Required knowledge 167 4 - Equity, acceptability, and feasibility: ‘For tests, assessment of equity, acceptability, and feasibility include consideration of both the test and linked interventions’. In the forementioned article, another paper from Schünemann et al. is referenced. This is an article about grading the quality of the evidence and strength of recommendations for diagnostic tests and strategies [7]. In this article, it is emphasized that the evaluation of the quality of evidence of a test in a guideline perspective should be seen in relation to people-important outcomes. Since direct evidence (diagnostic RCT’s) is scarce, usually indirect evidence is used to make inferences about impact on peopleimportant outcomes. In the GRADE Guidelines Series paper, also a paper from Brozek et al. is referenced, which is about grading quality of evidence about diagnostic tests and test strategies [8]. In their paper, Brozek et al. mention the importance of the interpretation of false negative and false positive test results to be able to evaluate the value of test. They also state that ‘this approach requires a clear understanding of the proposed place of a new test in a diagnostic pathway and its suggested benefits, as well as careful consideration of whether the patients detected by the new test are representative of the patients included in management trials’. Sultan et al. developed a competency framework for guideline developers [9]. They describe different competencies, sub competencies and milestones, such as ‘facilitate the development of guideline structure and setup’. No specific attention is given to competencies needed to develop testing recommendations. Wieringa et al. described the use of different kinds of knowledge as a challenge for guideline development [10]. They criticize the focus on frequency-based reasoning and emphasize the importance of taking other knowledge into account. This study does not pay specific attention to the development of medical testing recommendations. Zuiderent-Jerak et al. published their view on guideline development, in which they criticized the focus on RCT’s in guideline development [11]. They state that guidelines should reflect all knowledge. No specific attention is given to the development of testing recommendations. The Cochrane Collaboration has published a draft version of the second edition of the Cochrane Handbook for Systematic Reviews of DTA (available for Cochrane members only) [12]. Aspects of this handbook that might be relevant for the knowledge needed to develop testing recommendations in guidelines are stated below: - ‘The PRISMA-DTA reporting standards should be followed [14]. - Review teams should include clinical and methodological expertise in the topic area being reviewed, as well as the perspectives of stakeholders. For systematic reviews of test accuracy, it is often helpful to include both health professionals who use the index test in daily practice for the purpose specified in the review, and
RkJQdWJsaXNoZXIy MTk4NDMw