198 Chapter 6 Box 1. Final step-by-step guide for developing a test-management pathway This step-by-step guide aims to assist guideline panels in formulating focused questions about healthcare related testing through drafting a test-management pathway. Figure 1 shows an example format of such a pathway. Health question Test-management pathway Population (people/ patients/etc.) Testing (index and comparator (reference)) Testing result Including burden Impact on people- important outcomes Interpretation of testing results & subsequent management Including burden Figure 1. Illustration of a test-management pathway Guideline panels can use this guide to define focused questions by selecting signalling questions for their topic of interest. The user can change the order of the steps and questions. Steps Signalling questions People (Setting & Timing) For whom is testing considered? For which persons is testing considered? Define healthcare setting Consider personal characteristics, setting, referral patterns, previous test results. Are we interested in a particular age, sex or gender? Have the persons been referred from another setting? Were other tests performed? In what setting will the persons be tested? (population screening program, general practitioners practice, physiotherapy practice, hospital, etc.) Should subgroups be considered? Index test Which test or testing strategy is considered? Define measurand Primary purpose of the index test Define measurement platform or assay(s) The guideline panel will have to be specific enough in the description of the test that is considered. What is the measurand (the physical quantity or property that is being measured)? What is the primary purpose of testing (screening, diagnostic, prognostic, predictive, monitoring, etc.) What is the role of the test relative to other tests (triage, replacement, add-on, parallel/combined) Is a combination of tests or specific testing strategy considered? (multimarker score, sequence of tests, etc.) What is the burden associated with the test (efforts to undergo the test, adverse effects, complications, costs, etc.) Are there any feasibility considerations? (resource requirements, training, storage, transport, etc.) Are there any acceptability considerations? (patients values and preferences, equity, costs, etc.) What platform or which kind of assay is used for the measurand?
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