Required knowledge 141 4 Introduction In healthcare, tests are used to screen for a disorder or disease (such as mammography in asymptomatic women at risk of breast cancer) and to confirm or exclude a diagnosis (such as a haemoglobin test to diagnose anaemia). Other purposes of testing include risk assessment (e.g. weight, blood pressure and cholesterol measurements to determine the likelihood of getting a cardiovascular event) and monitoring: to follow-up patients with a known disease (such as checklists to monitor rehabilitation) [1]. The benefits and harms of testing will depend on population characteristics (context and setting, related to the pre-test probability of having a particular condition), test characteristics (such as sensitivity and specificity), testing process (e.g. burden), and the impact of management, guided by test results, on people-important outcomes (also called patient important outcomes), such as mortality, morbidity and quality of life [2]. Assessing the net benefit of healthcare related testing in daily practice is complex, and likely more complex than assessing those benefits for other interventions, such as treatment [3, 4]. Therefore, guidelines can be developed to provide support in decision making for healthcare professionals and consumers[5]. Trustworthy guidelines should be based on systematic reviews of the evidence (or systematically and transparently extracted evidence if scientific evidence is missing), should consider important population subgroups and people’s values and preferences, should be based on an explicit and transparent process that minimizes biases, should provide a clear explanation of the relationship between policy options and health outcomes, should be explicit about the certainty of evidence and the strength of recommendations, and should be reconsidered in case of new evidence [5-7]. This includes critical appraisal of the evidence on testing beyond their clinical performance, in particular assessment of the impact on people-important outcomes, which appeared to be challenging [8-10]. Additionally, a lack of transparency in processing the evidence and considerations that lead to recommendations about healthcare related testing in guidelines was observed [11]. Facilitation of guideline development on testing could improve this process and might eventually lead to better guidelines and improvement of the quality of care. This not only applies to critical appraisal of the evidence but also to other essential aspects of guideline development, such as the formulation of questions, the definition of the role and purpose of a test, and the evidence-to-decision processes [12]. Currently available competency-based frameworks for guideline developers do not focus on expertise about test evaluation [13, 14]. Clarification about the knowledge needed for guideline
RkJQdWJsaXNoZXIy MTk4NDMw