Step-by-step guide 213 6 Appendix 5. Draft step-by-step guide for developing a testmanagement pathway Steps Trigger questions Patients (Setting & Timing) Define patient characteristics Define the target condition Define prior tests & setting What kind of patients are being considered? Consider patient characteristics, setting, referral patterns Trigger questions: Are you interested in a particular age, gender, etc? What is the disease or disease stage that the index test is intended to identify? Have the patients been referred from another place and have other tests been done there? In what situation will the patients be tested? Is it a screening situation, or at the GP’s, or somewhere else? What is the healthcare setting in which the index test will be applied: community, primary, or secondary care? Index test Role & purpose of the index test Point in the pathway where the index test might be considered Test variations, if relevant Test specifications What is the test or tests of interest? The guideline development group must have a clear idea of where the new test may be placed in the pathway. There may be a need to go back to this item once the pathway is better defined. Trigger questions: What is the purpose of the test i.e. diagnostic, prognostic, monitoring etc? What is the role of a test (i.e. triage, replacement, add-on in comparison to existing test(s))? What are the test variations i.e. are there different manufacturers of a test, who will be operating and interpreting the test, and is there more than one threshold to be considered? What are the test specifications to need to be considered (i.e. resource requirements, training, translations, specialized equipment or conditions etc)? Comparison or Existing test(s)/strategy Define the pathway that would be in place if the index test was not available. What is the comparison or existing test strategy to avoid/achieve the outcome of interest? This refers to the ‘C’ in the PICO framework, the comparator. The comparator may be standard care. Trigger questions: What is currently being done to avoid/achieve outcome(s)? What would we do if we do not use the index test? What will alternatively guide clinical decisionmaking? What treatment options are available?
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