192 Chapter 6 false positive and false negative results one may expect with testing but this information should be put into context. For instance, the clinical performance of a test may differ in public health compared to a clinical setting due to factors such as the pretest probability of the population being tested, previous tests conducted, and the resulting management decisions. To develop recommendations about testing, guideline developers need to consider (a) the purpose of testing, (b) the desired downstream consequences of the test, in terms of minimal important changes in people-important outcomes, and (c) the link between test results, (healthcare) actions, and these outcomes [9, 12-14]. In addition, feasibility of the test (including sustainability), test burden (e.g. pain, time, discomfort), resources and costs need to be considered. The aim of testing is to improve people-important outcomes. A test-management pathway provides a visual representation of the essential steps required to move from testing to people-important outcomes, which is crucial in guideline development [15]. If guideline developers do not oversee and consider the consequences of testing, they cannot balance the relevant benefits and harms of testing. Relying on test accuracy solely may overestimate the added value of a test and may lead to overtesting, overdiagnosis and overtreatment. Several agencies refer to the identification of test-management pathways in the evaluation of healthcare related tests and in drafting testing recommendations [13, 1618]. These organisations mention the development of such pathways as part of the scoping process of a guideline, or as part of developing focused questions for systematic literature review. Studies in the guideline development community also support the integration of pathways in diagnostic test evaluation [19]. Identifying and outlining the elements of a test-management pathway in time and formulating focused questions about healthcare relating testing is not an easy task [20, 21]. Guideline developers have acknowledged that the inclusion of people-important outcomes in guideline development regarding testing is necessary but currently lacking. The formulation of key questions has been identified as a challenging aspect of this process, and there is consensus that education can play a crucial role in addressing this challenge [19]. Guideline developers therefore need support to formulate focused questions about testing at the start of a guideline development process. Currently, a practical guide for the development of a test-management pathway is not available. Our group aimed to create, and user test a step-by-step guide on how to
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