Clinical practice guidelines & test consequences 115 3 Due to the document analysis design we could not retrieve information about the dynamics in the CPG panels that could explain their decisions and reasons for lack of transparency in the CPG documents. We did not contact the CPG developers, since in our opinion CPG users should be able to find the considerations of the panel beyond the recommendations in the published documents of the CPG. Implications for practice We suggest that developers of CPGs about diagnostic tests clearly describe which elements of a test-treatment pathway were or were not considered and why. In addition, CPG developers should indicate the presence or absence of systematic reviews of the evidence, including determination of the certainty in that evidence, for all evaluated parts of the test-treatment pathway, which is also usual in recommendations about therapy. Facilitating the implementation of GRADE for diagnosis will be useful to improve the clinical content of CPGs. Implications for research This study highlighted the lack of (transparency about) supporting evidence for diagnostic test recommendations in CPGs. A next step could be to study why CPG developers do not report all elements of the test-treatment pathway, including a review of the evidence and its quality. Furthermore, it is worthwhile to research how to facilitate CPG developers in explicitly and reliably considering all relevant steps of a test-treatment pathway when developing diagnostic test recommendations. Conclusion Diagnostic test recommendations in the included CPGs are mainly based on evidence and considerations on diagnostic accuracy. Other steps of the test-treatment strategy, such as burden of the test, natural course of the disease of interest, effectiveness of treatment of the disease of interest and the link between the test result and the administration of treatment should receive more attention in CPGs in order to consider evidence about test consequences on patient-relevant outcomes.
RkJQdWJsaXNoZXIy MTk4NDMw