Dunja Dreesens

89 - Work towards reporting standards for knowledge appraisal and inclusion; and - Develop a guide for appraising and including different knowledge. For this paper, members of the GIN AID Knowledge Working Group met several times to discuss the issues of using different knowledge and reasoning in guideline development, based on examples from their own experience and from published literature. After several rounds of revision, the work was presented in a workshop at GIN 2016 Conference in Philadelphia. Input of workshop attendees was compiled, reviewed and included in the final draft of this position paper. For more information please visit: http://www.g-i-n.net/working- groups/aid-knowledge The purpose of guideline development The efforts of the pioneers of the EBM movement were primarily in response to the discovery of the variation problem in population studies. Reducing variation of the care provided at a population level was considered to be an important way to achieve improved quality for individual patients (217). Hence, epidemiology, the science of studying populations, gained prominence in guidelines, the aims of which are to support decisions for individual patients. Classic epidemiology became clinical epidemiology when introduced to the bedside and the dominance of RCTs as the gold standard for intervention studies to assess causal relation between interventions and effect followed in this construct of epidemiology as used in EBM. The underlying – yet little explored – assumption is that guidelines based on population studies provide the best advice to inform clinical decisions for individual patients or situations. However, reducing variation is not the only reason for developing guidelines; they are developed for several reasons, of which the most important one is to improve the quality of care. In order to meet the range of needs, guidelines may need different approaches, such as summarising large quantities of knowledge for practising healthcare professionals, serving as an intermediate product for other tools or applications (such as clinical decision support software) or providing implementation guidance. Although not primarily developed for this purpose, guidelines can also serve as tools to legally shield both patients and professionals, to help governments and health insurers allocate scarce resources and to act as governance frameworks for practitioners and governments. There is also the role of guideline development as a discipline in itself; along with its associated practices and institutions, it provides employment and intellectual interest for many. There has been surprisingly little research into the purposes of guideline development. One mixed-method study found the purposes of guidelines were: defining norms, summarising evidence, formalising current consensus and/or describing current practices in a handbook-type format (8). Making the purposes of guidelines more explicit may help determine how different types of knowledge could and should be used. For instance, if the aim is to describe current good Chapter 5