Required knowledge 165 4 First author (publication year) Short description of the study (design/type) Main results concerning knowledge to develop guideline recommendations about healthcare related testing GRADE Handbook (2013) [13] Handbook Be explicit about the purpose of the test Establish the role of the test Determine the standard diagnostic pathway Recommendations regarding use of medical tests require inference about consequences of false positive and false negative test results Diagnostic intervention studies can be evaluated using GRADE for interventions Otherwise, focus on test accuracy studies and make inferences about the likely impact on people-important outcomes Recommendations about tests require evaluation of the balance between desirable and undesirable consequences of that test, based on systematic reviews. Test accuracy studies are vulnerable to limitations, mostly due to indirect evidence Albarqouni et al. determined core competencies in evidence-based practice for healthcare professionals in a systematic review and Delphi study [1]. Critical appraisal and interpretation of diagnostic accuracy studies as well as distinguishing evidencebased from opinion-based clinical practice guidelines were mentioned in the set of core competencies. However, the knowledge needed to develop guidelines about tests was not appointed. This also goes for the study of Berger et al. in which they described a program for competence training in evidence-based medicine for patients, patients counsellors, consumer representatives and health care professionals [2], as well as for the study of Hinneburg et al. who described a learning program for physicians and medical students to enhance competencies in evidence-based decision-making [3]. Messerli et al. advocate in an editorial that clinical expertise about the topic of interest is crucial to develop clinical practice guidelines for acceptation by health care professionals, by evaluating hypertension guidelines [4]. The authors do not specify knowledge needed to develop guidelines concerning tests. Norris et al. described a set of minimum skills and experience required for GRADE methodologists working on the development of guidelines [5]. One of the recommended components of required experience is about tests: ‘Perform one or more systematic reviews or develop guidelines that involved a question of diagnostic test accuracy or value – The development of key (PICO) questions and the synthesis and assessment of evidence related to diagnostic tests have many unique considerations and the GRADE methodologist should have relevant experience’.
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