190 Chapter 6 Abstract Background: Guideline development on testing is known to be difficult for guideline developers. It requires consideration of various aspects, such as accuracy, purpose of testing, and consequences on management and people-important outcomes. This can be outlined in a test-management pathway. We aimed to create and user-test a stepby-step guide for guideline developers for designing a test-management pathway. Methods: Developmental design with a co-creative strategy. We created a draft stepby-step guide, that was user tested in a workshop with 19 experts, and by interviewing 7 guideline panel members. Results: Our proposed guide consists of five blocks of signalling questions: patients/population, index test(s), current practice/comparison/control, peopleimportant outcomes, and the link between testing and outcome(s). The user testing led to refinement of the signalling questions, the use of inclusive terminology, and addition of a test-management pathway figure with detailed explanation. Conclusions: The step-by-step guide for formulating focused guideline questions regarding healthcare related testing can help in identifying relevant characteristics of the population, tests, and outcomes and to create a test management pathway. This should facilitate the formulation of evidence-based guideline recommendations about healthcare related testing. Funding: The creation and expert user testing of the step-by-step guide were part of the DECIDE project, a 5-year project which ran from January 2011 to December 2015, cofunded by the European Commission under the Seventh Framework Programme. The funder was not involved in the design, conduct, interpretation or reporting of the study. The research work done to adjust and test the step-by-step guide was done without specific financial funding. Keywords: healthcare related testing, guidelines, methodology, education in guideline methods, guidance
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