Paper short abstract:

The overall aim of evidence-based medicine is to reduce uncertainty through the use of standardized methods for knowledge evaluation and use. We argue that uncertainties are possible sources to informed decision making and not a threat against evidence-based clinical reasoning.

Paper long abstract:

The evidence-based practice (EBP) and evidence-based medicine (EBM) movements have increased the focus on standardization through the development of new guideline development methodologies based on systematic reviews and meta-analysis of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement.

In this paper we will argue that the overall aim of EBM is to reduce uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty as integral parts of medical practice.

We question the productivity of the attempts to standardize professional health care through a discussion of the importance of uncertainty. Trisha Greenhalgh's taxonomy of uncertainty is used for an analysis of the clinical reasoning occurring in a life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan's theory about human understanding and the act of knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that knowledge can be obtained. The analysis demonstrates possible subversive consequences of an increased standardization of health care. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of clinical decision making but a productive component.

Paper short abstract:

Drawing on Derrida's notion of the supplement we will challenge what we claim to be an implicit assumption within evidence-based medicine: that the production of evidence is separate from its transfer and that translation is secondary to the production of evidence.

Paper long abstract:

Knowledge translation has become a buzzword in modern medicine referring to a set of activities bound together by the common goal of 'bridging the gap' between science in laboratories and clinical use, and more generally, putting research evidence into practice.

This paper argues that the concept of knowledge translation is based on a reductive conception of translation that leans on a double presupposition: 1.The research evidence which is translated is "outside translation" in terms of being autonomous, complete and independent of the translational operation. So called barriers and drivers of translation are also understood as outside translation itself. 2. The act of translation is a process of "copying the original" where the translational act itself is a non-act and the translator a non-actor and where the purpose of translation is to transfer the original message in a trustworthy manner without adding, transforming or in any other ways betraying the original.

We will suggest an alternative conception building on Derrida's notion of the "logic of the supplement". On the one hand, knowledge translation names new approaches to the communication of scientific knowledge to different groups in the health care system with the aim of supplementing a lack of knowledge in the receiver. On the other, it demonstrates that a cultural supplement, a concern with target cultures or audiences, is inevitable in the creation of 'autonomous' science and evidence. Hence, we will argue that the division between evidence and its translation is both impossible and unproductive to maintain.

Paper short abstract:

Knowledge translation and co-creation are expected benefits of participatory research. Our study of a participatory research project found that the participants’ strategies for translating knowledge across contexts may cause dilemmas to knowledge production that ultimately influence on co-creation.

Paper long abstract:

The 'turn to translation' in healthcare has promoted increased use of participatory research. The term encompasses a range of approaches for stakeholders' involvement in research with the goal of increasing relevance and usability of research by mutual exchange and translation of knowledge. But how does knowledge become translated and co-created in these collaborations?

Our study of a participatory research project focused on the micro level of knowledge translation; the verbal presentations and negotiations of knowledge in discussions between researchers and clinicians attending collaboration meetings.

The material was examined by analytical terms inspired by the STS literature: knowledge object, knowledge form, knowledge position, and knowledge tasks.

We identified a recurring rhetorical pattern of translation that we call 'relevance testing': a strategy by which the participants attempt to create coherence and identify relevance of knowledge across different contexts. However, this 'translational work' was never explicitly addressed by the participants.

A limitation to the strategy was a tendency to reinforce a 'two-communities' logic: re-establishing the separated worlds and rationales between clinicians and researchers leading to recurring 'epistemic dilemmas'; dilemmas based on the two groups' different criteria for valuable, relevant and legitimate knowledge. While the clinicians emphasize that knowledge should be instantly accessible and applicable on individual level, the researchers convey that results must adhere to academic criteria and contribute to the state of the art.

This implies: 1) Conceptual tools may contribute to more radical knowledge translation. 2) The evaluation of participatory research results by strict academic research criteria may prevent integration of stakeholders' perspectives

Paper short abstract:

This workshop aims to explore and extend the basic epistemic concepts of knowledge creation and interpretation in EBM and guideline development using the concept of 'mindlines'.

Paper long abstract:

While frequency reasoning in EBM is taken for granted, multi-morbidity, over-diagnosis and person centred medicine prove to be challenging. In order to cope with this, the Guideline International Network (G-I-N, a collaboration of NICE and other guideline developing institutions) started to explore how to appraise and include other types of knowledge. Many more types of reasoning appear to occur during guideline development processes. These could be important as they may help to develop guidelines when there is no clear frequency of events, for instance in rare diseases, complex interventions in social care or prediction in the single case scenario of a patient in everyday practice.

A better understanding of the epistemological assumptions that underlie medical knowledge creation is urgently needed. Using a more advanced perspective on knowledge in the form of Gabbay and Le May's mindlines (collectively shared, largely tacit knowledge influenced by past personal experience and interaction with others) and Lonergan's interpretation model (observation, interpretation, judgment and deliberation), we set up an international research study at the Universities of Oxford and Oslo.

We invite you to this workshop to help explore and solve these epistemological issues as part of this research. We want to discuss with you what it is that EBM tries to accomplish, how to increase our knowledge base as efficiently as possible and how to improve our inductive inferences to benefit healthcare for patients when there is no frequency of events.