are not always defined explicitly, we do not always attach the same meaning to them or use them in the same way, and we get lost in translation. We have not yet even looked beyond the national borders, even though increasing cooperation between clinicians and patients from different countries (117-119) means additional languages, additional tools and terms, and additional meanings. Some recognise the need to have a common language within and outside the knowledge domain. In 2012, an international study group explored the notion of developing a common terminology for knowledge translation interventions. The rationale for doing this was that ’a wide range of diverse and inconsistent terminology exists in the field of knowledge translation. This limits the conduct of evidence syntheses, impedes communication and collaboration, and undermines knowledge translation.’ (120). At an even more fundamental level, organisations have started to work together towards a shared terminology. An international consortium consisting of WHO (ICD10), IHTSDO (SNOMED CT) and LOINC, worrying about the confusion of tongues regarding data collection in (health) care for the use of research and policy development, worked out a framework describing core concepts using concise process descriptions (121). Is the chaos restricted to the Netherlands? A search on foreign websites and PubMed yielded no information or articles on chaos regarding knowledge tools. At the same time, no overviews or frameworks of tool types – which state definitions and possible links between them – were found either for other countries. Glossaries, definitions, A to Z’s, jargon busters and taxonomies found (search took place in April 2013) on the websites of e.g. AIWH (Australia), NIH, Informed Medical Decisions Foundation, AHRQ (US), CIHR (Canada), NHS, NICE (UK), ÄZQ (Germany), Cochrane Collaboration, EU and WHO mainly dealt with words and terms related to medicine/ health (adverse event, condition), epidemiology (absolute risk), research (abstract), quality (patient safety terms) and organisation of care domains (advocacy) (122-136). The document that came closest to an explanation of tool types was found on the AHRQ website and concerned a collaboration between Russia and the United States, dating from 1999. It listed under the heading ‘Quality standards’ terms such as ‘practice guidelines’, ‘clinical path’, ‘critical path’, ‘standard’ and ‘quality standard’ (137). Our suspicion that the chaos case was not limited solely to the Netherlands was confirmed when we presented the preliminary results of the review at the Guidelines International Network (GIN) Conference (138) and International Shared Decision Making (ISDM) Conference (139). The conclusion that there are too many tools was endorsed, together with the notion that the links between the tools are often lost. The DECIDE project (Developing and Evaluating Communication strategies to support Informed Decisions and practice based on Evidence) – funded by the European Union – has tried to address these issues, by increasing the accessibility and use of tools such as clinical practice guidelines, linking interconnected tools such as decision aids in a more visible way and updating them (140). The website of the European Union makes it clear that health care is not the only area Chapter 2