Dunja Dreesens

57 Discussion Our study aimed to agree at a national level on a core set of knowledge tool types supporting clinicians and patients in knowledge translation and (shared) decision-making and other stakeholders in healthcare quality improvement and policy. We succeeded in reducing the number of tool types from 34 to 13. Furthermore, the experts reached consensus on the importance of nine tool types as being important to for knowledge translation and supporting (shared) decision-making. Additionally, for five tool types, the experts agreed on their definition. We also created awareness among the organisations and experts involved, encouraging them to follow-up actions. More collaboration between organisations and experts is necessary for mutual understanding and sustainability of the set of tool types agreed. Strengths and limitations of the study The Delphi consensus method has a number of limitations. Some issues include: the accuracy of experts’ answers; time constraints; the level of detail of the input by experts; and the possible effect of the presented order of the tool types on the scoring. We think that the accuracy of the answers did not affect the outcomes too much because of the number of participants and their diverse backgrounds. The same applies to the level of detail; some experts gave more input than others, but because of the size of the group we feel that the input overall was balanced. The time to respond in the Delphi rounds was limited. As 17 experts of the original 21 also completed the second Delphi round, the effect of the time constraint might be considered as limited. To reduce the effect of the tool order, the order was reversed in the second Delphi round. Although none of the invited insurers participated in the study (they indicated that this exercise should be left to the experts), most health care domains with varying expertise were represented. We think that selection bias is limited, because the number of experts participating in the Delphi was above the required minimum of nine. There were some discrepancies between the narrative comments on tool types, which were described as unimportant but which still scored four (neutral) on the Likert scale. This issue was addressed by the project group during the analysis. Our study is the first study that systematically evaluated the tool types available to support knowledge translation. Other studies focus on defining or assessing the quality of clinical practice guidelines (155-157), developing or validating tools (158-160), or prioritising research agendas (161, 162). Some organisations use A-to-Z’s and glossaries but without detailed analysis and comparisons. There are also studies listing the divergent names and terms being used in health care, concluding that this hinders knowledge translation (120, 163). For example, Elwyn et al discern between decision and behaviour support interventions to describe the characteristics of these two categories; however, they do not address the individual tools within these categories (91). Follow-up of the study The Delphi has already had impact in Dutch healthcare policy and management. In June 2015, the National Health Care Institute presented the Delphi results in a meeting of the Chapter 3