Dunja Dreesens

95 real. For example, integration of different knowledge could be based on combinations of coherence (what fits best in a network of other theories), on consensus (what people agree on) and/or on correspondence (what links best to what is believed to be real). Given the current state of evidence to decision frameworks, there is still little guidance on how to robustly and consistently combine knowledge of different types without using the frequentist understanding of knowledge. A broader discussion within the guideline community is needed about the frameworks used to integrate and include different kinds of knowledge. Considering theories from epistemology and findings from ethnography (see Text box 5) could be instrumental to deepen our understanding of how other types of knowledge can be synthesised and integrated in guideline production. Text box 5: Theoretic and empirical concepts of integrating knowledge THEORETIC AND EMPIRICAL CONCEPTS OF INTEGRATING KNOWLEDGE William James was a philosopher of science who developed the idea of pragmatism, where many kinds of evidence can serve to support and continuously update beliefs about reality and truth within communities of people [1]. Another philosopher of science, the physicist Thomas Kuhn described how researchers within a research tradition develop and nourish theories which are overthrown, leading to the emergence of new paradigms [2]. Based on an ethnographic research on knowledge translation Gabbay and Le May coined the term “mindlines” to denote the continuously evolving, socially shared and mostly tacit knowledge that informs clinical practice [3]. Explicit knowledge from guidelines is incorporated into mindlines – where it is made sense of, challenged and integrated (or not) with practitioners’ existing knowledge-in-practice-in-context. 1. James W. Pragmatism and The Meaning of Truth. Rough Draft Printing 2011. 2. Kuhn TS. The Structure of Scientific Revolutions. The University of Chicago Press 1970. 3. Gabbay J, Le May A. Evidence based guidelines or collectively constructed‘mindlines?’ Ethnographic study of knowledge management in primary care. BMJ Br Med J 2004;329:1013. doi:10.1136/bmj. 329 .7473.1013 Chapter 5