148 Chapter 4 Box 1. Required knowledge for guideline panel members who develop recommendations about healthcare related testing The development of guideline recommendations about healthcare related testing requires specific knowledge, in addition to the knowledge required to develop guidelines in general. Figure 2 illustrates the key elements of the development of healthcare related testing recommendations in guidelines. This framework is used to structure the specific required knowledge components for guideline panel membersa [12, 33]. The listed knowledge components have different levels of cognitive learning (recall, understand, able to interpret/formulate), according to Bloom’s revised taxonomy [18]. Definitions: Test/testing: this includes all healthcare related tests and test strategies [34]. A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, risks and treatment [35]. Test-management pathway (also called test-treatment pathway, management pathway, care pathway, clinical pathway, test-management strategy, test-treatment strategy): a schematic pathway that includes all aspects in time related to the application of a healthcare related test and consequences for management that may follow such as (re)treatment, monitoring, side effects and complications as a result of testing and/or treatment [36]. Target population: population eligible for the test, including the context in which the test is performed (such as earlier tests received) and setting (such as public health, primary care, secondary care). Burden: undesirable aspects of the test or treatment for healthcare consumers, patients, or caregivers (e.g., family) with psychosocial, physical, or practical impact, such as need to take medication, the inconvenience of visiting the doctor’s office, financial costs, pain or anxiety. People-important outcome (also called patient important outcome, patient relevant outcome, patient relevant outcome measure, patient centred outcome): a component of a participant’s clinical or functional status after an intervention has been applied that is used to assess the effectiveness of an intervention [16]. Depending on the condition of interest people-important outcomes may include consequences of having a certain test result (such as reassurance or labelling), consequences of the test or management (such as side effects (including adverse events and complications) and diagnostic and therapeutic yield), and society relevant outcomes (such as public health outcomes and costs). Modelling: decision analytic modelling, often undertaken when evidence is limited, involving prediction based on probabilities of possible outcomes (e.g., modelling the relation between pretest probabilities, clinical performance/test accuracy, treatment strategies and people-important outcomes). This includes formal (complex, statistical) and informal (‘back of the envelope’) modelling [37]. Knowledge components: Health question Test-management pathway Target population Testing Testing result Including burden Impact on people- important outcomes Interpretation of testing results & subsequent management Including burden Figure 2. Analytical framework for the development of a healthcare related testing recommendation Health question: Defining health question: The development of a testing recommendation starts with defining a health question. A guideline panel member is able to formulate a health question which includes definition of the target population, the test, the test-management pathway, and people-important outcomes.
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