178 Chapter 5 2023 GIN conference [12], participants requested additional elaboration of pathways for different test outcomes (such as false positives and false negatives) being helpful for explaining the test-management pathway concept to guideline panel members. The aim of this paper is to facilitate the understanding and uptake of the testmanagement pathway concept by offering four test scenarios in different settings and with different purposes and roles (table 1). The first scenario is a hypothetical example; the other scenarios are based on existing guidance. Table 1. Test scenarios including examples Scenario Setting Test Condition of interest Role of the test References Self-testing Home Smart watch with singlelead ECGapp Atrial fibrillation Triage Hypothetical example Screening Secondary care Annual MRI Breast cancer Replacement NICE Guidance familial breast cancer [13] Diagnostic testing Primary care CRP point of care Severe lower respiratory tract infection Add-on Dutch GP guideline on acute cough [14] Follow-up testing Primary care Annual spirometry COPD Add-on Dutch GP guideline on COPD [15] Self-testing Self-testing means that individuals take their own samples, conduct a simple test, and interpret the results without assistance. Examples comprise assessment of blood glucose levels via finger prick tests, and detection of pregnancy through a urinary test. Validated self-tests are easy to perform, are straightforward to interpret, and have a safety net (e.g. healthcare access) in case of unexpected test results. Limitations of self-tests include possible incorrect test execution and interpretation, and low quality tests with limited accuracy (such as commercial home-use HbA1c tests)[16]. Integrating and recommending self-tests in guidelines may be useful. To illustrate this, we worked out a hypothetical test-management pathway example for the detection of atrial fibrillation (figure 2a). A guideline panel might recommend use of an ECG-app on a consumer watch as a triage test for people with symptoms or atrial fibrillation who are at risk of cardiovascular disease. This may lead to early detection of atrial fibrillation and subsequent treatment, possibly lowering stroke risk. A prerequisite would then be sufficient test accuracy, which means an acceptable rate of false positive, false negative, and inconclusive test results. In this scenario, feasibility concerns could lead to obtaining unreliable test, even if the test accuracy
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