Step-by-step guide 197 6 - Refining the population of interest (such as adding information about the setting and earlier tests performed) - Specifying the purpose of the test and its place in the test-management pathway - Addressing practical aspects of testing, such as difficulties in performing the test adequately - Defining test burden - Adding the impact of testing in terms of impact on people-important outcomes Participants found the step-by-step guide helpful for structuring questions and defining the purpose and impact of the test of interest. They also found the examples provided useful and intended to use the guide in a guideline panel setting. Suggestions for improvement included the need for instruction for usage, a figure/example of a testmanagement pathway, and the explanation of terminology for patient representatives. Final step-by-step guide In the final version of the step-by-step guide, we added an introduction, instructions, and a figure with the test-management pathway. The final version of the step-by-step guide is presented in box 1. Discussion This study presents a step-by-step guide for guideline panels to formulate focused questions regarding healthcare related testing. The guide can aid in creating a testmanagement pathway by identifying relevant characteristics of the population, tests, and outcomes of interest when developing clinical practice guidelines or public health guidelines. The formulation of focused rather than broad questions allows explicit consideration of factors beyond test accuracy. These include feasibility, timing, test burden, management effectiveness and impact on people-important outcomes. Furthermore, the step-by-step guide offers the possibility of distinguishing between different patient subgroups. It is assumed that this approach will result in recommendations that are better balanced and that are explicitly aimed at improving people-important outcomes. This may lead to less overtesting, overdiagnosis and subsequent overtreatment, which would be beneficial from a patient’s perspective as well as from a public health perspective.
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