14 Chapter 1 comments and feedback. This step may include pilot testing of the draft guideline to identify barriers for implementation. Then, the final version of the guideline can be submitted for endorsement or authorisation. Finally, the guideline, and any related materials, such as summaries, patient versions and decision support tools are published. The guideline outlines specific criteria for reviewing and updating the guideline [2]. Note that endorsement and authorisation is not universal in guideline development worldwide. In the Netherlands, authorised guidelines become part of the professional standard for healthcare providers. This guarantees legal embedding of guidelines in the healthcare process and fosters their implementation. Several manuals and guides are available for the development of guidelines [3-5]. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group was established in 2000 to provide assistance for the process of guideline development. The GRADE approach highlights the importance of evaluating the certainty of evidence in the development of recommendations, for example by assessing risk of bias and indirectness [6]. Another crucial aspect of this methodology is its emphasis on clinical relevant differences in outcomes that are regarded as important by patients and consumers, so-called people-important outcomes [7]. The GRADE evidence-to-decision framework systematically considers relevant issues such as balance of benefits and harms, values, resources, and acceptability [8, 9]. The GRADE Working Group has produced and continues to produce comprehensive guides for guideline development [7, 10-25]. The GRADE approach has been adopted by many organisations worldwide, including the Netherlands [26]. In the GRADE approach, special attention is given to the development of guideline recommendations on testing, as the link between testing and the impact on peopleimportant outcomes is indirect and requires a specific approach [27-30]. This includes consideration of the consequences of false positive, false negative, and inconclusive test results, specific risk of bias assessment, moving from test results to peopleimportant outcomes (so-called linked evidence), and the need for formal or informal modelling. Competencies needed for guideline development While the essential steps for guideline development have been outlined [31-33], there is limited understanding of the competencies required for the appropriate development of guidelines, particularly those that feature recommendations about testing. Some research has been conducted in this area: Sultan et al. provided a theoretical framework for competencies and educational milestones that should be acquired by
RkJQdWJsaXNoZXIy MTk4NDMw