196 Chapter 6 important outcomes when considering alternative testing in the test-management pathway. Participants had different opinions about the ordering of the questions, the use of PICO, and the way the guidance was set up. People wondered why we chose a particular order in some cases (such as IPCO) and preferred sticking to the original PICO-order. One participant mentioned that setting should be explicitly included as an element in addition to the PICO. Some participants would have liked to see harms and patients’ values and preferences added to the outcome section as well. Following the user testing conducted in this phase of the study, no significant amendments were made to the step-by-step guide. However, a number of refinements have been incorporated. All participants, except one, would consider using the test-management pathway in their guideline work if step-by-step user guidance would be available. About half of the participants preferred an open question format for the guide, while others favoured a checklist format. One participant suggested producing software that could help in the visualization of the pathway. Besides knowledge about tests, diagnostic research, and evidence-based medicine, participants indicated that they would value training in interviewing skills and in moderating discussions involving the guideline panel. This training could have different formats, such as video tutorials, hands-on practicing, online training, and/or a more detailed step-by-step checklist. User testing with guideline panel members During the final round of user testing, seven guideline panel members from two Dutch panels on the topics secondary care for people with autoimmune haemolytic anaemia and primary care for women with dysmenorrhea were included. The participants included two clinical chemists, one haematologist, one general practitioner, and three patient representatives. In the first online interview, all interviewees were able to formulate an initial testing question. Prior to the second interview, six participants had reviewed the step-by-step user guide that was provided after the initial interview. During the second interview, all participants were able to create a test-management pathway for their question of interest, by using the step-by-step guide and instructions provided by the interviewer. After drafting the test-management pathway for their test of interest, six participants adjusted their original question. These adjustments included:
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