General introduction 15 1 guideline developers for example through training. The authors identified three core competencies: 1. Facilitate the development of guideline structure and setup 2. Make judgments about the quality or certainty of the evidence 3. Transform evidence to a recommendation These core competencies are divided into subcompetencies and milestones. Additionally, the authors acknowledge that a guideline panel includes various roles, i.e. chair, methodologist, and panel members, with different competencies [34]. The specific knowledge and competencies needed for creating guidelines on testing are not explicitly incorporated in this framework. Testing and people-important outcomes A test refers to any procedure performed on a person to detect, diagnose or monitor a condition. This includes testing of a person’s fluids, cells, tissue, functioning and subjective experience. The final objective of testing is to improve people-important outcomes (and/or to prevent deterioration of people-important outcomes). Additional objectives may include offering other benefits (such as simplifying healthcare organisation or reducing expenses) without worsening people-important outcomes. People-important outcomes, also known as people relevant outcomes, patient important outcomes, patient relevant outcomes or patient-centered outcomes, are components of people’s (health) status following an intervention. These outcomes serve to evaluate the effectiveness of the intervention [35]. People-important outcomes may differ depending on the condition and the individual. Common examples include mortality, morbidity, quality of life, and quality of life subscales such as functioning capacity and societal participation. When assessing the effectiveness of a specific treatment, the link between treatment and change in people-important outcomes is usually clear. For example, antibiotic treatment is related to curing bacterial pneumonia (and reducing mortality), radiotherapy is linked to reducing pain in patients with bone metastases, and hip replacement surgery to improved walking function (although side effects and complications should be considered in all cases). Unlike treatment, testing itself typically has no immediate effect on people-important outcomes, although reassurance when a serious illness is ruled out, and the occurrence of serious burden (such as serious adverse events) due to testing are common exceptions to this statement. In general, to progress from testing to people-
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